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Ebola in US no surprise to local expert

Dr. Daniel MogyorosAMERICANS followed the Ebola epidemic in West Africa from a safe distance until Liberian national Thomas Eric Duncan landed in the US on Sept. 20 and developed symptoms four days later.

Suddenly, “over there” was here.

Now in critical condition in a Dallas hospital, Duncan’s family is under quarantine. Fifty people who came into contact with him are monitored twice daily.

The arrival of Ebola in the US is no surprise to Dr. Daniel Mogyoros, an infectious disease specialist at Kaiser Permanente and chair of the infection prevention committee at Good Samaritan Medical Center.

“It’s almost inevitable that we’ll see cases of Ebola in the US, Europe, even the Middle East,” Mogyoros, who cites air travel as the major culprit in global contagion, tells the Intermountain Jewish News.

Panic often blurs the facts associated with the Ebola virus.

Mogyoros navigates Ebola’s mysterious waters with the informed calm of a seasoned diplomat.

First, the hemorrhagic disease first identified in Africa in 1976 and rarely seen outside that continent is not airborne.

You can’t catch it from a cough, like the flu.

Until a person who comes into contact with Ebola becomes symptomatic — starting with a fever and progressing to vomiting, diarrhea, etc., in rapid succession — that person is not contagious.

“The risk of getting Ebola is very small in the US,” Mogyoros says. “Our public health care and delivery system is so advanced that it won’t take hold in the same way.

“There is no need to panic because the right methods are in place to fight it.”

That said, Americans are frightened by the high contagion rate of Ebola — traditionally confined to small remote regions of Africa — and its wildfire leap to major urban centers in Liberia.

Read related IJN editorial, “What happens if someone begins to show Ebola symptoms while in flight?

Mogyoros explains that the current Ebola virus is 60% fatal, which is lower than previous outbreaks with a 90% mortality rate.

But it is more contagious.

According to the latest CDC figures, Ebola has claimed more than 3,500 lives and infected 7,470 individuals in Guinea, Liberia and Sierra Leone this year.

The CDC projects that between 550,000 to 1.4 million people in Liberia and Sierra Leone will die by January, 2015, unless badly needed medical and hygienic systems are established there.

EBOLA is transmissible through bodily fluids, particularly blood. Media outlets continuously run clips of health workers covered head to toe in hazmat suits designed to protect them from contagion.

Yet they can contract Ebola, as do photographers and others who have had little or no known contact with victims.

How does this happen?

Mogyoros provides a multi-tiered answer.

“Ebola is essentially transmissible through any bodily fluid,” he says. “Blood and vomit of course, but all fluids.

“And the amount and types of body fluids are very infectious in the Ebola virus.”

Contact, in its simplest, often unconscious form, is the operative mode of Ebola transmission.

Say you’re traveling on a plane and the person next to you, in back of you or 10 rows away from you feels feverish.

Fever is the first sign that a person may have Ebola. Couple that with a travel history to West Africa and red flags are appropriate.

“At that point, he or she is potentially contagious,” Mogyoros says. “And Ebola symptoms come on very quickly.”

Having intimate contact isn’t the only way to risk infection.

If you have indirect contact with the symptomatic person — like touching a coffee cup he or she handled and then touching your mouth, eyes or nose; eat your food with your fingers; even use the same restroom — it might put you in line for potential contagion.

It takes from two to 21 days to develop symptoms.

That’s why Duncan’s family members have been quarantined — and why passengers on the flights he took to the US were not detained.

The time lapse between infection and the onset of symptoms is relatively long and therefore crucial, Mogyoros says.

“My concern is that someone who comes into contact with Ebola in Africa gets sick while traveling and potentially exposes passengers in an enclosed space,” he says.

“It’s very important to prevent someone with a fever from boarding a flight and checking for fever at the end of the flight,” he says.

“But I think the government should consider banning flights originating in the affected countries.

“There’s this large window of time between exposure to Ebola and developing the active virus,”Mogyoros continues. “Say a person boards a plane feeling fine but becomes ill during travel.

“That would be a strong reason to ban flights originating in West Africa.

“I know this is a complex political situation, but it’s something we should consider.”

On Oct. 4, a man who had traveled in West Africa became sick on a flight from Brussels to Newark. Upon landing, he was immediately examined by physicians at University Hospital.

This man did not have Ebola.

The outcome was fortuitous — this time.

WHEN Thomas Duncan first visited a Dallas hospital with symptoms on Sept. 25, he was sent home with antibiotics. His family says that although the intake staff did not ask about travel to West Africa, Duncan volunteered the information.

The details remain unclear, but the resulting misinformation raised the Ebola threat level because Duncan was contagious for four days prior to hospitalization on Sept. 29.

“The burden is on hospitals and medical professionals to ask the right questions,” Mogyoros says.

“Frequently, a person might not present obvious symptoms.”

Kaiser has developed a firm protocol regarding Ebola.

A person with a fever who was recently in West Africa would be quarantined and his blood tested for Ebola. All blood samples are sent to the CDC.

“Until the CDC tells us that the sample is negative for Ebola, that person will remain in quarantine,” Mogyoros says.

“Remember, a person without symptoms cannot spread the disease.

“If you’ve been exposed to Ebola, develop a fever and get sick, you are at risk of transmitting the disease — but only then.”

Mogyoros feels Americans should disengage “their panic mode” and have faith in America’s advanced medical system and cautious containment procedures.

“I don’t think Ebola can get anywhere near the levels of the West African outbreak because we are so medically superior,” he says.

“Certain situations are unique to Africa, where there is a severe lack of medical resources, physicians, gloves, gowns and intensive care units.

“Americans and Europeans have a medical system that protects the general population,” he says.

Mogyoros is far more worried about the flu, which kills close to 30,000 to 40,000 people annually in the US, than Ebola.

In a bad year, flu deaths can soar to 50,000.

“Get your flu vaccination,” he stresses.

“Ebola is scarier, but the flu is deadlier — and preventable.”

Copyright © 2014 by the Intermountain Jewish News



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IJN Senior Writer | [email protected]


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