Ebola outbreak highlights the dangers of contagion in an interconnected world

Remember the ending of “Rise of the Planet of the Apes,” the first movie in the rebooted “Apes” series?  A character who has contracted a deadly contagion, which initially presents itself as a nasty cold, is revealed to be an airline pilot.  The route of his plane becomes a computer map showing other planes carrying the people he has infected, rapidly spreading the virus across the globe.

Fortunately, ebola doesn’t spread like that – it’s passed along through contact with infected bodily fluids, rather than being an airborne pathogen that transforms sneezes into shotgun blasts.  It is, however, less than comforting to see sweat and saliva listed among the potentially infected fluids.  If you’re sitting next to someone who has ebola in a crowded airplane, what are the chances you could come in contact with his sweat or saliva?

Alas, this is not a hypothetical question for health officials in Africa, as Fox News reports:

Health officials in West Africa are scrambling to contain a possible widening of an Ebola outbreak after a man believed to be affected by the virus traveled by plane from Liberia to Ghana to Togo to Nigeria, where he died on Friday.

The death of Patrick Sawyer, 40, has led to tighter screening of airline passengers in West Africa, Ebola has killed more than 670 people in Guinea, Sierra Leone and Liberia since the outbreak began in March.

The World Health Organization is awaiting laboratory confirmation after Nigerian health authorities said Sawyer tested positive for Ebola, WHO spokesman Gregory Hartl said. The WHO has not recommended any travel restrictions since the outbreak came to light.

“We would have to consider any travel recommendations very carefully, but the best way to stop this outbreak is to put the necessary measures in place at the source of infection,” Hartl said. Closing borders “might help, but it won’t be exhaustive or foolproof.”

Sawyer was an American citizen who was planning a visit to Minnesota to visit with his children next month.  He was “vomiting and had diarrhea aboard at least one of his flights with some 50 other passengers aboard,” according to witnesses.  If the timing had been a little different, that could easily have happened aboard several airplanes on his trip back to America, including a large intercontinental airliner.  As it stands, health officials have just about given up on tracking down everyone Sawyer could potentially have infected, because they quickly spread out to “dozens of other cities.”  It can take up to three weeks for ebola to incubate… putting long, slow fuses on biological bombs, which have a fatality rate of anywhere from 60 to 90 percent when they detonate.  The only lucky break in treating the outbreak so far has been the fact that ebola doesn’t become contagious until symptoms begin manifesting, so it’s not infectious during the incubation period.

Several aid workers who have been caring for ebola victims have contracted it:

The new concern comes as the condition of an American doctor diagnosed with Ebola reportedly deteriorated. The Associated Press reported that Dr. Kent Brantly, 33, is in grave condition and fighting for his life in an isolation unit on the outskirts of Monrovia, the capital of Liberia. A former colleague of Brantly, Dr. David Mcray, told AP that efforts to evacuate Brantly to Europe for treatment have been thwarted because of concerns expressed by countries he would have to fly over en route to any European destination.

On Sunday, another American aid worker tested positive for the virus. Nancy Writebol, a worker with allied aid group Serving in Mission (SIM), is in stable and serious condition, according to an official at the North Carolina-based aid group Samaritan’s Purse.

According to Ken Isaacs, a Samaritan’s Purse vice president, Writebol, who had been working as a hygienist decontaminating those entering and leaving the Ebola care area at the hospital, was showing full symptoms of the virus.

This is the first time an ebola outbreak has spread through major cities, putting the hideous disease into major population centers of poor countries with very limited health resources.  (Apparently the doctors in Nigeria, the most populous country in Africa, are currently on strike.)  Reuters reports that a private hospital in Lagos, Nigeria has been shut down and quarantined following the death of a Liberian man from ebola.  Liberian authorities have finally implemented airport screening for infected passengers, and have begun closing borders and isolating infected communities.  Sierra Leone and Guinea have also reportedly begun airport screening.  But it’s coming a bit late in the game, and ebola is very difficult to detect with checkpoint screening, especially in its early stages.

