Ebola: The Lessons We Can Learn From The SARS Outbreak

Reports are all over the news this morning that 56 more people have died from Ebola in West Africa, and that 128 more have been diagnosed with the disease. You can read more about that here and here.

There have been articles, too numerous to list trying to downplay the current outbreak of Ebola Zaire. Articles and news reports pointing out the death rates per day of other diseases such as:

HIV 6,000 (source)

TB 5,000 (source)

Viral Hepatitis 2,739 (source)

Measles 449 (source)

The point seems to be that with thousands of people dying across the globe from so many other communicable diseases we should not to too fearful of Ebola that is killing a couple of dozens a day half a world away.

Admittedly the figures quoted above are high, but the difference between those infectious diseases and Ebola Zaire is that we have treatments for those.

Love them or loathe them vaccines have cut the death rate from these diseases by millions a year. Modern medical interventions with antibiotic therapy and intensive nursing care have increased the chances of survival even amongst those unvaccinated people who have access to medical care.

Sadly, even with vaccines,antibiotics and medical assistance some people will still fall prey to these conditions and that will continue to be the case regardless of intervention.

The point is that there is treatment available for these conditions, millions do not have access to those treatments and some choose to refuse those treatments, but they are there, they are available.

This is the difference with Ebola, at this point there is nothing that has been proven to work, there is currently no treatment, refusal is at this point in time not an option as there is nothing there to refuse.

Like so many diseases in its initial stages Ebola resembles the flu. Muscle aches, fatigue and general malaise give no indication of what is to follow until in many cases it is too late to do anything about it.

Currently someone with flu like symptoms is likely to raise alarm bells, we are not yet at the time of year when every other person seems to have a cold or the flu, but that will change as the year rolls on.

As I said in a recent article my worry is the winter. When so many people have symptoms of the flu it is going to be impossible to detect those who really do have influenza, and those who have Ebola.

I don’t care what all the politicians and government paid doctors say about ‘it can’t happen here’ and ‘we are geared up to prevent an outbreak on American/British/German soil’. That is utter crap and they know it.

There is not a health care system on the planet that can test every peorson that has the flu, or even a heavy cold, for Ebola, and then keep them in quarentine until the results come back. There is not a lab on the planet that could cope with that amount of specimens.

Now the chances are that if you develop flu like symptoms that you do indeed have the flu. Having said that, someone, somewhere, will not have the flu, and it’s that person that could start an outbreak on home soil.

I have travelled a fair bit, at all times of year, and there is always someone on the plane that’s snuffling and sneezing. There’s always someone looking a bit green and feeling sick from their last night on the town before the end of their holiday, or even from hitting the duty free bar in the airport. it’s likely these people will be picked up at the airport as having a high temperature or whatever.

It’s the ones who feel a bit shitty but don’t have a temperature at that point that scare me. The ones who will start to feel rough a few hours, or a day or so after their return.

If those people haven’t been to one of the countries currently hit by the outbreak they may think nothing of it, but the guy sitting next to them who maybe wiped his brow and then put his hand on their armrest as he stands to go to the W.C. may have been in any country on the planet 24 hours earlier. Maybe the aircraft is cool and he’s not sweating but he sneezes, puts his hand to his mouth as polite people do. Maybe he has a simple spot that he knocks and it bleeds.

Our traveller, returning home from where ever then pokes the buttons to see what he can get on the radio, usually nothing in my experience. The food arrives and he breaks his bread roll…

ANY and ALL bodily secretions carry the Ebola virus if a person is infected.

Once home, everyone disembarks and goes on their way. They get through security, none of them are feverish. If infected, at some point between 2 and 21 days after the flight out innocent traveller feels a bit rough, like a cold is coming on. Once the symptoms start he is infectious, anyone who shares ANY of his bodily secretions from that point on is going to get infected.

Ebola can’t live long outside of the body, but often it can live long enough for the infection to be passed on. Be vigilant. If you are travelling internationally be aware of what you are doing at all times.

• Carry wet wipes and use them before eating or touching you face, after using elevators etc.
• Push elevator buttons with your knucles rather than your finger tips as there is less chance of touching your face with your knuckles.
• Use hand sanitizer gel often when out and about. Sanitizers have very limited effectiveness against viruses but make your hands unwelcoming to them, meaning less stick to your skin.
• Be wary of handling paper money. Money is filthy. It contains traces of everywhere it has ever been and bacteria and viruses from anyone who has touched it.
• Cover even the smallest cut,scratch or graze on exposed skin with waterproof dressings. If it can’t get into you, it can’t infect you.
• In airports and stations try and skip the first public washrooms you come across after disembarking. Those will have been used most and therefore have a higher than average nuber of bacteria and viruses.
• In ALL public washrooms push the door open with your foot rather than your hand.  Try to minimise your contact with anything inside the washroom. Use tissue or something similar to lock and unlock the stall door and to turn the taps on afterwards. wash your hands properly, not just a quick flash under the tap. DO NOT then contaminate your clean hands by pulling open the main door to leave the area, wait until someone is coming in or again use a tissue or wet wipe. If you have to open the door pull without your hands being covered pull the top or the bottom of the handle, most people just grab the middle of the bar and if someone hasn’t washed their hands you are inheriting whatever they have deposited there.
• Wipe door knobs after visitors have been to your home.
• Take your shoes off before going into the house. Have a tray to put them on inside the door if you don’t have a porch, that way nothing on the shoes can get onto carpets etc and possibly into broken skin on your feet.

Many people think I am some OCD germophobe because I employ these techniqes in my regular, routine life even when Ebola is not an issue. I’m actually not either of those two things, but any foray into public washrooms, airports and even the local shops leaves you with God knows what on your hands and the soles of your shoes.

All medical staff are taught about universal precautions within the first week of their training. Universal precautions are just that, precautions you take with EVERY patient. It’s based on the premise that there will be a percentage of patients that are carrying an infectious disease that neither they or the medical staff know about. Therefore, if you protect yourself in the same way with all patients, those known to be infected as well as those who are not known to be infective, there is less chance of contracting a disease.

The things I describe above are my own universal precautions that minimizes me and mine being exposed to unknown pathogens.

It is worthwhile remembering that when SARS first reared it’s ugly head patient zero was in an elevator at the Kowloon Metropole Hotel, Hong Kong, with several other people. Although he contained his coughing and sneezing to some extent, residual deposits and the hand rails and elevator buttons were  found to be contaminated and to have transmitted the virus to the other guests via them touching those items and then touching their faces.

The World Health organization believes that most of the 8,422 cases of SARS, and the 916 deaths worldwide can be traced back to the Metrople Hotel. (source)

Whilst nobody is admitting that Ebola can be airborne, SARS was an expert at airborne transmission the universal precautions listed can be applied to both diseases, and any others you care to mention. Think about what you do when you are out and about, how can you minimize your exposure to pathogens ? Getting into good habits now mean they will become  second nature in a relatively short space of time, hopefully before Ebola or some other pathogen hits our shores.

Maybe I am not so OCD after all.

Take Care

Liz

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Contributed by of Underground Medic.