By Dr Martin Forde
Ebola! In most people, the very word ‘Ebola’ strikes a deep-seated morbid fear, a sickening dread, of something even worse than any nightmare one might have suffered through.
But really, how likely are you to get Ebola in Grenada, or for that matter, anywhere else in the Caribbean? How does this fear compare to other infectious diseases and your likelihood of contracting them?
Take for example measles. Yes, measles, that disease we rarely, if ever, talk about today. Were we not all vaccinated against this disease a long time ago as a child? It turns out that although much progress has been made in reducing the global incidence of measles, this disease is making a comeback. Why? One reason is that an increasing number of parents are refusing to let their children be vaccinated against measles. Another is that persons who are coming from countries where measles are endemic or even epidemic are travelling to other countries, such as Grenada, that have been more or less free of this disease and now spreading it.
This is especially worrisome, unlike Ebola which is not spread by the air, like measles; it just takes one infected child breathing or coughing in the same room with your child who, if not vaccinated, can then very easily contract this disease which killed over 120,000 children in 2012 alone.
So, let’s go back to Ebola. Remember, Ebola is NOT an airborne transmitted disease meaning you can’t ‘catch’ Ebola simply by being in a room with someone who has Ebola and breathing in the same air they breathe. In a recent article published by the New England Journal of Medicine, researchers reported that for every case of Ebola, on average, this leads to 1.5 to 2.2 persons being infected. On the other hand, one person with measles is infectious for several days before they become sick, and will, on average infect 12 to 18 additional persons.
Worldwide, 330 people die of measles every day. Outside of the 3 West African countries where Ebola is indeed ravaging their populations, if you were to count the number of those who have been infected by Ebola, you could easily do so using your fingers and toes and still have unused digits remaining.
Take a look at the Ebola ‘outbreak’ in the U.S. To date, a grand total of 9 Ebola cases have been documented in the U.S. Of these 9 cases, only two, yes only two, were transmission cases. That means only two persons ‘caught’ Ebola from someone who had it while in the US. By the way, the two persons in the U.S. who ‘caught’ Ebola were nurses who were taking care of a very sick Ebola patient. Now, does this sound like a raging epidemic spreading like wildfire through the Western world?
This thus begs the question: If Ebola is so rare outside of the three affected African countries of Guinea, Sierra Leone, and Liberia, why has there been this visceral response to the supposed threat this virus poses to Caribbean countries? Given the travel bans and restrictions several Caribbean countries have hastily scrambled to enact, one would have been excused if they came to the conclusion that Ebola’s invasion of our shores was very much closer, and probably far worse, than Armageddon itself.
A lot of what the general media said on this issue, has also not helped in clarifying what is the true risk associated with Ebola and hence, what the most appropriate responses should be. That said, the overriding question we should ask is “Should we Grenadians along with our Caribbean brothers and sisters be scared of an Ebola epidemic in our islands?
Firstly, let me clearly state that Ebola is indeed a very scary disease, one that you would not wish to contract, ever. However, while Ebola is a terrible disease with the chances of you dying rather than recovering from it greater than 50%, there are two key questions we all need to ask ourselves. Firstly “How likely am I to be exposed to this deadly virus?” and secondly “If someone with Ebola was identified in my island, town or village, is my country prepared to handle and treat this person?”
The answer to the first question is that for almost all Caribbean people, the chances of you being exposed to Ebola range from extremely slim to none. One would have to go through inordinate lengths to firstly, find anyone who is infected with Ebola and then take actions such as deliberating touching this person’s bodily fluids and then rubbing these fluids in their eyes, nose or month to contract Ebola. As you will realize, unless you have some overpowering death wish, no sane person is ever going to do this.
But what if? You ask, if I touch someone who has Ebola, but do not yet display symptoms, am I not still at risk? Again, based on all the data and close to 40 years of experience we have learned about Ebola, the answer is still a clear, reassuring No. Based on all of the scientific information we have collected to date, we have found that persons who are infected with Ebola but are not displaying any symptoms do not spread the virus to anyone else.
With regard to our second question, this indeed must be carefully considered if we do not want to become the Caribbean versions of a Guinea, Sierra Leone, or Liberia. What these three West African countries emphatically show to us is what will happen to a country that has a poor healthcare system and is ill-prepared to rapidly address an emerging viral threat such as Ebola. Guinea, Sierra Leone, and Liberia have had years of civil strife and harsh economic realities, and as a result, their public healthcare infrastructure has been decimated. Can anyone thus be surprised that with such a backdrop, Ebola’s entry and spread among the populations of these countries has been breathtakingly easy?
Thus, we need to honestly ask and then quickly evaluate whether our current healthcare and public health systems are sufficiently robust to deal with an Ebola assault. Some key questions we need to answer are: Can we quickly identify any suspected Ebola infected person and test to confirm if they are indeed infected? Do we have in place facilities where infected persons can be quickly isolated and treated? Are our healthcare personnel, who will be asked to treat these infected persons, properly trained and motivated to do so? Will they have all the supplies and equipment they will need in order to do so safely without placing them at risk of infecting themselves?
Thus, if we are going to be frightened, then it should be because we do not definitively know what are the answers to the above questions. Rather than paralyze us, this fear should then drive us to take appropriate actions as quickly as possible. Remember, Ebola has not entered the Caribbean as yet. Indeed, it may never do so. However, we have the blessing of time to get our house in order. Let’s use it wisely.