Ebola Tipping Point? Dispelling Myths And, Possibly, Less Hysteria Over Virus

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

Has the national hysteria over Ebola peaked? Who knows. Maybe. There seem to be fewer front page headlines screaming about it; a new national poll finds most Americans are “positive” about the response by public health authorities; and today’s news is that more than 40 Dallas residents (all who had been in contact with the Liberian man who died of Ebola) were declared virus free.

Still, education is the antidote to hysteria, so it’s worth reiterating some of the facts. Many of them can be found in this must-read commentary in the London Review of Books by Paul Farmer, the rock star Harvard infectious disease doctor and leading advocate for global health equity in the world’s most impoverished regions.  Farmer, who is also a co-founder of the Boston non-profit Partners in Health, writes that despite some of the truly scary aspects of the virus, an Ebola diagnosis is not necessarily a death sentence:

The Ebola virus is terrifying because it infects most of those who care for the afflicted and kills most of those who fall ill: at least, that’s the received wisdom. But it isn’t clear that the received wisdom is right….

…the fact is that weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread. Weak health systems are also to blame for the high case-fatality rates in the current pandemic, which is caused by the Zaire strain of the virus. The obverse of this fact – and it is a fact – is the welcome news that the spread of the disease can be stopped by linking better infection control (to protect the uninfected) to improved clinical care (to save the afflicted). An Ebola diagnosis need not be a death sentence. Here’s my assertion as an infectious disease specialist: if patients are promptly diagnosed and receive aggressive supportive care – including fluid resuscitation, electrolyte replacement and blood products – the great majority, as many as 90 per cent, should survive.

And he adds this:

I’ve been asked more than once what the formula for effective action against Ebola might be. It’s often those reluctant to invest in a comprehensive model of prevention and care for the poor who ask for ready-made solutions. What’s the ‘model’ or the ‘minimum basic package’? What are the ‘metrics’ to evaluate ‘cost-effectiveness’? The desire for simple solutions and for proof of a high ‘return on investment’ will be encountered by anyone aiming to deliver comprehensive services (which will necessarily include both prevention and care, all too often pitted against each other) to the poor. Anyone whose metrics or proof are judged wanting is likely to receive a cool reception, even though the Ebola crisis should serve as an object lesson and rebuke to those who tolerate anaemic state funding of, or even cutbacks in, public health and healthcare delivery. Without staff, stuff, space and systems, nothing can be done.

If you want to become more educated on Ebola and find out what you can do to support the global effort, Partners In Health/Engage and Harvard are sponsoring an Ebola teach-in Wednesday night in Cambridge with a panel of practitioners and public health experts. Continue reading

The True Cost Of A Mother’s Death: Calculating The Toll On Children

A health worker interviews a client at a health care facility in Tharaka, Kenya. (Photo: Family Care International)

A health worker interviews a client at a health care facility in Tharaka, Kenya. (Photo: Family Care International)

By Emily Maistrellis
Guest contributor

Walif was only 16 and his younger sister, Nassim, just 11 when their mother died in childbirth in Butajira, Ethiopia.

Both Walif and Nassim had been promising students, especially Walif, who had hoped to score high on the national civil service exam after completing secondary school. But following the death of their mother, their father left them to go live with a second wife in the countryside. Walif dropped out of school to care for his younger siblings, as did Nassim and two other sisters, who had taken jobs as house girls in Addis Ababa and Saudi Arabia.

Nassim was married at 15, to a man for whom she bore no affection, so that she would no longer be an economic burden to the family. By the age of 17, she already had her first child. Seven years after his mother died, Walif was still caring for his younger siblings, piecing together odd jobs to pay for their food, although he could not afford the school fees.

In all, with one maternal death, four children’s lives were derailed, not just emotionally but economically.

More than 1,000 miles away, in the rural Nyanza province of Kenya, a woman in the prime of her life died while giving birth to her seventh child, leaving a void that her surviving husband struggled to fill. He juggled tending the family farm, maintaining his household, raising his children and keeping his languishing newborn son alive.

