We interrupt your regularly scheduled blog pos– I just had to take a break and post about a timely topic that has been engulfing me lately. In a really exciting way. Unless you’re living in a hole, you probably have Googled something related to the Ebola virus in the last 30 days. Go on, admit it. Guess what, world? Welcome to my everyday life! It’s nice to have you. I’m 100% serious, I thrive on this kind of stuff!
I wanted to write a little bit about my experience with the current Ebola outbreak for a couple of reasons. One, many of my family and friends know what I do, but they don’t really know what I do. And two, I feel that for personal purposes, I would like to document my feelings about this historic happening for posterity. Because I know I’ll enjoy reading about this when I’m 90.
I have been working in corporate infectious disease control for the past three years after graduating with my Master of Public Health (MPH) degree in epidemiology. What does epidemiology mean? Well, for starters, we love looking at things like this:
We study the distribution and determinants of disease. In other words, the ‘who, what, why and how’ of disease spread. Malaria was the first to draw me in. In college, I did something a lot like the following, where I studied mathematics. It’s a simulation of how quickly Ebola spreads and how lethal it is compared to other diseases:
Click here to see the full simulation on the Washington Post.
Now, my work runs the gamut, from influenza to measles to (re)emerging diseases like MERS and, you guessed it, Ebola! My specific job deals with mostly writing data-informed infectious disease control policy, health communication and data analysis for a big corporation. I basically work in risk management, helping with infectious disease control programs in the company’s locations around the world.
In my time with this company, I’ve also led a research study and made many, many presentations on infectious disease to thousands of non-epidemiologists associated with the company. Wow, I’m starting to sound like an academic! In all seriousness, I want you to know where my opinions are coming from. I’m not a doctor with decades of experience, but I am armed with relevant experience and education. More importantly, I’m absolutely fascinated by the spread of infectious diseases and consider it extremely exciting to be able to work in the field that I do.
To start, some cartoons that reflect my general feelings about Ebola and the Western world:
Essentially, what people are concerned about and how they express said concern, is some kind of weird entertainment to me.
My thoughts about what the Western world is trying to do about Ebola:
One of the reasons I went into public health and infectious diseases is because it never gets boring. When you are dealing with an outbreak, you can never run out of interesting forces at play, whether it be cultural, political, biological, economic or others.
One of these forces is particularly striking in the U.S. The societal-level American panic going on is completely exacerbated by media coverage of the outbreak. Instead of focusing/reporting on the people who need our help and attention most, aka those residing in West Africa, we have conjured up, for lack of a better term, a shitstorm of panic about how we in the Western world are affected by what’s going on there. You know, like terrorism…?
…So we need a war leader/’czar’ to protect us all?
And let’s be honest, your average American couldn’t tell you the differential symptoms of Ebola until a couple months ago when it landed on U.S. soil and we were all Googling. (By the way, those symptoms include fever, weakness or fatigue, head/muscle/joint aches, bleeding or bruising, vomiting, diarrhea, and more.)
So, we take our film crews, put on our hazmat suits and go into the “war zone” that is Ebola instead of treating these people with the care and concern that they deserve as members of humanity. We lionize the “poor” (white, well-educated American) victims who come home from their noble* fight in West Africa, and come to know everything about them. Meanwhile, there are thousands of people dying of Ebola. But that’s over there. Not here. Not yet. And if we can help it, not ever.
*I truly mean noble. We should not lessen what any of the assisting health professionals’ efforts, especially those who have become ill. I am merely referring to the American public’s treatment of them.
Now this one is just absurd. Some government officials have called for banning all flights into the U.S. from West African countries. One way or another, people are going to get to the U.S. Whether they fly through Denmark or Doha, they are coming and there’s nothing you can do to stop it. Get off your isolationist high horse and focus realistic ways to prevent disease. We live in a global community, and you ignoring that fact isn’t going to stop Ebola.
New York and New Jersey recently implemented (and then revoked) a mandatory quarantine for health professionals who went to West Africa to assist with the Ebola crisis and then return to the U.S. through those states. A nurse in Maine who went to West Africa is now fighting with local government which wants to keep her in her home. It i also rumored that she will sue over her treatment while she was in quarantine for three days, after which New Jersey allowed her to return to Maine.
When it comes to this issue, I may have had a different feeling not more than a year ago when I lived in the U.S. For Americans, political issues are almost entirely about our perceived rights and liberties. God forbid anybody try to take them from you. Side note: it is comical to me to see politicians implementing mandatory quarantine who would use opposite arguments about “government intervention” in other realms of the universe, but that’s another rant for another day.
