The announcement that a case of Ebola virus has been diagnosed in a Dallas hospital sent a chill through the medical, public health, and basic citizen communities. I know my jaw surely dropped as far as it has dropped since 2001, when the word of the first anthrax case in New York appeared in my email. As the details have begun to emerge, many people are wondering the same thing: Will this happen in my city?
The answer is quite clear: Maybe.
The facts are straightforward, at least in the version that the Centers for Disease Control and Prevention laid out: A man of uncertain age flew from Liberia, where the disease remains uncontrolled, to Dallas to visit family. When checked for illness on departure, he had no fever. Upon landing in Texas on September 20, he was fine. Within four days, though, he began to feel ill—sufficiently so that he sought medical attention on September 26. That evaluation apparently failed to provide clues to the diagnosis, but two days later his symptoms had progressed enough that he again sought medical attention and this time was hospitalized, placed immediately into isolation, and diagnosed on September 30.
The timeline as presented raises countless questions. First: Was he contagious when boarding the plane and are his plane-mates therefore at risk? Surely not—the most compelling epidemiological fact in the entire tragic seven month outbreak has been the story of Patrick Sawyer, the Minnesotan who after traveling from Liberia to Nigeria, developed symptoms of overwhelming Ebola and died soon thereafter. Although few details have been revealed, none of those who traveled with Sawyer developed the disease despite the fact that he, unlike the Dallas case, was ill with the infection while traveling. And it is axiomatic (and hopefully true) that a person is contagious only when they are sick, not when they are brewing the infection.
Second: What about others? Surely others in Texas were exposed and are at risk—specifically those the new case spent time with from September 26, when he first felt ill, until September 28, when he was hospitalized and placed promptly into isolation. Here is where the CDC’s calm and forceful “Nothing to See Here” message cracks a bit around the edges. Dr. Thomas Frieden, who has led the CDC admirably throughout the Obama years, stressed in his press conference Tuesday that Ebola could and would be controlled by hewing to the basic principles of infection control: isolation and contact tracing of anyone suspected of contact. With this approach, people with exposure are placed into quarantine and, if sick, into isolation. This method works for TB, for cholera, for rabid animals—for just about everything.
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