What would the process be if a case of Ebola was diagnosed within the general U.S. population? What agencies and institutions would be involved? How would they prevent – or curb – mass panic? In the wake of the recent outbreak of Ebola in West Africa, Dr. Rena Jones, a Research Fellow at the National Cancer Institute, Excelsior College faculty instructor, and an expert on public health and epidemiology, shared her thoughts with Excelsior Life via email.
What is Ebola and what makes this outbreak in Africa different than those of the past?
Ebola virus is the cause of Ebola hemorrhagic fever, a highly fatal disease that occurs in both humans and non-human primates. The primary symptoms include fever, headache and muscle aches, as well as diarrhea, vomiting, stomach pain, and lack of appetite. Weakness and abnormal bleeding may also occur. Ebola is transmitted through direct contact with bodily fluids of an infected person or with contaminated objects, like needles. Humans can also contract Ebola virus through consumption of blood, milk, or raw or undercooked meat of an infected animal. The fruit bat is a suspected reservoir for the virus; it carries the disease although it does not appear to be affected. Although some of the symptoms are similar to influenza, Ebola is not a respiratory disease and is not known to be transmitted through the air. It is also not transmitted through food or water supplies.
Does the long incubation period prevent person-to-person transmission or slow the spread of Ebola?
Symptoms most commonly appear 8-10 days after exposure to Ebola virus, though the U.S. Centers for Disease Control and Prevention (CDC) indicate that they may appear as early as 2 days and as long as 21 days after exposure.
A long incubation period for any infectious disease may actually hinder containment of its spread. If an individual is not aware of their exposure, and symptoms do not appear for 8-10 days, they could have potentially traveled far and come into contact with many people during that length of time. A rapid progression from exposure to illness would limit this opportunity to infect others. However, even with a long incubation period, if a person knows they have been exposed, we can get them into quarantine quickly and potentially before they experience symptoms. The faster an individual is isolated the better, because you can expose others even if you are not experiencing symptoms.
There has been much debate about whether bringing the two infected Americans back to the U.S. poses a public health threat. In your view, is this a concern?
As of today, there have not been any cases of individuals contracting Ebola within the U.S. as part of the current outbreak. The CDC has established protocols for the transport and care of the patients back to the U.S. who contracted the virus overseas, as has been done for patients with other highly infectious illnesses like SARS. With proper following of such procedures, these patients should not pose undue risk to those in close proximity, such as those involved in the transport or the clinicians caring for them.
What would the process be if a case of Ebola was diagnosed within the general U.S. population? What procedures and protocols are in place to prevent its spread?
The scope of the procedures would be dependent on whether it was determined to be an isolated case, the identified source of the virus, and potential number of individuals with whom the case had been in contact. For instance, if a particular region of the U.S. had more than one case, the CDC might issue a travel alert recommending deferral of non-essential travel to that region for a period of time, until the source could be identified and proper containment procedures are in place to reduce the threat of spread.
However, I think it’s important to note that while the threat of an outbreak in the U.S. exists, the U.S. has a sophisticated infrastructure for isolation and other precautionary protocols that would make this highly unlikely. For example, Ebola is a reportable disease, which means that when diagnosed it is reported directly to the CDC. The isolation of an infected individual that would follow reporting would be very effective in reducing the spread of Ebola.
Which agencies and institutions would be involved?
The CDC is the federal agency responsible for the response. The National Center for Emerging Zoonotic and Infectious Diseases is often at the center of such responses, as they investigate many outbreaks of infectious disease in the U.S. Experts from other public health agencies and biomedical research institutions such as the federal National Institutes of Health, or those in academic settings, may be called upon for their expertise. Depending on the level of concern and the amount of effort required, other federal agencies may be brought in to help. In a large-scale outbreak scenario requiring quarantine of large groups of people, you could imagine National Guard, etc. helping out. However, this is a rather dramatic and highly unlikely scenario within the U.S.
How would officials prevent or curb mass panic?
Clear, consistent, and transparent health communication would be critical in this hypothetical scenario. Health officials will aim to dispel rumors about who is infected and how people become infected, and will make recommendations to reduce risk of exposure. For instance, during an unusually virulent recent influenza season, the CDC recommended that high risk individuals (the elderly, pregnant women, otherwise unvaccinated individuals, etc.) avoid travel and situations where they would be in communal settings to avoid exposure. Recommendations will be commensurate with the level of perceived threat of the spread and the actions that will be most effectual in preventing that spread.
I’ll note here that the ability we have to rapidly communicate these days is both a benefit and a disadvantage during an infectious disease outbreak. For instance, social media can be used to communicate quickly and effectively to millions of people, but it can also be used to disseminate false information. Health officials would likely encourage citizens to check for updates on their web sites and social media accounts such as Facebook and Twitter, or to rely on messages conveyed by them to the public through other means (e.g., TV, radio). They would likely discourage action based on recommendations from anything other than a reputable public health agency. It would be important to ensure that people without access to computers, televisions, etc. also receive appropriate recommendations where public health officials feel they are needed.
To conclude, what would you want the average U.S. citizen to know about Ebola?
I want them to understand that some of what you may read about Ebola may be myth rather than fact. It is absolutely a dangerous disease and any threat should be taken seriously. However, many people might think Ebola is transmitted through the air and that just by having an infected person in the U.S. that we are all at risk of contracting the virus. This is simply not the case. Our sophisticated public health infrastructure, while not failsafe, is designed exactly to handle this type of situation. We engage in routine public health monitoring and disease surveillance with near real-time attention in order to track, contain, and prevent such outbreaks.
Individuals who are treating Ebola patients or family members who may come into contact with bodily fluids of an infected person – yes, they might be at increased risk of contracting the virus. However, it’s very unlikely that you as a citizen of the general population are going to come into contact with an infected person and be exposed to their bodily fluids, or for you to consume contaminated meat from an infected animal. The best approach under threat of an outbreak is to pay attention to and adhere to the advice of public health authorities.