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Wednesday, October 01, 2014

A Close Encounter With Ebola

With the first reported case of Ebola in the US today, I thought it might be an appropriate time to share my own recent close encounter with the disease.

I should begin by mentioning (for those who don't know me) that I am a bit of a germophobe.  I'm not sure where such things come from, but from an early age I recall not liking to share drinking glasses or to let anyone take tastes directly from something I was eating.  Naturally, my older sister did both at every opportunity just to see all my fuses pop (hi Val!).  

My wife can attest to the fact that whenever I have had to go anywhere near a hospital, I have washed up afterwards like a doctor prepping for surgery.  And the one time I was hospitalized for a few days I nearly bathed in the sanitizing hand gel they had at the entrance to my room.  I mean, seriously... what do you expect?  These places are full of sick people!

Anyway, as a result of what I would call a mild phobia regarding germs, I usually keep a bottle of hand sanitizer or disposable alcohol hand wipes in my briefcase/hand luggage whenever I travel abroad.

Back at the beginning of July I had a couple of business trips to countries in West Africa.  One of those trips was to Sierra Leone.

Before I left on the trip I was aware that there had been a serious outbreak of Ebola in West Africa.  But when I checked with the Israeli health authorities, I was assured that the only cases in Sierra Leone were in remote areas where that country shared borders with Liberia and Guinea, and since all my meetings were scheduled to take place in the capital - Freetown -  I should be fine.

However, midway through the third day of my visit, I noticed an ominous development:  All of the government buildings I was visiting had set up special stations outside their entrances where masked / gloved employees were requiring everyone who entered to wash their hands in a bleach solution, and some were using thermal scanners to check if anyone had a fever.

I may not be the sharpest knife in the drawer, but that certainly got my 'Spidey Sense' tingling.

I had been given a government driver for the duration of my visit, and on the way back to my hotel I asked him what was going on.  He informed me that several hundred cases of Ebola had been confirmed in the capital and that the country's leading infectious disease expert and several of his nurses had also been confirmed to have contracted Ebola (they all died within weeks).

When I got back to my hotel, I immediately started making calls to find out if I could move up my departing flight.  But the few airlines flying in and out of Freetown were already overbooked with people attempting to leave because of rumors that commercial flights in and out of the country would soon be suspended.

I had one more day of meetings before my scheduled flight out, so I had no choice but to finish my itinerary of meetings and hope that my British Airways flight to London would still be listed when I showed up at the airport.

Getting back to my slight fear of germs, I tend to try to limit physical contact with people I meet on business trips... even in developed countries.  I do this by presenting my business card with two hands upon meeting someone for the first time (which eliminates the need for a handshake in most cases), and within a minute or two of exchanging parting handshakes at the end of a meeting, I usually avail myself of a private moment to wipe my hands with the above mentioned hand sanitizer or towelettes.

To be clear, I don't mean to imply that foreign people are somehow dirty or disease-ridden.  It's just that when traveling to new places, one generally lacks resistance to the local colds and garden-variety maladies, and a hectic travel schedule further degrades one's immune system.   I just hate coming down with something after every business trip, so I tend to err on the side of caution.

Back to the story...

By the time I checked out of my hotel and headed to the airport, the gathering storm had descended on the capital with hundreds of new Ebola cases reported.  

As I stood waiting to check in for my flight, I replayed in my head all of the meetings I'd had and tried to remember if anyone had seemed feverish or in any way out of sorts.  Keep in mind that in tropical areas of sub-Sahara Africa, nearly everyone walks around with a sheen of perspiration... so my imagination had plenty to feed on.

When I got to the airport I was relieved to find my British Airways flight was still operating (I read that they suspended flights to Freetown a few days after I left), so I breathed a sigh of relief when I was finally in the air on my way back to Israel (via London).

But during the flight, I couldn't help looking around at my fellow passengers and wondering who they had come into contact with over the past few weeks.

My suspicions about my fellow passengers seemed to be vindicated when we landed in London, because instead of taxiing to the arrivals gate as expected, the pilot announced that he had been instructed by 'the authorities' to taxi the plane to an isolated area at the edge of Heathrow Airport.

As soon as the plane arrived at the designated area, I looked out the window and saw several police vehicles accompanying a stairway truck pull up beside our airplane.  The pilot came on the intercom and told us to remain in our seats and that representatives of the British Police would be coming onto the plane.

We watched as several armed police wearing protective vests came down the two aisles and continued towards the back of the plane.  Within a few minutes they reappeared with an African man and three children and escorted them off the plane.  It was only then that the fight attendants informed us that apparently there was some sort of domestic custody issue being sorted out (nothing to do with Ebola) and that buses would be coming to take us to the main terminal.

While I was on the ground at Heathrow, I availed myself of the WiFi to do a little research on the Ebola situation in the country I had just left, as well as to educate myself more thoroughly on the disease itself.

It turns out that so long as one doesn't come into direct physical contact with someone who is symptomatic, there is virtually no risk of infection.  The modifying effect of that word 'virtually' did little to assuage my fears.  After all, if the most knowledgeable physician in the country and his staff had taken all necessary precautions and had been infected anyway, there was something that wasn't completely understood about how transmission was taking place.  

