I’m Off to Fight Ebola

Channelling the energy of this photo from Partners in Health’s office.

Originally written February 22, 2015

Our stateside Ebola training is complete, our passports have arrived complete with our work visas just in the nick of time, and today we begin our long trek to Sierra Leone! I’ve utilized all my packing prowess and succeeded in whittling my belongings down to carry-on luggage only, which I’ll admit I’m pretty proud of! I even FedEx-ed my one set of winter clothes back to Seattle, and then sprinted back through Boston’s heavy snow to the warmth of our hotel. I’m as ready as I’m going to get.

When we arrive in Sierra Leone’s capital, Freetown, we will have a week of World Health Organization training complete with a mock Ebola Treatment Unit (ETU) and actual survivors playing patients. Then comes real “Red Zone” training inside a working ETU before we are sent to our respective assignments. It has been an absolute pleasure spending time with the rest of my cohort of clinicians; there’s nothing like hanging out with a bunch of like-minded people who “get” why you do what you do, to really light you up. I think we are all itching to get started.

Yesterday we had a session with Partner in Health’s occupational health doctor to discuss the protocol if we become ill in the field. No PIH clinicians have contracted Ebola (knock on wood!), but it’s common to experience travelers’ diarrhea or other illnesses that could mimic some of the symptoms. We’ll be checking our temperatures twice a day, reporting any issues, and isolating ourselves if necessary. Which I explain only because I think it’s interesting, not because I expect it to happen! [Little did I know when I wrote this what would occur later]

Of course, we have also spent plenty of time discussing the surveillance process that we will experience when we get home. I’ll explain a bit now, just to soften the ground for when it’s my turn:

Regulations for returning Ebola responders are set by the county in which they live. The Centers for Disease Control has guidelines, but states are not required to follow them, so it’s up to each county to decide how they want to do it – which is why some of our clinicians are being told they can’t leave their homes for 21 days (the incubation period for Ebola), while others have much more reasonable restrictions.

Unfortunately, some counties are basing their requirements on public perception rather than actual science. I understand that people are terrified of catching Ebola, but acting on irrational fear rather than proven facts simply doesn’t do anyone any good.

The fact is that Ebola CANNOT be transmitted by someone who is not showing symptoms. It is NOT like the flu, for example, which someone could spread to others before they even knew they were sick (by the way, thousands of Americans will die of the flu this year and likely none will die of Ebola, so if you’re freaking out about Ebola, get your damn flu shot). This is the exact reason that clinicians returning from West Africa check their temperatures at least twice a day and monitor themselves closely for any symptoms. Even if we had somehow been exposed and contracted Ebola, it is impossible for us to transmit it to anyone else until we show symptoms.

Furthermore, Ebola is only passed through direct contact with the bodily fluids of someone who is ill – it is NOT airborne. “Direct contact” includes physical touch but also contact with infectious droplets. The common misconception that I have heard is that Ebola could, in certain cases, be transmitted through a cough – so doesn’t that make it airborne? Not in an infectious disease sense.

To clarify, for this specific example to happen you would have to be in close proximity to someone who is already sick with Ebola, and they would have to cough in a way that their saliva or blood landed in your mucous membranes (eyes, nose, mouth). The difference with airborne viruses (like a cold) is that the virus can hang in the air in a lingering cloud. So if I have a cold and I cough, you could walk through the room a few minutes or even hours later, after I’m long gone, and still catch my cold. That is not possible with Ebola. I know it seems like a fine distinction, but it’s an important one. I mean, you usually notice when someone coughs their bodily fluids onto you, and it’s easy to prevent, whereas you don’t have any idea when you walk through a virus that’s hanging in the air.

Still concerned I’m going to somehow give you Ebola? Let’s get real, and imagine how many more infections there would be, not just in West Africa, but everywhere, if Ebola was airborne.

There’s a reason Ebola has been referred to as “a disease of caregivers”: most people who have contracted it have done so while taking care of someone who was ill. They don’t catch it walking down the street, or hugging their healthy friends. Family members and healthcare workers catch it while caring for someone who is very ill and losing a lot of highly infectious bodily fluids through huge amounts of vomit and diarrhea (sorry, non-medical friends!).

Remember Thomas Duncan, the Liberian man who died of Ebola in Dallas? He was misdiagnosed in the emergency room and sent home with Ebola for DAYS. He lived with his family members while he was actively ill, and NONE of them caught it. If Ebola truly was airborne, how did they come out unscathed?

Another huge factor in the spread of this outbreak is the sanitary conditions in West Africa. Imagine caring for a family member who is losing liters of fluid through diarrhea and vomiting, in a hut with no running water or flush toilet or washing machine. Now compare that to the United States. Though of course I don’t know for sure, I would guess that Mr. Duncan’s family avoided close contact with him and washed their hands a lot, as any of us would do if our family was sick with anything. That’s the reason Ebola spread like wildfire in West Africa and was stopped in its tracks in America.

So please excuse the long rant, but that brings me back to – me. When I return from this mission, my plan is to live in my house with my husband for 21 days, see my friends and family, and (just to be extra safe) refrain from swapping bodily fluids with anyone. It shouldn’t be terribly hard – I rarely lick strangers or uncontrollably release bodily fluids at the grocery store 

So let’s say, in theory, that I’m home with my family a week after I get home from Sierra Leone, and I develop a fever. I’ll immediately self-isolate, alert public health, and if I meet the criteria, I’ll be taken to a designated hospital for treatment before I pose a risk to anyone. And fortunately I will have been keeping my bodily fluids to myself in the meantime anyway, so there’s no way for anyone to get sick. This is, by the way, all in line with the regulations that King County Public Health has set for me.

Questions about this? Ask me! It is hugely important to me to make this clear so that the public isn’t living in fear for no reason, and so that returning clinicians aren’t stigmatized. I know plenty of Ebola responders who are doing this work in semi-secret, for fear of how their friends and neighbors will treat them if they find out. I believe that is truly a shame, and they deserve better.

While I completely respect everyone’s choices regarding how much of this experience they want to share, I’ve been very open about what I’m doing in the hopes that some simple conversations and education will turn the tide. If all of the scientific data doesn’t convince you, take a moment and really ask yourself: Do you honestly believe that humanitarian responders would put their lives at risk to save strangers on the other side of the world, and then come home and knowingly put their friends and family in danger?

There’s so much more to say about what we’re expecting to see on the ground, but I’ll report back to you when I’ve begun to see it for myself. I promise my next post will be more about what we’re doing, and less lecturing. We arrive in Sierra Leone in a couple of days but I’m not sure exactly when I will have internet access again, so hang tight!

To end on a happy note, I’ll leave you with this short video that was shared with us in training: “The Boy Who Tricked Ebola”. He’ll put a smile on your face!

Next post: National Ebola Training Academy Begins

Previous post: Ebola Response Training – Day One

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