Don’t get me wrong, America runs in my blood in so many ways. And no doubt, freedom should be appreciated, because not everyone has that privilege. But when it comes to sacrificing the individual for the betterment of the larger community, Asia has taught me a lot. Let me be 100% clear: at this point, science says that you cannot transmit Ebola unless you show active symptoms of infection. However, that doesn’t mean this nurse would not develop those symptoms in the next couple of weeks, and that is what this quarantine is all about, though the risk should be low if she followed standard sanitation precautions.
There are a few interesting points to this debate. Some say that the mandatory quarantine (which has now been lifted in some places) will deter folks from going to West Africa to help stem the epidemic. In my opinion, if you’re educated enough as a health professional and willing enough to put yourself at risk and go there in the first place, a quarantine upon arriving home would not only be the last thing to worry about – but you would already be a strong advocate for minimizing personal contact with others upon return. I wouldn’t want to get my friends and family ill on the off chance that I developed symptoms, let alone infecting strangers.
Some also mention there is no “science” to support the quarantine. I argue that this has almost nothing to do with the science of the symptoms and biology of transmission, but all about the risk of an outbreak. If you work in my field, almost every decision is measured by relative risk, which, by the way, is an actual epidemiological measurement, but I digress.
Authorities are not concerned that even if she were to be infected she would be unlikely spread it to others. They don’t care that she probably took all of the proper precautions as a volunteer with Doctors Without Borders. Just look what happened in Dallas. And moreover, look at the sheer panic this disease is causing in the U.S. and you have your answer. The university that this nurse attends (teaches?) has stated that they need to have the ability to keep order on campus, which is why they barred her from attending until after the quarantine period is over. If she came to school, it’s all anyone would talk about. This is more about managing community panic and the and the small but potentially disastrous chance for this disease to spread than worrying about the odds of this one individual developing Ebola. Given my work in risk management, I can’t entirely blame them.
Bottom line: do I think this nurse should be kept in substandard conditions against her will because she went to West Africa trying to do good in the world? By any measure, absolutely not. However, it is important that the government be able to track her in some way and have some ability to restrict her movement while there is still a (low) risk that she could develop symptoms and further transmit the disease.
For heaven’s sake, the biggest news today is that this woman has defied authorities and rode her bike. We all can recognize her face now; well done media, for covering the real suffering.
This is perhaps my favorite topic, because I love to take a back seat and watch everyone (aka the Western world and media) react to the developments of the outbreak. I give you, Real Questions Real People Have Asked Me**:
1. “Can you get Ebola from sweat?”
The answer might surprise you: Yes – BUT as I understand it, you’d have to have an open wound that contacts someone else’s sweat or some other way to ingest someone else’s sweat. Technically you can get it from pee too. I know, gross.
2. “What is the risk of getting Ebola in an elevator?”
Honestly? Unless someone has collapsed and is bleeding everywhere and you’ve got open wounds or are ingesting their bodily fluids somehow, most likely slim to none. See sweat situation above. As far as we know now, droplets in the air really don’t cause Ebola to spread.
3. “Should we really be concerned about this?”
Well, yes and no. There are a lot of things I could say to answer this question. But for Americans who have access to healthcare and a relatively good public health infrastructure, this graph should do it:
Get your MMR vaccines, ya’ll.
4. “What does XYZ Corporation do for situations like this?”
Well, to protect my job, I won’t share too many telling details but I can say a couple of things: we make preparedness and response plans. Then, we make sure everyone involved knows those plans. What this requires is keeping up with the outbreak as it evolves, learning all the time, and the big one: communication! The first two are where my degree really comes in handy. Being able to analyze the situation with an academic background in epidemiology and the experience I have gained in my job is what helps assess the threat of the situation and educate others about the big picture. This helps the company management make decisions about how to protect people – which mostly involves good communication.
**Everyone who has asked me these questions has at minimum a bachelor’s degree in a difficult field of study. I give these examples not to make them seem or feel stupid or silly, but just to show that information about infectious diseases is not well spread (no pun intended) until the disease actually matters to the Western world. Ebola has been around since the 1970s but the US wouldn’t touch it with a 10 foot pole (and still won’t) until it poses a serious, potentially uncontrollable risk to our country. And that’s just the way it is, my friend. Ever wonder why we don’t have malaria? Well, news flash: we used to! But again, we don’t talk about it much because it’s all the way over there in Africa now. I could go on for days about that one too.
Let’s just say, my job is never over, and I have good ol’ microbes to thank for that. Ebola, you rock – I say that in the most politically correct way possible.