The Black Death/ Ebola Smackdown

Right now, the news is full of Ebola.  Everyone–especially politicians–is in a tizzy about this dread disease, which is infecting and killing thousands in a certain area of Africa.  Should we ban air travel to West Africa?  Has the CDC done enough to protect American citizens?  How afraid should we be? do we keep kids home from school when we hear a rumor that somebody has a fever and knows somebody who might have once been to Africa?

Er.  Okay, maybe nobody’s asking that question, although a number of parents did keep kids home from school because of rumors that someone got off an airplane with a fever.  Maybe I’m the only one this happens to, but I often catch a local cold virus while traveling, and I have yet to be stopped at the airport. . .  So let’s return to the question, how afraid should we be?

How about a look at the real face of disease vectors in America, and a reminder of a threat which is still among us:

A marmot prepares for quarantine. . . er, for winter.

This is a marmot. It happens to be a Yellow-bellied Marmot in Rocky Mountain National Park.  In Mongolia, the bubonic plague is endemic to the local marmots.  You remember the Bubonic Plague,  AKA, the Great Mortality, AKA, the Black Death?  Bubonic Plague was likely carried on fleas spreading from the area of central Asia, and transported by rats all over Europe, both rats and fleas being pretty ubiquitous in earlier times (and still in many places).  Fleas likely also traveled in blankets, cloth and clothing, also pretty common.

When the fleas bit people, people became infected. Lots of fleas.  Lots of infections.  30 to 50% die-offs in areas where the plague ran rampant in the 14th century, for example.  You can also get it by exposure to bodily fluids of the infected. About 50% of people who contracted the plague died from it.  Later, the plague becomes Pneumonic:  it adapts to be spread by coughing or sneezing, and has a higher death rate, say, 75% (there is also a septicemic variety which killed about 90%).  Remember, all of the historical percentages are based on either eyewitness accounts (likely exaggerated), death roll analysis, or archaeological evidence, so they are a bit fuzzy, and may be lower or higher.

The Black Death lead to widespread panic, lots of praying, lots of anger and suspicion against the wrong people as many people looked for someone else to blame.  It also lead to the use of quarantine (from an Italian word, meaning separating possible infectious individuals for 40 days), which was often effective.  Eventually, the disease died out on its own–returned periodically, and died back again due, at first, to environmental factors (cold winters), and later to an increased understanding of disease vectors coupled with more effective prevention and treatment.

Okay, E. C., but that’s history.  Except in the areas where the plague remains endemic. Plague is endemic (meaning, it’s already present) in many rodent populations in the Southwest–like marmots, prairie dogs, and those adorable ground squirrels people are always feeding when they visit the western National Parks.   According to the CDC, we get an average of 7 cases per year in America. That’s more than the current number of confirmed Ebola cases in the States.    Thankfully, we’ve gotten the death rate down to around 11% with prompt treatment.  The World Health Organization says about 4000 cases of the plague are reported every year, though they suspect this number should be higher due to under-reporting in many areas.

Here’s a brief rundown on Ebola:  it has an incubation period of 21 days (which is much longer than the 2-6 days of Bubonic plague–so that’s kinda scary, but you have to be symptomatic to spread the disease), you must have contact with bodily fluids to become infected (whether from an individual, or from contaminated objects), and in Africa, it has a current death rate of about 50%, but outbreaks in the past have ranged from 25% to as much as 90%.

Yep, that’s scary–especially if you live in West Africa or work directly with patients. However, if you look at the trend over time you find that, yes, more people are being infected, but a smaller percentage of them are dying.  Just as with the death rate from the Bubonic Plague going from 50% or so, down to 11%, as we develop counter measures against the spread of the disease, better monitoring and better treatments, the disease becomes more survivable.  We still do not have a vaccine for the plague. Thousands of people live and visit areas where the plague is endemic, and avoid getting sick–and almost none of them even think about the potential for sickness.

It seems to me that, rather than spend time, money and human attention worrying about Ebola becoming an epidemic in America, we should spend some proportion of that on developing and offering effective prevention and treatment for people who *are* likely to be exposed to the disease–those in Africa and the compassionate people who work with them. That requires the travel of health professionals and scientists to study and treat the disease. It may require education and the encouragement of openness about how to handle the dead, and what foods are safe to eat because the first cases likely came from consuming bush meat, and were transmitted by customs surrounding the care of the dead.  Yes, it also requires keeping the uninfected safe, for instance, reasonable precautions about travel from affected areas, and the increased protocols introduced recently by the CDC for healthcare professionals.

Hand-wringing? Paranoia and accusations?  Stigmatization of the families of the affected after they have passed quarantine?  That’s what we don’t need. Instead of harnessing a manufactured hysteria to produce political gains, let’s harness our energy to send Ebola back into the woods and encourage it to stay there.