There’s a good deal of confusion in media reports over just how infectious ebola is.  For example, the Fox News report linked above says “the risk of travelers contracting Ebola is low, because it requires direct contact with bodily fluids or secretions such as urine, blood, sweat or saliva.”  The Reuters report, on the other hand, describes it as “highly infectious.”

Reuters also has quotes from world health authorities stressing the importance of everyone who might have come in contact with Patrick Sawyer – a task the Fox News report suggests local officials have already given up on completing comprehensively.  Here we also learn the chilling detail that Sawyer’s final flight wasn’t non-stop:

David Heymann, head of the Centre on Global Health Security at London’s Chatham House, said every person who had been on the plane to Lagos with Sawyer would need to be traced and told to monitor their temperature twice a day for 21 days.

The World Health Organization said in a statement that Sawyer’s flight had stopped in Lomé, Togo, on its way to Lagos.

“WHO is sending teams to both Nigeria and Togo to do follow- up work in relation to contact tracing, in particular to contacts he may have had on board the flight,” spokesman Paul Garwood said.

NBC News offers a list of “six things you need to know about ebola,” one of which stresses the point that it’s a potential global threat in a world of fast, cheap air travel, combined with thus-far lax epidemic controls in the countries of origin.  It’s almost inevitable that it will get to the United States eventually – as mentioned above, Patrick Sawyer was only a few weeks away from bringing it here.

A companion article at NBC relates the confidence of American health officials that they’ll be able to contain any domestic outbreaks, with the less-than-totally-reassuring title “Little Risk: Ebola’s Just One Flight Away, But Risk Is Low, CDC Says.”  Here we are assured by the Centers for Disease Control that ebola will get busted the minute it walks off a plane in the United States, because there are “quarantine stations in major airports, and agents can forcibly isolate or quarantine people with symptoms of ebola and other diseases such as cholera, tuberculosis, plague, or bird flu.”

I don’t want to throw undeserved cold water on these assurances, but I’ve seen plenty of performances of TSA Security Theater at airports, and I can’t remember seeing any obviously sick people getting isolated or questioned like that.  TSA agents are going to spot people who had a bout of diarrhea on long international flights and pull them aside for investigation as possible ebola carriers?  If that’s our first line of defense, I hope a lot of enhanced training is being quickly and quietly carried out behind the scenes.  It’s reassuring to know that a few potential outbreaks brought onto American shores by foreign travelers have been successfully detected and contained by the CDC, with Middle East Respiratory Syndrome (MERS) cited as a marquee success.

And at least our borders are sealed up tight as a drum, right?  It’s not as if a huge number of sick people are flowing into “refugee camps” and spreading a variety of diseases to the people that care for them.  It’s not as if our government has been trying to keep the extent of the health crisis at detention centers under wraps.  It’s not like our government is secretly dispersing these people to cities across the United States.

Other not-so-fun ebola facts delivered by NBC News include reassurances that “it doesn’t make you pour blood” (which the body of the article goes on to clarify as, it only makes you pour blood 50 to 60 percent of the time), nobody knows where it comes from, and there is currently no cure.  Unless it mutates into something that spreads more quickly and easily, ebola is no sci-fi doomsday plague… but it’s hideous beyond belief for those it strikes down, and it can cause a terrible amount of suffering in crowded, fast-moving metropolitan areas without becoming a civilization-threatening pandemic.  It’s also troubling that we have little knowledge of how it behaves in modern urban environments, which introduce many variables not present in remote African villages.  Unfortunately, it seems like we’ll have more data on how ebola fares in a variety of environments before long.

We can hope global health organizations will reinforce African authorities and keep the outbreak contained, but in an interconnected world, the smart bet is that it a few infected people will slip through the dragnet and make it to other countries… perhaps other countries that can’t contain ebola as effectively as the U.S. Centers for Disease Control.  It would be wrong, and counter-productive, to panic, but at this point, it’s appropriate to be troubled.