August 31, 2014
The Spreading Threat of Ebola – Part I
BY Mary Mahoney
This is the first of a three-part series about the reappearance of the Ebola virus in Africa. Part II will look at the struggle in Ebola-stricken regions to access even the most basic hospital supplies and how the Centers for Disease Control plans to address the alarming rate of infectious disease outbreaks in our own hospitals. Part III will address why we should be worried about antibiotic resistance and the pervasive presence of antibiotics in food, cleaning products and the environment.
By now, most of us have heard about Ebola, the deadly and highly infectious viral illness that is spreading across West Africa. With ever-increasing globalization, the possibility of Ebola moving further across the African continent and beyond is a real concern. Without a doubt, the World Health Organization and the Centers for Disease Control and Prevention should be taking every precaution.
Still, it’s important to note that Ebola has come and gone before. According to the World Health Organization, there have been about two dozen reported disease clusters since it was first discovered in simultaneous episodes in Sudan and the Congo in 1976. The previous epidemics were all contained.
As of Aug. 28, the WHO counted 3,069 reported illnesses and 1,552 deaths. While that number is shocking in itself, it pales in comparison with the lives claimed by many other diseases in poor and rich countries across the globe.
Ebola is not as easily transmitted as widespread airborne pathogens like tuberculosis and influenza. According to the WHO, there must be direct contact between broken skin or mucous membranes and blood or other bodily fluids from infected people, or items contaminated with an infected person’s fluids.
Is this the beginning of a larger epidemic? Or is it just a minor blip in the global health picture?
No one can say for sure, but the CDC and the WHO are always keeping their collective eyes peeled for threats. These agencies maintain mountains of data on the world’s largest and deadliest diseases. So what is really on the radar screen of these guardians of global health?
In this and the next two blogs we will look more closely at the numbers behind Ebola and discuss what will much more likely be fatal to both our distant neighbors in this global community as well as the family next door.
The pandemic potential of Ebola should not be minimized. But it is far from the most dangerous threat to public health. In fact, this current — albeit the largest — outbreak has had a fatality rate of 55 percent. (Ebola overall has a mean fatality rate of 61 percent.)
Rabies, which can be found, literally, in our back yard, has a fatality rate of virtually 100 percent if untreated. Rabies can be contracted from the bite of infected domestic or wild animals — dogs, bats, skunks, raccoons and so on. Every year, 55,000 people worldwide die from rabies, although the cure rate is high if treated immediately.
Compared with rabies and other dangerous bacterial and viral illnesses including HIV, malaria, influenza, encephalitis and many more, Ebola is nearly statistically insignificant.
So what is the most likely cause of death for the average American?
The most recent WHO census found that 56 million people died worldwide in 2012. About two-thirds of those died from non-communicable diseases. The top four causes were cardiovascular disease, cancer, diabetes and chronic lung disease. The remaining 30 percent of fatalities were attributed to communicable diseases, such as respiratory infections, malaria, HIV/AIDS and diarrheal diseases, as well as nutritional deficits and injuries. Injuries accounted for 9 percent of all global fatalities, many from car accidents.
Looking at the United States alone, one might be surprised to find that the flu, suicide and nephritis, an inflammation of the kidneys, were among the top 10 causes of death.
Perhaps less surprising are, in order, heart disease, chronic respiratory disease and diabetes. These top three killers are more often than not caused by smoking and/or obesity. According to a blog in the Columbia University Mailman School of Public Health, one in five Americans die from obesity. Worldwide, the WHO says that obesity has nearly doubled since 1980. In 2008 there were 1.4 billion at-risk obese and overweight adults and children.
CDC posts a list each year, looking back and looking ahead. CDC accomplishments in 2013 included a tobacco education campaign and improvements in its Advanced Molecular Detection program, described as “the use of supercomputers and forensic DNA in the identification of infectious agents for better prevention and control.” The CDC also launched an initiative to prevent heart attacks and contributed to the United States President’s Plan for Emergency AIDS Relief, or PEPFAR.
What does the CDC anticipate being hot-topic issues for 2014 and the rest of the decade? Antibiotic resistance — which is also very much on the radar of the WHO — HPV-caused cervical cancer, prescription opiates addiction and what the report calls a “perfect storm of infectious disease threats.”
Back to infectious disease threats: In an Aug. 7, statement on Ebola, CDC Director Tom Frieden said, “We do not view Ebola as a significant danger to the United States because it is not transmitted easily, does not spread from people who are not ill, and because cultural norms that contribute to the spread of the disease in Africa – such as burial customs – are not a factor in the United States.”
Frieden cannot make any promises, of course. But he does note that while the United States receives 362 million travelers a year, airlines and airports are taking precautions.
However, that perfect storm of globalization and antibiotic resistance may be a cause for an explosion of many other infectious diseases. Besides fighting microbes, we have other battles to wage: obesity and smoking and a toxic-laced environment. These last three are the most relevant to the United States, and something we could, perhaps, make greater strides in controlling.