But he didn’t know how to feed his son, so he gave him cow’s milk mixed with water. At three months old, the baby was severely malnourished. A local health worker visited the father and showed him how to feed and care for the baby. That visit saved the baby’s life.

As these stories illustrate, the impact of a woman’s death in pregnancy or childbirth goes far beyond the loss of a woman in her prime, and can cause lasting damage to her children — consequences now documented in new research findings from two groups: Harvard’s FXB Center for Health and Human Rights, and a collaboration among Family Care International, the International Center for Research on Women and the KEMRI-CDC Research Collaboration.

The causes and high number of maternal deaths in Ethiopia, Malawi, Tanzania, South Africa, and Kenya — the five countries explored in the research — are well documented, but this is the first time research has catalogued the consequences of those deaths to children, families, and communities.

The studies found stark differences between the wellbeing of children whose mothers did and did not survive childbirth:

• Out of 59 maternal deaths, only 15 infants survived to two months, according to a study in Kenya.
• In Tanzania, researchers found that most newborn orphans weren’t breastfed. Fathers rarely provided emotional or financial support to their children following a maternal death, affecting their nutrition, health care, and education.
• Across the settings studied, children were called upon to help fill a mother’s role within the household following her death, which often led to their dropping out of school to take on difficult farm and household tasks beyond their age and abilities.

How to use these new research findings to advocate for greater international investment in women’s health?

Continue reading

Opinion: Why America’s Ebola Fears Are Dangerously Misplaced

Cpl. Zachary Wicker demonstrated the use of a germ-protective gear in Fort Bliss, Texas on Tuesday. (Juan Carlos Llorca/AP)

Cpl. Zachary Wicker demonstrated the use of a germ-protective gear in Fort Bliss, Texas on Tuesday. (Juan Carlos Llorca/AP)

By Richard Knox

At the memorial service last weekend for the only person to have died of Ebola on American soil, the Liberian clergyman who eulogized his countryman Thomas Eric Duncan posed a question we all should be thinking hard about right now.

“Where did Ebola come from to destroy people — to set behind people who were already behind?” Methodist Bishop Arthur F. Kulah wondered.

Here’s the reality: Until the world (and especially the United States of America) refocus on the “people who were already behind” in this battle of virus-versus-humanity, no one can rest easy.

Ebola is an animal virus that has sporadically caused local human outbreaks in Africa for at least 38 years. But now it has crossed into people who live in densely populated African nations with barely functioning health systems and daily jet connections to the rest of the planet.

“It’s like you’re in your room and the house is on fire, and your approach is to put wet towels under the door.”
– World Bank chief Jim Yong Kim

This is entirely predictable, as scientists who watch emerging diseases have long known. They just didn’t know which virus would be the next to terrorize the world. (SARS and HIV showed how it can happen, remember?)

Those of us who, like me, report on global public health have a sense of inevitability as we watch the Ebola crisis unfold. We always knew it would mostly affect, as Bishop Kulah so aptly puts it, “people who were already behind.”

And we knew the people least affected by this scourge — privileged denizens of wealthier countries — would overreact out of misplaced fear for themselves, rather than a reasoned and compassionate understanding about what needs to be done.

So we see the freaked-out, wall-to-wall, feedback-loop media coverage we’re experiencing now. Schools closing down in Ohio for completely unnecessary disinfection. Recriminations against hapless health workers who suddenly find themselves dealing with an exotic new threat. Continue reading

Outbreak On Trial: Who’s To Blame For Bringing Disease Into A Country?

Francina Devariste, 3 years old, is one victim of an ongoing cholera outbreak in Haiti that has killed 8,000 people and sickened over 700,000. (2010 photo courtesy of the United Nations)

Francina Devariste, 3 years old, is one victim of an ongoing cholera outbreak in Haiti that has killed 8,000 people and sickened over 700,000. (2010 photo courtesy of the United Nations)

By Richard Knox

If an international agency introduces a devastating disease to a country, should it be held accountable?

That’s the big question at the heart of a court proceeding that gets underway next Thursday. The international agency is the United Nations. The disease is cholera. And the nation is Haiti.

