Patient Zero? Not So Fast

Dr. Kent Brantly, a US citizen who contracted ebola in Liberia, was evacuated to Emory University Hospital in Atlanta on Saturday for treatment in a special isolation unit. His colleague Nancy Writebol is also expected to arrive there this week. The usual suspects are busy fearmongering:

But Susannah Locke defuses fears:

Transmission of Ebola will be prevented using standard protocols, and health officials say that the two pose very little risk to the general public. Even if there were some terrible, unforeseen accident with one of these patients, Ebola wouldn’t be likely to spread very far. First, Ebola doesn’t jump from person to person through the air, but through close contact by touching bodily fluids such as sweat, vomit, or blood. The outbreak in West Africa is so severe for a number of key reasons, including a lack of resources, inadequate infection-control measures, and mistrust of health workers. The United States, by contrast, has far better public-health infrastructure. And that makes all the difference.

And Emory is taking every precaution to ensure that those fears aren’t realized:

[Dr. Bruce Ribner, the head of the unit,] went on to explain that Emory would be providing what he called “supportive care,” which consists of “carefully tracking a patient’s symptoms, vital signs and organ function and taking measures, such as blood transfusions and dialysis, to keep him or her as stable as possible.” “We just have to keep the patient alive long enough in order for the body to control this infection,” he explained. In the meantime, Brantly and Writebol will be separated from healthy people by a plate-glass window, and communication with non-medical personnel will mostly happen via intercom and telephone.

So, for now, it seems that Donald Trump and those who share his concerns don’t have much to worry about. At the very least, it seems that the people in charge of handling Ebola’s new American presence are being significantly more careful than the CDC was with that anthrax.

Kent Sepkowitz outlines the logic behind the evacuation:

[W]ith the move, the CDC, or whoever made the decision, is betting that high-tech American care using Ebola-inexperienced medical staff is better than not-so-high-tech care with remarkably experienced staff. This high-low discordance often is seen in tropical medicine. For example, many are taught in medical school that the best place to be treated for severe malaria is not the tertiary care medical palace on the American hill where a case is seen every year or two but the run-down clinic in the local country where malaria is as common as a stubbed toe and the staff knows every trick of the trade.

For Ebola treatment, though, I suspect the decision is correct: Writebol and Brantly are better off here. Much about the disease and its related conditions, called collectively the “viral hemorrhagic fevers,” is not well studied for the very reason a patient is being flown home. The resources simply are not available to articulate and record, to take extra blood, and to perform additional X-rays—all necessary to fully define any disease.