I turned to Dr. Elke Muhlberger, an Ebola expert long intimate with the virus ”” through more than 20 years of Ebola research that included two pregnancies. (I must say I find this the ultimate antidote for the fear generated by the nurses’ infections: A researcher so confident in the power of taking the right precautions that she had no fear ”” and rightly so, it turned out ”” for her babies-to-be.)
Dr. Muhlberger is an associate professor of micriobiology at Boston University and director of the Biomolecule Production Core at the National Emerging Infectious Diseases Laboratories (widely referred to as the NEIDL, pronounced “needle”) at Boston University. Our conversation, lightly edited:
Many of the EMTs I know keep worrying about being exposed to ebola through coughs and sneezes. They seemingly equate every infectious disease with flu-like symptoms.
This is really a very helpful article. It gives a plausible theory on why the two Dallas heath care workers were infected but the people living in Mr. Duncan’s apartment were not. So far none of the contacts of either of those women have become ill, and it seems likely that no New Yorkers on the subway or Ãœber will catch it, either, because Dr. Spencer was not seriously ill when he was out and around in the city. Ebola is spreading so rapidly in west Africa through people taking care of the very seriously ill without complete biohazard gear and also through African funeral practices.
Good article, but even in CDC land it all depends on what the meaning of the word “is” is. From the article:
The CDC recently tweeted an answer to a common Ebola question: It said yes, if someone with Ebola sneezes on you and the droplets land in your eyes or mouth, then conceivably you could catch Ebola. But that doesn’t count as airborne?
Exactly, and it’s all about timing. When someone is infected with measles and then sneezes or coughs, and is not sick at this point, they can transmit the virus to others and you’re not even aware that someone with the disease is contacting you. That’s the big difference with Ebola virus and these bigger droplets — but nevertheless droplets, of course. When Ebola virus patients start to transmit the virus, they have already developed a fever and are obviously sick.
So airborne doesn’t mean airborne droplets like that contained in a sneeze or caugh. They are airborne, but not that airborne. One can pass the disease and the other can’t. Simple once you understand.
According to the US Army:
On page 117 of the handbook, in a chapter discussing “Viral Hemorrhagic Fever†(VHF), a category of viruses that includes Ebola, USAMRID says: “In several instances, secondary infections among contacts and medical personnel without direct body fluid exposure have been documented. These instances have prompted concern of a rare phenomenon of aerosol transmission of infection.â€
http://www.usamriid.army.mil/education/bluebookpdf/USAMRIID BlueBook 7th Edition – Sep 2011.pdf
Note also that she says that BSL 4 is the proper level of containments for viruses like Ebola, “A Biosafety Level 4 lab is such a high-end lab, it is not possible to use protective gear like that in every hospital in the U.S.” So what she is saying that hospitals treating Ebola patients should be at BSL 4 levels, but it is not practical to have them at the level they should be, so they have to make do with BSL 2 or 3 levels of protection.
My bottom line: If Ebola is a BSL 4 pathogen treat it as a BSL 4 level pathogen and spare me the “it’s not really that bad” stuff.
What it means, Br. Michael, is that the people at risk in the US are going to continue to be emergency and critical care personnel, primarily nurses, as we saw in Dallas. The reason is, as you and the virologist point out, aside from the super treatment centers hospitals here do not have BSL 4 level equipment and facilities. They will do their best with less, and, like the missionaries in Africa, a few of them will be infected in spite of their best efforts.
And that is why a more robust isolation or a 21 day quarantine called for. Certainly some form of isolation and more than self monitoring is required.
The real problem is lack of trust due government officials down playing the danger due to political correctness. I am nore than willing not to “panic” if I can be assured that government officials are not lying “in order not to cause panic”. There may be a situation where a little “panic” is called for.
The article does mean that the general population in the US are not at serious risk. However, I do care about the emergency and critical care people. It seems to me that American medical missionaries returning should have a self-quarantine with monitoring and a plan of whom to call so they can be taken to a properly prepared facility if they become ill. The Christian medical missionaries have been very responsible, and the Doctors Without Borders physician also called for the people in full protective garb the moment his temperature went up moderately (100.3º, not 103º as was misreported.)
I think it is reasonable at this point to restrict visas for nationals of Liberia, Sierra Leone and Guinea until the medical crisis is over in those countries, and to restrict re-entry for US nationals who have gone there as tourists. There is a small child in New York City currently in a hospital being treated by people in space suits after his return from a “family trip” to Guinea. The irresponsibility involved in taking a child on such a trip at a time like this boggles the mind.