Four years ago this month, thousands of Haitians downstream from a U.N. peacekeeping encampment began falling ill and dying from cholera, a disease not previously seen in Haiti for at least a century.

Since then cholera has sickened one in every 14 Haitians — more than 700,000 people; and over 8,000 have died. That’s nearly twice the official death count from Ebola in West Africa thus far.

A year ago, a Boston-based human rights group sued the U.N. for bringing cholera to Haiti through infected peacekeeping troops from Nepal, where the disease was circulating at the time. The U.N. camp spilled its sewage directly into a tributary of Haiti’s largest river.

There’s little doubt that the U.N. peacekeepers brought the cholera germ to Haiti. Nor is there argument over the poor sanitary conditions at the U.N. camp.

When I visited the scene in 2012, it was plain how untreated sewage from the camp could easily contaminate the Meille River that runs alongside before it spills into the Artibonite — Haiti’s Mississippi — which provides water for drinking, washing and irrigation for a substantial fraction of the country’s population.

The smoking gun, scientifically, is a molecular analysis of the Haitian cholera bug compared to the Nepalese strain from the same time period. It showed the two differ in only one out of 4 million genetic elements.

“That’s considered an exact match, that they’re the same strain of cholera,” Tufts University environmental engineer Daniele Lantagne told me last year. Continue reading

Don’t Worry, Be Rational: Why Extreme Fear Of Ebola Is Bad For Your Health

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

Let’s face it, Ebola is scary. My kids are scared. The moms at school are talking about giving their children extra multi-vitamins to boost their immune systems in a desperate attempt to do something, anything, to protect their families. But we live in Boston and there are no cases here — yet. Still, that “yet” can make us crazy.

So, in a crisis, who do you call for comfort? The level-headed risk perception consultant: David Ropeik, who spoke with me briefly today about why such intense, prolonged worry and anxiety can backfire, make your body weaker and perhaps even damage your health:

Here, edited, is our short interview:

RZ: So, why is being scared of Ebola bad for your health?

DR: The health ramifications of this are profound. When we worry, that, biologically, is stress — that’s a mini fight-or-flight response going on in the body. When stress persists for more than several days (short-term stress is not the problems), it becomes damaging to our health. Chronic stress raises our blood pressure and increases the risk of cardiovascular problems; it suppresses our immune system and makes us more likely to catch infectious diseases or get sicker from them if we do. It interferes with neurotransmitters associated with mood, and it is strongly associated with clinical depression. Chronic stress interferes with digestion and memory and depresses fertility and bone growth (slows it down).

[The negative effects of chronic stress are widely reported, but Ropeik cites the book "Why Zebras Don't Get Ulcers," by the biologist Robert Sapolsky, as a key source here.]

So you think people are overreacting and we’re moving into some kind of widespread nation-wide chronic stress phenomenon here?

We’re on the cusp. It’s like what the fear of SARS did to people in Canada — it freaked [them] out for weeks: “Here it comes again,” is what they’re saying.

How do you see all this evolving?

In the last day and a half the criticism of how health officials have handled things and the mistakes they made in Dallas, real as those mistakes are, have become a focus, and it’s now starting to undermine trust in our health care system.

In a crisis, trust is the pivotal factor for how worried people are. Continue reading

Mass. Lawmakers Hear Calls For Ebola Training

As nurses raised alarms that they are untrained and ill equipped to handle cases of Ebola virus, Massachusetts hospital officials said Thursday that the health crisis emerging from West Africa demands a unique response.

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

At a Public Health Committee hearing, Massachusetts General Hospital Emergency Preparedness Chief Dr. Paul Biddinger said handling cases of Ebola is “fundamentally different” than regular medical care, and suggested hospitals should create a “highly trained expert cadre” to handle Ebola rather than attempting to train all staff equally.

Massachusetts has not had a confirmed case of the deadly disease, though there have been suspect cases and two nurses at a Texas hospital have been infected with the disease. Ebola is spread from the fluids of a person who is infected and symptomatic.

Massachusetts Nurses Association President Donna Kelly Williams said the training and equipment at Massachusetts hospitals is “inconsistent,” and nurses have said they have been provided with “flimsy” garments that Williams said would not adequately protect them against infection.

