The announcement that Ebola patients were being transported to the United States made me nervous. Ebola is one of the most dangerous viruses in the world. There is no cure for the disease and it has a fatality rate around 90 percent. Currently the best way to deal with Ebola is containment. Quarantine is the traditional and most effective means of dealing with a virus. Isolate the area of contamination and let the virus burn itself out. Though effective, it is not foolproof and it is also cruel. At times it requires a level of callousness that simply consigns people to die a horrible death. Quarantines, though, are becoming more difficult in our modern transit age. SO, is it wise to intentionally bring infected people into a country that has not had a single case of Ebola?
There are dangers in transporting Ebola patients into the US. Ebola is not airborne and if proper steps are followed it can be contained. But humans are notorious for making mistakes. The missionary from SIM did not have direct contact with patients, but was infected because of failure in safety protocols. There is always the threat of a mistake that will have horrific ramifications. And by the time the mistake is realized hundreds of people may be exposed to the virus. The ones who worry me most are those who claim there is no significant threat. Rational fear is a good thing and those who dismiss any fear are those who are prone to mistakes brought on by hubris.
A virus is not a sentient being (despite what you may see in movies), but the virus follows a biological imperative to spread. The nature of a virus is to reproduce and it will adapt to fulfill its imperative. At the moment the Ebola virus is stable, but there is the possibility that it may adapt and become more contagious. It is an unlikely scenario, but with a virus this deadly every scenario must be kept in mind.
There is also a historic note that worries me. Nearly a hundred years ago the world was ravaged by a mysterious virus known as the Spanish Flu. The 1918 Flu Pandemic killed somewhere between 3 and 6 percent of the world's population (perhaps as many as 100 million). That variation of the flu, which actually originated in China, was spread because of mass transit. Soldiers and laborers were transported to meet the needs of armies in World War One. The infection spread among those deployed in the war and then they took it back home with them. Public transportation and crowded public venues helped to spread the virus throughout urban populations. The same elements helped spread the SARS virus in urban Asian cities. There is not a direct correlation between the 1918 flu pandemic and the current Ebola outbreak, but is does paint a bleak picture of what can happen with an uninhibited virus.
HOWEVER, there are some good reasons for bring back the two infected missionaries back to the US. First, these are people who are dedicated to help others and every effort should be made to save them from the disease. Though Ebola has a high mortality rate, it can be survived with the right type of support. Basically, victims need support to keep them hydrated and to keep organs from failing. Primitive hospitals lack the equipment and personnel to meet the needs of large outbreaks. A modern, well staffed hospital can meet the needs for a handful of patients. The best hope for any victim would be a First World hospital. It would be impractical to bring all the Ebola patients to the First World and such a course of action would eventually overwhelm available resources. Epidemiologists have to be selective in who they bring out of Africa. At the moment a Spanish priest has been evacuated to Spain and two Americans have been brought to Atlanta.
The evacuations are more than an attempt to save medical missionaries. Emory is an university hospital and as a university hospital they not only train doctors, they also perform cutting edge research. Many First World hospitals (or even medical ships) can treat Ebola, but few facilities are equipped to cure it. I have no doubt that part of the motivation to bring the Ebola patients to Emory is to find a cure (and earn a Nobel Prize). If the two infected missionaries survive the virus it will provide needed data to create a vaccine. The expense and risk of bringing the Ebola patients to Emory will be worthwhile if a solution can be developed.
Intentionally bringing Ebola patients into the US is risky. However, history demonstrates that Ebola will make its way into the US at some point. Global air travel guarantees the spread of viruses. At some point an Ebola carrier will enter the US undetected. By the time the disease is diagnosed hundreds will have been infected. The best way to head off this threat is find a treatment before that event transpires. The treatment of the two Ebola patients is still the best hope to protect the US population and to provide hope for the infected in Africa.
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