Wednesday, October 22, 2014

What would happen if Ebola came to the United States?

World Health Organization officials prepare to enter a hospital during a 2012 Ebola outbreak in Uganda. Isaac Kasamani/AFP/Getty Images

The world is currently experiencing the worst Ebola outbreak in history — it's in West Africa and has killed about 672 people as of July 23.

But what would happen if the disease came to America?

The scenario isn't as far-fetched as it might sound. With air travel as common as it is, borders don't mean all that much when it comes to disease. It's entirely possible — though by no means certain — that at some point, someone infected with Ebola could get on a plane and land in the United States. And then what?

As it turns out, experts say, we'd probably be able to contain an Ebola outbreak here pretty quickly. But it's worth exploring why that is. The outbreak in West Africa is so severe for a number of key reasons, including a lack of resources, inadequate infection control measures, and mistrust of health workers. The United States, by contrast, has far better public-health infrastructure. And that makes all the difference.

So here's a detailed look at how Ebola in America might go down:

1) The first 24 hours: identify the outbreak

The most likely way for Ebola to arrive in the United States would be an infected person flying from West Africa who has Ebola but doesn't even know it. Ebola can hide in a person's body from two days to three weeks before symptoms emerge. And people don't transmit Ebola during that incubation time — they're only contagious once they show symptoms.

Once an initial Ebola patient starts feeling sick, the person will probably seem at first like he or she has the flu or traveler's diarrhea. (Some of the more famous symptoms of Ebola, like bleeding from orifices, don't tend to come on until later. And bleeding doesn't even happen in about half of cases.)

Although the patient would now be contagious, that doesn't mean that it's exceptionally easy to catch. Ebola doesn't spread through the air, and it's harder to catch than things like the flu. You can't get it just from being on the same plane or in the same public space. The only way to get Ebola is to touch a patient's bodily fluids, like vomit, diarrhea, sweat, saliva, or blood.

Now would be when speed and public awareness plays a big role, no matter where in the world an Ebola patient is. The patient or someone around her will have to figure out: (1) This is something that looks like the flu or diarrhea and (2) This person was just in a country that has Ebola.

If people realize that this might be Ebola early on, they should be able to avoid getting infected by keeping away from the patient's bodily fluids. But if that doesn't cross their minds for a while, people will be more likely to get the virus by accident. In that first day of symptoms, every hour counts.

2) The next step: isolate the patient

In US hospitals, any suspected case of Ebola would be treated as a potential risk until tests come back negative. This means that standard procedures to protect other patients and health-care workers from the patient's bodily fluids would be put into place.

Because Ebola doesn't spread through the air, hospital workers wouldn't have to wear respirators or what you might think of as full Outbreak gear. However, they would protect their body and face from fluids that might splash on them, using things like gowns or full body suits, masks, gloves, and goggles.

Anything that touches the patient would be sterilized or disposed of in a safe manner. And if the patient dies, the body would be carefully handled so that it won't be a danger to anyone, either.

Better adherence to these safety guidelines is one reason why the virus wouldn't spread as quickly in the United States as it has in West Africa. For example, over there, some health-care workers have gotten infected, most likely because the rules weren't followed as closely. And there's actually a reason for that — people who are supposed to wear protective suits in 100°F weather will get extremely hot and might cut corners, says Michael Osterholm, of the Center for Infectious Disease Research and Policy at the University of Minnesota. But US hospitals are more climate controlled, he says, and even that small difference makes a breach less likely.

3) Track down other potential patients

Detective work is a major part of controlling a disease like Ebola. Experts would interview the patient, her relatives, and other potential close contacts to monitor them and make sure that they don't spread the disease to others.

Officials will then suggest various options for these people, depending on the level of risk, including watching and waiting, isolation at home, and testing for infection.

Tracking down contacts has been especially problematic in West Africa in ways that unlikely to happen in the US. An editorial in the major medical journal The Lancet says "The geographical spread of cases and movement of people in and between the three countries presents a huge challenge in tracing those who might be infected." And the World Health Organization says that "low coverage of contact tracing" is one key problem it uncovered in a recent assessment the Ebola response in Liberia.

4) Keep patients in hospital until they're not a threat

It's important to remember that about 40 percent of the patients in this Ebola outbreak have survived. There's no specific pill or shot that will make an Ebola infection go away, but doctors can try to make the patient comfortable, give IV fluids, and treat symptoms.

To prevent Ebola from spreading, health authorities wouldn't release a patient from the hospital until it's clear that the person won't be a danger to others.

This might seem intuitive, but it hasn't always happened in West Africa. For example, the BBC reports that there are several missing patients in Sierra Leone — where some people don't trust that medical care will help them. That, obviously, increases the odds that the outbreak will spread.

The best case scenario and the worst case scenario

To sum up, the best case scenario is that someone coming back from, say, Guinea, realizes that he might possibly have Ebola as soon as he starts feeling sick. Everyone makes sure not to touch her vomit or diarrhea or other fluids. And the outbreak ends with just one patient.

The worst case scenario is that this person is ill for days and in contact with a whole lot of people before anyone realizes that something unusual is going on and brings her to a hospital. But it's still unlikely that Ebola will get farther than a local problem in one city or town. Even in the worst case scenario, "I don't think we’ll have a serious public health threat in any of the developed countries," Osterholm says.

For more on the basics of the Ebola outbreak, check out my previous story Ebola: what you need to know.

Update: Included more examples of bodily fluids that can transmit Ebola and removed a statement that Ebola can't be transmitted by cough or sneeze.

Get Vox in your inbox!

By signing up, you agree to our terms.

X
Log In Sign Up

forgot?
Log In Sign Up

Forgot password?

We'll email you a reset link.

If you signed up using a 3rd party account like Facebook or Twitter, please login with it instead.

Forgot password?

Try another email?

Almost done,

By becoming a registered user, you are also agreeing to our Terms and confirming that you have read our Privacy Policy.
Spinner.vc97ec6e

Authenticating

Great!

Choose an available username to complete sign up.

In order to provide our users with a better overall experience, we ask for more information from Facebook when using it to login so that we can learn more about our audience and provide you with the best possible experience. We do not store specific user data and the sharing of it is not required to login with Facebook.

tracking_pixel_10934_tracker