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What is my real risk of contracting Ebola?

by Joseph E. DiCorpo, BSc, MMSc, PA, Chief Medical Consultant, Assist America Inc.

Over the past few months we have all been bombarded through the media by the Ebola Epidemic. Now I am not saying, in any way, that this is not a serious global health concern. Nor, would I ever argue that the resources committed to the containment and eradication of this disease are wasted in any way. That being said, I would like to reflect upon some of the more realistic concerns I have about Ebola and how those concerns relate to our Assist America members. 

Here are the Centers for Disease Control in Atlanta, Georgia’s recommendations on the Ebola Epidemic:

CDC urges all US residents to avoid non-essential travel to Liberia, Guinea, and Sierra Leone because of unprecedented outbreaks of Ebola in those countries. CDC recommends that travelers to these countries protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola. This is a Level 3 Alert. This is the highest warning that the CDC can issue.

Additionally, the CDC has posted the following warning for the Democratic Republic of the Congo:
CDC recommends that travelers to the Democratic Republic of the Congo protect themselves by avoiding contact with the blood and body fluids of people who are sick with Ebola. Although cases have been reported only in the Equateur Province, all travelers to the DRC should be alert for reports of possible further spread within the country. This is a Level 2 Alert.

Now let’s look at some other numbers, like number of cases, mortality (death rate), and population. 

  Total Cases Lab Confirm Cases Deaths Population Infection Rate Mortality
Liberia 6536 2515 2413 4.2 mill 0.16% 37%
Guinea 1667 1409 1018 11.7 mill 0.01% 61%
Sierra Leone 5338 3778 1510 6.1 mill .08% 28%
Dem Rep Congo 66 49 38 67.5 mill .00001% 57%
USA 8 8 1 319 mill 0 12.5%

Numbers can be interesting. What I think is relevant here is that the infection rate in Liberia is the highest versus the total population of the country but their mortality is lower than I expected. Overall we are still dealing with very low infection rates, but the reason Ebola garners the media attention is because of the high mortality rate.  Some would argue that the reason for this high mortality rate is that the healthcare infrastructure in these West African nations is abysmal—in that fact, they are correct. 
Another problem in this region of West Africa is the practice of epidemiology. In the Western developed countries of the world we have the ability to communicate, track, and quarantine (if necessary) suspected infected Ebola patients. This ability does not really exist in these countries. Without the technical and communications infrastructure that we take for granted it is very difficult to track and quarantine individuals suspected of carrying the Ebola virus. Also, certain religious and cultural traditions in this region may cause the frequent transmission from a victim of Ebola to his own family members after his death. These factors have contributed greatly to the spread of the disease in this region.
For many years at Assist America, we have not recommended that any of our members seek almost any form of invasive medical care in these countries. We routinely evacuate our members from this region to either Europe or South Africa for definitive Western level care. Our concern up to this time has been more with HIV contamination and Hepatitis C transmission due to inadequate sterilization methodologies and practices. Also the hospital institutions in this area do not meet Joint Commission International standards for healthcare organizations, so we really do not feel comfortable having our members treated therein. 
So what would I recommend for our members? Well, first of all do not panic. You are not going to die of Ebola today, tomorrow or the next day. However, you should be proactive. I would recommend the following;

1) As per the CDC recommendations DO NOT travel to these countries or region non-essentially until the epidemic has been contained. 
2) Be aware of the travel itineraries of your colleagues and co-workers. 

3) Be aware of the people you come in close personal contact with and make sure that they have not traveled to this region within the past 45 days. (Please note this is double the standard incubation period for Ebola)

4) If you do discover someone close to you who has travelled to this region within the past 45 days make sure they are monitoring their health status closely. 

5) If you are a healthcare provider, remember that regardless of Ebola that the practice of Universal precautions is warranted with all our patients. 
With all this analysis and advice what if you do, somehow, someway, become exposed and/or infected with the Ebola virus? Well, there are two things you should know. First of all, it appears, from the limited number of cases treated by western level medical care outside the region, that your chances of survival, if diagnosed early are good. The bad news is that getting you back into the US, or your homeland, may be a real hassle. As of this time there is one US based air ambulance provider, and one European based, who can bring you back to home. The authorization for bringing you back MUST come from the CDC and US State Department for US Citizens and the respective home government for European citizens, otherwise these air ambulances will not be dispatched and/or you will not be allowed into your homeland. 

Let me conclude with this statement—for the past 25 years, Assist America has been here helping our members around the world, through other accidents, disasters, epidemics, and pandemics. Ebola is just another challenge which we and our members face together. If you have a concern, need advice, or get exposed/infected can we help? Yes we can, and we will.