Ebola — just hearing the word frightens us. The outbreak in West Africa, originating in Guinea in March, has stunned us with its rapid spread, because Ebola, in fact, is not highly contagious.
But although it is hard to get, it is also proving hard to stop. That's why clear thinking and reliance on public health practice offer this nation and the world the best opportunity to contain this virus.
A quick reminder: Ebola was first recognized in 1976 and named for the Ebola River in Zaire, now the Democratic Republic of Congo. The highly fatal virus is transmitted to humans through close contact with the blood, secretions, organs or other bodily fluids of infected fruit bats, primates, forest antelope and porcupines found ill or dead in the rainforest.
Humans transmit the disease to other humans only by direct contact with the blood, secretions, organs or other bodily fluids of infected people and with surfaces and materials contaminated with these fluids. Ebola is not an airborne virus and as such, it is more readily contained through early identification and isolation than is the annual influenza virus, which is far more contagious.
But these relatively simple control measures are nearly impossible to employ in settings lacking basic public health infrastructure — settings like those in the resource-poor communities of West Africa. With new cases mounting daily and the death toll rising in lockstep, it is no wonder that the situation has sparked keen international interest and a level of fear not unusual in a situation that seems unfamiliar.
While Ebola is a relative newcomer in the world of infectious pathogens, it does behave in ways familiar to the public health community. We know that the incubation period is from two to 21 days and that an individual is not infectious until symptoms appear. We know that the symptoms mimic those of other infectious diseases including malaria, typhoid fever and meningitis requiring confirmatory laboratory diagnosis. Once confirmed, we know that treatment within strict biological containment protocols virtually eliminates the possibility of transmission.
This is not the first disease to spark anxiety among the general public in the United States. HIV comes to mind, as do cancers. These diseases inspired fear because the high level of mortality associated with them led to a sense of futility and frustration. Today, they no longer evoke the same level of fear — partly because treatments for these illnesses extend a high-quality life and, more important, known preventive measures can minimize the numbers affected.
Successful public health efforts hinge on the ability to prevent disease; when we cannot prevent, we act to control the spread of disease through well-honed emergency response systems. Indeed, primary prevention and disease control are the hallmarks of public health, reflecting the enduring interest of societies in enjoying the highest state of health and by extension, the greatest quality of life.
Disease outbreaks, usually unanticipated, challenge public health and clinical care professionals to mobilize resources and act quickly. But the idea that disease can be prevented is not new to public health; in fact, experience suggests that we are more effective at preventing disease when we come together as a society to do so. Quarantine, immunizations, infection control protocols in health care settings, directly observed therapy, traveler screening, disease reporting, basic hygiene, education about disease transmission, and research to develop preventive and therapeutic responses to infectious disease are all part of the authority vested in our public health system, granted to it by the public for its own safety.
Even without a vaccine, an Ebola outbreak in the United States like that occurring in West Africa is extremely unlikely with collective, reasonable precautions to prevent exposure and the risk of transmission. Controlling the outbreak at the source will further reduce the likelihood of additional infected persons entering the United States.
With a case fatality rate of over 50 percent, we are right to be concerned about Ebola and remain vigilant. At the same time, we can anticipate over 200,000 hospitalizations and 30,000 to 40,000 deaths from influenza in our country this year. Flu shots are widely available, yet less than 40 percent of the public takes advantage of them. Simple measures like frequent hand washing and staying home with symptoms would reduce the spread even more.
Yes, Ebola is frightening but, like other infectious diseases, it reminds us just how thin the veneer of civilization is and why public health strength matters here at home and around the world.
Dr. Donna J. Petersen is a senior associate vice president for USF Health and dean of the University of South Florida College of Public Health. She wrote this exclusively for the Tampa Bay Times.