Ebola in the US – what’s next!?

Last month, the first Ebola patient was brought to the US – a physician infected in Africa and brought back to the US for treatment.  I reviewed Ebola and that case in a earlier post on 8/2/14. That was a controlled transfer, just as the 2 other known cases transported to the US for treatment were. On September 30th, the first case of newly diagnosed Ebola in the US occurred, in a person who had recently traveled from West Africa to Dallas, Texas.

Once in the US, he went to an Emergency Room for fever.  He was sent home with antibiotics. He returned 2 days later when his symptoms had progressed and his travel history was noted. He was quarantined, tested and diagnosed with Ebola.  Why he was discharged after the first visit has been blamed on a computer error and then on poor communication between the intake nurse and the doctor. Since I wasn’t there I can only hypothesize that the truth is somewhere between.

Since being admitted to the hospital, his immediate contacts have been isolated and a HazMat team is cleaning the apartment where they stayed.  The CDC is monitoring about 50 more people he may have had contact with and so far, no one has developed fever – the first sign of Ebola.

What does this mean for the US now?

Ebola is a virus, causing fever, body aches, headache and sore throat. Unlike most viruses, it can also cause internal bleeding. You need to have symptoms to be contagious, and the incubation period – the time from exposure to symptoms is 2 to 21 days. Treatment is mostly supportive – meaning fluids and oxygen, although experimental treatments are in use as well.  It is likely that the death rate, nearly 50% in West Africa, would be much lower in the US due to better facilities, quarantine and access to care.

Ebola is spread by fluid contact – meaning you need to directly come into contact with secretions from an infected person – similar to HIV or Hepatitis.  It is not an airborne virus – meaning a cough or sneeze won’t spread it.  It also does not live long on surfaces. Therefore, if none of this person’s contacts develops symptoms, then the current US outbreak will be over.

That said, it is likely that another traveler will bring the virus to the US. Modern air travel makes this more likely, even with screening at both the departing and arriving airports.  Vigilance in the doctor’s office and Emergency Department will be needed to quickly identify potential cases – and most importantly, a travel history!

For updates from the CDC

The path to wellness begins with a proper diagnosis 

 

Author: Eric Goldberg, MD, FACP

I am a Board Certified Internal Medicine physician. I currently practice at and am the Medical Director of NYU Langone Internal Medicine Associates. Posts are my opinion and not medical advice or an official position of NYU Langone Medical Center.

What are your thoughts?