Diary

Without Reliable, Rapid Tests, Ebola Ignorance Infects Us All

ebola_hazard

 

Like most Americans, I suffer from a bad case of Ignorantia Febris Ebola, or Ebola Ignorance.  When Ebola first hit American shores, my gut instinct was to simply ban travel from the affected countries, or at least quarantine travelers for 21 days.  I wrote “I’m all for preventing a panic, but a panic is what we will get if we don’t get this situation in hand quickly.”

The media-fed panic we are seeing (and it’s not a true panic, more a malaise or angst) is the result of the rapid spread of Ebola Ignorance, which has an R0 value of at least one million*.  Ironically, Ebola Ignorance is very curable, and in fact the cure is all around us.  Double-ironically, the cure does nothing for the symptoms:  an unspecific, uneasy, and persistent fear of Ebola spreading, possibly closer to me than comfort allows.  But it does at least make the sufferer feel more informed about the real disease that kills people.

Ebola Hemorrhagic Fever is a terrible disease, a virus which can literally cause its host to bleed to death from the inside.  There’s no cure and no reliable treatment.  There’s no vaccine, and any candidates (short of a miracle cure) are likely to take years to test and deploy, if found to be effective.

At this point, Ebola Ignorance is a much worse disease since most of us have it.  That goes for the emergency room receptionist at a Fairfax, Virginia hospital who has to ask if you’ve got a fever or have traveled to Africa in the last 21 days, or the security guard in Reston who stops you before you even enter the ER, as reported by the Daily Signal.

[Journalist John] Siniff had to go to the radiological department to undergo X-rays for an upper-respiratory infection, he told The Daily Signal. Upon approaching the receptionist to check in, she immediately asked him two questions:

Do you have a fever?

Have you traveled to Africa in the past 21 days?

Siniff answered, but was curious what would have happened if he replied, “Yes.”

The woman told the journalist she wasn’t sure, as she normally didn’t work in that specific department.

I’m sure of one thing:  if anyone answers “yes”, the woman will have a close encounter with the Grim Reaper, accompanied by all the predictable symptoms and laundry requirements.  Even in healthcare facilities, people suffer from Ebola Ignorance, albeit a different strain.

The reason for the angst is simple:  there’s no fast and reliable test for Ebola in use right now.  The lab test the CDC and other health organizations use is called polymerase chain reaction (PCR), and takes between 12 hours and 4 days to yield a result.  The smaller the viral load in the patient, the less reliable the test.  In fact, there have been reports of false negatives (meaning the test reported no Ebola when the patient in fact was infected) in Ebola PCR tests done in Africa.  This is the why the CDC is performing all Ebola PCR testing in the US**—it’s got the most reliable labs right now.

It’s also the reason why countries like Belize and Mexico wouldn’t get within a nautical mile of the Carnival Magic cruise ship.  If the CDC says PCR testing isn’t 100% reliable, especially in patients who are not exhibiting full-blown symptoms, there’s no way less-developed countries are going to allow any contact with potential exposed persons.  They simply don’t have the infrastructure to support it.

If there were an instant, reliable test to screen potentially exposed people entering the US, it would be far better than the health screening kit they get now.

The travelers also will be handed a care kit that includes a thermometer, a tracking log, a pictorial description of symptoms, a colored card they can present to health care providers if they are ill, and information on where to call and what to say if they develop symptoms, [CDC Director] Frieden said.

A box of stuff I can get at CVS and a couple of “call me if you’re sick” cards does not build my confidence in our public health system.

Two companies are ready to produce near-instant Ebola tests, which would work with people already exhibiting some symptoms (which means a detectable viral load).  The FDA has issued an emergency authorization for two tests made by BioFire Defense, which can detect Ebola in one hour.  According to the company, more than 300 hospitals possess equipment to use the tests, including Emory Hospital and Bellevue Hospital.  Cogenix, working with Tulane University under a NIH grant, has developed a handheld, instant Ebola test, which the Daily Beast reported is “as easy as a pregnancy test”.  But this test has not been deemed reliable enough for the FDA, at least not yet.

Without a reliable method to quickly determine who has Ebola and who does not, we have a terrible situation of ignorance.  Everyone in West Africa who dies from flu-like symptoms is assumed to have had Ebola; anyone who gets a health screening for Ebola in West Africa is likely not to return to the hospital for the results—they don’t have the resources to quarantine everyone who is waiting for test results; therefore, many Ebola patients die at home after spreading the disease.  On the other side of the Atlantic, everyone in America who reports flu-like symptoms, who has flown on an airplane, enjoyed an ocean cruise, visited a hospital in Atlanta, Dallas, or New York, is going to be treated like Typhoid Mary until test results are confirmed, while the rest of us must merely submit to a few questions when visiting the hospital for gallstones.

One good prognosis from a bit of Ebola Ignorance cure is the knowledge that Ebola won’t be spreading fast in the USA, ever.  One disconcerting bit is this from the CDC:  Ebola can survive on dry surfaces outside the body for serval hours, and in bodily fluids (such as blood) for several days at room temperature.  This, combined with the most germ-infested places on the planet—airline seats and bathrooms—doesn’t make me feel any better about flying, at least not without a box of Clorox wipes at hand.

I certainly benefited from my vaccination against Ebola Ignorance, but like all vaccines, it’s got a bit of the disease mixed in.  The more I know, the more I know how little We (with a capital “W”) know about the deadly African killer.

*R0 is the number of people who will be infected by one infectious patient.  The R0 of Ebola is 2.

**The CDC uses its Laboratory Response Network to perform the actual tests.

(crosspost)