On Tuesday, the Centers for Disease Control and Prevention informed the world that the Ebola virus had come to the United States. This was not the first time the virus has set foot (or filament) on American soil, yet the other three instances occurred under the watchful eye of public health officials. As such, this is the first time the virus has travelled unsupervised to North America.
For many, this intrusion may be a sign the epidemic in West Africa is expanding and may soon turn into the ever-feared pandemic. However, by taking a step back from the specifics of the case, the reality of the entire situation can be appreciated. More importantly, worry can be wrangled and panic can be placated.
This case was inevitable. In any situation where there is a breach, whether a liquid stored in a tank or an epidemic in a country, the potential for spread is apparent until the leak is stopped. When it comes to Ebola, there are no borders and cases may "leak" out from affected areas. Such movement has already been seen in Africa with infected people travelling to Nigeria and Senegal. Now Ebola has made a transatlantic trip. The only difference is the waiting party, which is much more diligent and prepared.
This case was expected. With an incubation time of between two and twenty-one days, the virus can easily hide inside an unsuspecting traveler. Public health officials from around the world are knowledgeable of this and many have implemented precautions in anticipation of an Ebola arrival. In Canada, any person showing up at a health care institution with suspect symptoms is asked about travel history. Should any of the affected countries -- Guinea, Liberia, Sierra Leone, Democratic Republic of the Congo -- be mentioned a different level of care is given. The patient will get a private room and also be tested for the virus. This already has happened several times in Canada since March; none have turned up to be positive.
This case is not an emerging threat. Ebola is not like the common cold or even the nightmarish norovirus. Quite simply, infection is not easy to acquire. First, an infected individual needs to show signs of Ebola virus infection before it can be transmitted. This can include fever, sore throat, chills, muscle pain, weakness, vomiting, diarrhea and a rash. Then another person has to come into contact with bodily fluids before transmission occurs. Now imagine someone exhibiting these symptoms in your office or school. Would you touch them? Probably not. It's why the majority of spread occurs between family members and the people who are paid to deal with bodily fluids, the courageous and admirable health care workers. Not surprisingly, in the Dallas case, these same individuals are being monitored to ensure they are free of infection.
This case will spark earnestness. Back in August of this year, the World Health Organization declared the Ebola epidemic in West Africa a Public Health Emergency of International Concern (PHEIC). When this occurred, the world was asked to work together to resolve the crisis. However, in this case, while many pledges were made, little was done on the ground. The result was a dramatic increase in cases leading to health organizations becoming overwhelmed. Last week saw the United States call for pledges to turn to action at the United Nations. Presumably, with this case now confirmed, that action will be implemented as quickly as possible. If all goes as planned, the number of cases won't come near the outlandish 1.4 million some have suggested but will slow in their rise, level off and eventually decline.
This case should not cause Canadians unease. Through the eyes of a microbiologist or public health official, what is happening in Dallas, while unfortunate for the patient and any possible contacts, is an excellent way to better appreciate the work of our health care systems. In Canada, since the SARS Commission recommendations were implemented, we have had a few false alarms with Ebola, MERS and H5N1. Yet, there has yet to be an actual case come to the Great White North. If only by proxy, we can learn from the events in Texas to refresh and reinforce our public health system and its commitment to the best health care in the world. While the chances of any of these viruses actually coming here are rare at best, few would argue against the famous Scout Motto: Be prepared.
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