Continue reading

‘Ether Dome': The Story Of Numbing And Inflicting Pain

Greg Balla, Lee Sellars (seated), Tom Patterson and Richmond Hoxie act in a scene from "Ether Dome." (Courtesy T. Charles Erickson/Huntington Theatre)

Greg Balla, Lee Sellars (seated), Tom Patterson and Richmond Hoxie act in a scene from “Ether Dome.” (Courtesy T. Charles Erickson/Huntington Theatre)

On Oct. 16, 1846, a flustered young man named William Morton raced up marble steps to the dome of Massachusetts General Hospital.

“He was late, and you don’t want to keep surgeons waiting,” said Dr. John Herman, a psychiatrist at Mass General who is steeped in the history of that day.

A group of physicians awaited Morton in the operating room, located high above other floors because “before ether, people screamed,” Herman said.

Morton, a dentist, had promised to put an end to those screams, to the pain patients endured during surgery.

That day, with a patient waiting, Morton pulled out a glass bottle of ether that he had colored red, according to Herman, to disguise the common gas. Morton told the patient to inhale. Moments later, a surgeon sliced into the neck of a relaxed man.

“As he came out of the anesthesia, the surgeon, John Collins Warren, said ‘Mr. Abbott, did you feel pain?’ and Abbott said, ‘Did you begin the procedure?’ ” Herman recounted. “The world changed. Within days, news of what happened here traveled by steamship and by locomotive … to the capitals of the world.” Continue reading

Harvard Poll On Ebola Risk Finds Public Dazed And Very Confused

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

A World Health Organization worker trains nurses on how to use Ebola protective gear in Freetown, Sierra Leone. (AP)

By Richard Knox

Americans are seriously confused about how Ebola spreads. And it’s no wonder.

A new national poll from the Harvard School of Public Health finds that nearly 9 out of 10 Americans think someone can catch Ebola if an infected person sneezes or coughs on them.

Not so, according to all health authorities and 38 years of research on this virus. But maybe people can’t be blamed for thinking Ebola can be spread through the air as they see powerful images day after day of health workers clad in head-to-toe protective coverings and face masks.

And there’s little to no possibility that Ebola will mutate into a virus easily spread by aerosol droplets, like influenza or SARS, for reasons that Laurie Garrett of the Council on Foreign Relations recently pointed out in The Washington Post.

Similarly, all the attention on the imported Ebola case of a Liberian man in Dallas and subsequent infection of two of his nurses (so far) is apparently leading many Americans to overestimate their risk of getting the virus.

In contrast, the great majority (80 percent) think they’d survive Ebola if they got immediate care. That’s probably right — though no sure thing.

(Courtesy of Harvard School of Public Health)

(Courtesy of Harvard School of Public Health)

The Harvard poll, conducted between last Wednesday and Sunday, finds that a little over half of Americans worry there will be a large outbreak of Ebola in this country over the coming year.

More than a third worry they or someone in their immediate family will get Ebola. Continue reading

For Hospitals And Clinics: Insurance To Protect Against Losses From Ebola

A Boston-based insurance broker is rolling out a new policy for Ebola-related losses at hospitals and clinics across the country.

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

How much money might hospitals lose during an Ebola-related quarantine? And will patients use hospitals that treat the virus? Phil Edmundson at William Gallagher Associates developed Ebola insurance to address these risks.

“People may choose to put off their health care, or to get it at an alternative facility, if they feel there’s a reason to suspect Ebola in a given clinic or hospital,” Edmundson said.

Ebola policies could run half a million dollars or more for large hospitals. They will not cover the cost of closing off wards, training staff or overtime.

Other insurers are offering similar coverage for theaters, restaurants, hotels and other public spaces that may have to close if they have a customer with Ebola.

“All Massachusetts hospitals have general insurance policies and liability policies in place for extreme events,” the Massachusetts Hospital Association said in a statement.

The group said it’s aware that hospitals in the state may be evaluating whether “additional insurance for Ebola-specific events” is necessary.

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