The Fear Factor
It is hard to escape the news these days. What is scarier than a religious extremist with a sadistic streak, a knife fetish, and lots of stolen Iraqi weapons? An enemy you can’t see that could be infecting your family member or neighbor, right this very minute. Ebola. Fear of it has nearly wiped the group terrorizing Syria and Iraq, off the front page.
Modern Medicine
Since the 1970’s we have been in a comfortable state of ignorance that modern medicine had all our worst fears beat. That vaccines and antibiotics would protect us from any microscopic invader. AIDS was a huge wake up call, but we now all know folks who are managing to live with HIV by treating it with new medicines. Growing up in the 1960’s, I am just old enough to remember the infectious diseases of childhood, before the massive vaccination efforts that began in 1971. I caught the three biggies – measles, mumps, chicken pox. I had heard horror stories about polio and other terrible diseases finally conquered with the advent of vaccines and antibiotics. We all have. But now we are facing an infectious disease without a vaccine as well as new strains of bacteria that are resistant to our old antibiotics. Like in a Jurassic Park movie, “life finds a way” to make ours a little more nervous.
Profit
We live in a profit-driven world. Not every disease rates the economic attention of the pharmaceutical companies, health policy makers, or politicians until it gets out of hand. When HIV/AIDS first hit, the mainstream did not want to spend money investigating a disease seemingly targeting a stigmatized population such as the LGBT community or intravenous drug users. When the treatment drug AZT became profitable, some pharmaceutical makers did not want cheaper alternative treatments available or even investigated. As the epidemic grew, and affected a broader group of victims, HIV research garnered more attention, action, and money. In the case of Ebola, the countries it affected were poor ones with spotty access to medical treatment and isolated victims. Out of sight, out of mind. Ebola was Africa’s private hell and we were blissfully unaware of the suffering there in the small pockets affected which were protected from spreading it further due to simple isolation. But we are in a global existence now. What happens anywhere can affect anyone, anywhere else. Planes, trains, buses, and boats connect us all. We aren’t just connected digitally these days. We are in this one together.
Vaccines
Vaccines used to be a more humanitarian endeavor. Now it is more about profit, and an Ebola vaccine did not seem profitable, or even practical, since the number of strains of Ebola make it similar to the flu - a moving target. Until this week. Now Glaxo is all in a rush to bypass the usual procedures to get a vaccine to market. These days because of the vaccine law on the books in the US signed by President Reagan in 1986, there is no industry downside to a hasty mistake. The vaccine companies are immune to prosecution. The Federal Government pays for any injuries caused by the vaccines. That may be a recipe for problems. Already healthy volunteers are being injected with bivalent vaccines and the makers are anxious to bypass even the most rudimentary safety studies in their haste to bring a vaccine to market. At the very same time they are rushing these vaccines into human trials, vaccine makers are being sued, due to whistleblowers in their own ranks, for lying about efficacy, or manipulation of data, or even bribery.
Tools in the Medicine Chest
Currently, many doctors believe we can stop this epidemic better if we use methods developed over centuries and ones that have stopped Ebola outbreaks in the past. Quarantine, vector tracking, contact tracing, serums that had been the previous treatment, screening at hospitals and health care access points as well as critical hydration and care for ill patients already with the disease.
The Fear Meter - Where do you go when it is already at 11?
What I think contributes to much of the panic gripping Texas and the rest of the US this week after a man slipped into Dallas before it was determined he had Ebola, is the way we have talked about infectious diseases and how to fight them. In an effort to get everyone vaccinated, the CDC and many doctors have played up the measles, mumps and chicken pox to terrifying levels that almost amuse those of us who have had these diseases as a rite of childhood. It is no laughing matter that in countries with poor sanitation, lack of clean drinking water and poor access to nutritious food, what we consider a mild illness is easily deadly. And that is the point. Right now, the CDC is trying to reassure folks of that very fact. But their previous efforts to put all their eggs in the vaccine basket are backfiring. In America, we are less likely to die from a bout of diarrhea, or dehydration, because we are more than well fed and there is help literally around every corner and a hospital minutes away – we even use helicopters if we need to get there faster. Even though Time Magazine and other news outlets are breathlessly reporting that measles is so much more infectious than Ebola, Ebola, with a mortality rate of 70% is actually far more deadly. For example, in 2011, the CDC reported 222 people caught measles in the US, of that, 70 were hospitalized, including 12 cases of pneumonia, 15 cases of dehydration and 17 cases of diarrhea. No encephalitis and no deaths. That is not the case in countries where poverty is rampant, sanitation is poor, and even traditional family burial rites are conducive to spreading illness. In poor countries, according to the World Health Organization, infant mortality rate from measles can be 6%. A huge difference.
What we have right now is a case where the doctors who terrified parents in the US over measles, likened chicken pox to small pox, and convinced folks the only way to deal with an infectious disease is a vaccine, are having to explain how to deal with an infectious disease 500 times more deadly than measles, for which there is no vaccine available yet. By stoking fear about diseases that are only deadly in rare cases, in those with poor health status, the fear meter went off the charts for a truly deadly, contagious disease with a 70% mortality rate and no other treatment except the use of serum made from the blood of patients who recovered. Being told not to worry about Ebola after watching the extreme care taken to transport the afflicted doctors home is ringing hollow for folks living in Dallas right now who had no such protection from the Ebola patient infectious there for 5 days.
Moving Target
In my case, even if there were a vaccine, I'll probably have to take my chances without it. I can’t have vaccines due to allergy. But I refuse to be terrified. We have placed too much faith in vaccines and it is time we realize that. Ebola mutates much too fast and some experts are even saying that if a vaccine came out, it may not be effective against all strains. We would be aiming at a moving target.
Treatment is Key
Our lesson from this should be: personal hygiene, washing hands, staying home when you are sick, reporting any symptoms during an outbreak like this, staying hydrated and in good physical health before something happens. Anyone exposed to the body fluids of a symptomatic victim can catch it, but your nutritional status and hydration status is critical to survival. More critical than serum. Which is why most health professionals are confident America can handle this crisis. We have the capacity to quarantine, hydrate, feed, and care for anyone who might contract this. Vaccines are not everything. They only prevent illness. They aren’t 100% effective, and not everyone can safely get them. Even screening procedures are not foolproof as we have seen this week. Once an epidemic is underway, treatment is the key. The 100% prevention ship has already sailed.
Resist the Fear
When I was growing up, measles meant a week off from school playing with my sisters. It was actually quarantine, but it was our only choice then and for many centuries before that. Right now, we need to resist the fear. This current outbreak demands our full attention, and is deadly serious, but there is no approved vaccine yet, so we need to respond in a sane, rational way our parents and society did years ago before there were vaccines for most things. Medicine is a whole lot more than vaccines. It is time we remember that.
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