Though it’s begun to quiet down, lately we have had 24/7 coverage of Ebola; all Ebola, all the time.
I suspect if someone came home from a visit to South Africa and developed the hiccups, they would immediately be surrounded by big men in biohazard suits and forced into quarantine (never mind the fact that South Africa has no Ebola, and hiccups are not a symptom of Ebola).
For the record, Influenza, commonly known as the flu, causes far more deaths than Ebola in the U.S. – by a very long shot. So far we have had exactly one death due to Ebola in the country – but anywhere from 3,000 to 49,000 people die of flu each year.
In the U.S., Ebola is only a threat to the healthcare workers treating the very sick Ebola patient. By good fortune, a patient with Ebola is only infectious when he is sick. Sick people go to the hospital where healthcare workers are at risk. A sick Ebola patient is pretty juicy – wet cough, vomiting and diarrhea. All fluids are highly infectious. Cough hard enough and you spray whomever is in front of you. This is not airborne transmission, it is more like being spit on. These large droplets do not stay in the air. They fall to the floor, and the virus dies when they dry.
So if you work on the Ebola isolation unit of the designated tertiary care hospital, extreme care is needed.
Those of us who aren’t treating patients in the isolation unit should be far more worried about the flu. This is a much more evolved virus. It has been interacting with human immune systems for thousands of years, and has progressed after going through about a bazillion virus cycles. Influenza is an unstable virus with a high mutation rates (“mutation” means a change in the virus). Most of the random changes don’t work out, but even a million monkeys typing for a million years do come up with something. The flu virus has enough successful mutations that it adapts and often becomes immune to last year’s vaccine. This is why you need a new flu vaccination each winter.
From a virus’s point of view, airborne transmission is ideal, and the flu has this figured out. A coughing fit in a room will likely expose most people in the room to flu. The virus remains suspended in the air indefinitely, and it is perfectly happy to dry out and still remain infectious. People in the very early stages of flu can spread large amounts of the virus before they feel bad enough to get treatment. Thus getting exposed to influenza this winter is a likelihood, and prudence would indicate vaccination was a great idea.
Getting exposed to Ebola outside of a hospital setting is extremely unlikely. How many people will encounter a person just back from West Africa who happens to vomit on them while on their way to the hospital? That qualifies as cosmic bad luck – less likely to occur than winning the Megabucks lottery.
Don’t let the overlap of symptoms concern you. Almost all viruses start out the same way. Some achiness, headache, fever and respiratory symptoms. Later you get the specifics, the rash of measles, the nausea of gastroenteritis, or the severe headache of meningitis.
So a reasonable reaction to flu season is vaccination. If you are not in healthcare, the chance of meeting Ebola is vanishingly small.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing Clinical Occupational Medicine for more than 25 years. Dr. B works in our Scottsdale, Arizona clinic.
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