Some Questions About the 2nd case of Ebola diagnosed in the US

A few important details regarding the healthcare worker who cared for Mr. Duncan will be key to interpreting the transmission that occurred:

• Was this healthcare worker part of the 10 definite direct contacts or 38 possible direct contacts that were being monitored? (We know 7 healthcare workers were included in the 10)
• Was this healthcare involve, at all, with the care delivered during Mr. Duncan's 1st visit to the emergency department during which Ebola was not suspect and no isolation of him was performed? 

Ebola requires meticulous attention to infection control procedures--often something easier said than done--and clearly poses disparate risks to the healthcare worker and general populations. Presumably this healthcare worker, who developed fever and hence became symptomatic and contagious on Friday evening, was immediately isolated delimiting those with direct contact.

Will Ebola Panic Sever the Chain of Survival for Cardiac Arrest?

The #1 killer of Americans is not Ebola.

It is heart disease. The fact that heart has that distinct honor in 2014 is a testament to the fact that medicine has tamed many of the world's infectious diseases through hygiene, sanitation, antimicrobials, and vaccines. 

One of the key aspects of decreasing the mortality associated with coronary artery disease is prompt initiation of bystander CPR during witnessed cardiac arrest. This is the second link in the Chain of Survival. Getting prompt CPR can make a substantial difference not only in terms of survival but also in ultimate neurological recovery (i.e. minimizing injury to the brain secondary to oxygen deprivation).

As Ebola panic envelopes the world, "Ebola Scares" are popping up all over. In some cases people might collapse and provoke panicked bystanders to assume that the person's condition is due to Ebola--irrespective of the actual minuscule prevalence of the disease outside of the epidemic zone.  

Such reactions, if they dissuade bystander CPR (which is a strong possibility), will sever one of the crucial links in the cardiac arrest Chain of Survival.

Faulty risk perception is a puzzling thing that, in some cases, could have fatal secondary consequences.

A Plague of Misinformation on NCIS: New Orleans

There's been a lot of criticism of the media during infectious disease outbreaks (current and past) about over-sensationalistic rhetoric that foments fear. However, a recent episode of the television program NCIS: New Orleans really breaks new ground in spreading misinformation. 

In the show's latest episode, a navy shipman is found dead of plague and sparks a major investigation. During the course of the show, a litany of misinformation is presented. Some of the inaccuracies:

• Plague in a dead body doesn't isn't particularly contagious to people who haven't even touched the body
• Plague is not unknown to the United States. In fact, cases are diagnosed every year
• There is no vaccine available for plague
• It only requires droplet/contact precautions; not space suits

When Hollywood portrays infectious disease outbreaks with brazen errors (widely known to be false), it is understandable that the general public has myriad questions during real outbreaks.

When there are plenty of actual insoluble infectious disease problems to focus on why does Hollywood need to fabricate erroneous scenarios? 

Facing the Ebola of Their Time: Montezuma, Napoleon, Justinian, and Pericles

In a recent interview, I was asked what was the worst case Ebola scenario I could imagine. Here's what I didn't say: Ebola becoming airborne or Ebola spreading in the US.

What did I say? I said that if Liberia and Sierra Leone are unable to control Ebola they might face the collapse of their states, creating a dead zone ripe for organized criminals, terrorist organizations, slavery, and other unsavory practices to take hold. 

I don't believe this will happen given that the pace of control measures is rapidly accelerating. However, contemplation of this scenario concretizes just how a natural infectious disease epidemic might intersect with national security--a fascinating topic. 

Infectious diseases, in certain contexts, have the power to collapse societies--just ask Montezuma (smallpox) or Napoleon (typhus), or Justinian (plague), or Pericles (the Athenian "plague").

Allergic to Taking a Travel History

Of all the ongoing revelations regarding the first domestically diagnosed case of Ebola in the US, the one that I find most problematic is the fact that the patient initially presented to the hospital, made his travel history known, and was discharged.

It has been reported that the nursing records indicated the travel history but this information was not communicated to others on the care team.

This is a real error.

As an infectious disease physician, travel history is something I always emphasize and not just for Ebola. MERS, chikungunya, dengue, and malaria are all other diseases in which the travel history can be key to the diagnosis. Even for those within the US, travel history is crucial. Diseases like hantavirus, plague, Rocky Mountain Spotted Fever, histoplasmosis, and coccioidiomycosis (and now dengue) have a geographic element to their domestic epidemiology.

No doubt this patient's drug allergies (or their absence) were plastered all over his chart and tethered to his wrist. Travel history is the lynchpin of our defense against emerging infectious diseases and it merits the same level of importance.