I also had no way of knowing with any certainty if any of the dozens of people I had met and shaken hands with during my visit had been symptomatic.

The bottom line was that Ebola has an incubation period of between 6 and 21 days (according to most sources), so from the time I left Sierra Leone, a dire countdown clock had started ticking in my head.

I didn't want to alarm my family or colleagues, but I also didn't want to take any unnecessary risks.  So wherever possible, I kept my distance... and began surreptitiously checking my temperature dozens of times per day with a digital thermometer I carried in my pocket.

I should mention that we don't have A/C in our home, so there were several nights that I woke up feeling a little sweaty and made a mad dash to the bathroom to check to see if I had suddenly developed a fever (I hadn''t).

There is a Jewish custom to say a special prayer in the synagogue after surviving illness, childbirth, or danger (including a hazardous journey or captivity).  Some Jews even have a tradition of reciting this blessing after taking an airplane flight over water.  

Personally, I find the recitation of this blessing of thanksgiving after something as routine as a commercial airplane flight to be a bit ridiculous.  But I suppose that if one contemplates all the things that can possibly go wrong with a pressurized aluminum tube hurtling through the air 35,000 feet above the earth at almost 600 Mph, perhaps offering a few words of thanks isn't such a bad idea.

But after I'd passed 21 days without spiking a fever, you'd better believe I recited that blessing after being called up to the Torah, and then nearly wept with relief;  breathing deeply for what seemed like the first time since landing back in Israel.  

In the time since I returned from that trip, I have become quite the Internet scholar about Ebola.  On the one hand, it remains a terrifying disease that an unprepared and ill-equipped world seems to have terribly underestimated.  But on the other hand, the dire predictions of a 90%+ fatality rate seems to have been replaced with a slightly less apocalyptic figure of 50-55% (still a sobering number to contemplate).

In any event, as I have been following the nearly daily news reports of the growing crisis in West Africa, and now the report of the first confirmed case in the US, I think about the nice people I met during that business trip... hoping that they and their loved ones are okay.  And I wonder if the World Health Organization and other international bodies are up to the task at hand.

For all our sakes, I hope so.

Posted by David Bogner on October 1, 2014 | Permalink

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I can't fathom how you allowed me into your home and eat off your plates considering the obscene amount of microbes I encounter daily.

Posted by: Quietusleo | Oct 1, 2014 2:15:20 PM

Quietusleo... We threw out the plates and silverware and burned the bedding after you left. ;-)

Posted by: treppenwitz | Oct 1, 2014 2:20:48 PM

The history of ebola outbreaks remind me of the Spanish flu. Like the Spanish flu, ebola seems to strike adults in their prime.

Does that sound right to you, David? (Since you have mild hypochrondria I believe you are better informed than I.)

Posted by: antares | Oct 1, 2014 3:24:53 PM

antares... Actually, the Spanish Flu (like other strains of influenza) was deadly in healthy adults because it actually used the person's immune system against them to trigger what is called a Cytokine storm (Google it). Basically, the more robust the person's immune system, the more deadly the Cytokine storm. The Ebola virus is deadly because few (if any) people have a natural immunity to it. Worse, it seems to be a very sloppy replicator so as it transfers from person to person, it makes imperfect copies of itself and morphs quite quickly, making it very difficult (I don't want to use the word impossible) to create an effective vaccine that will protect everyone.

Posted by: treppenwitz | Oct 1, 2014 3:38:07 PM

Wait...so you are a germaphobe and you have spidey sense? David, you have always been too cool :-)

Posted by: Eli Borow | Oct 1, 2014 4:00:16 PM

Eli Borow... I acquired most of my super powers from our time as roommates in University (much as Spider-Man got his super powers from being bitten by a radioactive spider). ;-)

Posted by: treppenwitz | Oct 1, 2014 4:10:57 PM

Like I said, you are better informed about diseases than I.

Posted by: antares | Oct 1, 2014 4:47:10 PM

Hey Trep; a word about that 90% fatality rate -- that may have been a mitigating factor in earlier outbreaks of the most virulent types. I've been thinking (as I do, having studied a bit about epidemiology at Loma Linda University) that the lowered death rate of the bug is allowing it to "burn" longer in the population, and -- paired with getting into a major African City or two -- succeed more in staying around than previous outbreaks.

I haven't been as concerned, because of the communicability issues, I am at low risk, but this one seems a little better suited to proliferating, especially in bureaucratic, crippled and inefficient nations.

Which, sadly, the USA is more like these days (see the CDC's announcement today about Case 1 and Case 2 in Dallas, and the possible public exposure of others in the city).

Cheers,

;./

Posted by: Wry Mouth | Oct 2, 2014 1:53:23 AM

The more a virus gets into the population the less deadly it becomes (generally) because if it's very effective it kills off its hosts before it can spread too much. Ebola used to have a 90% mortality rate attributed to it but that number is now 45% or so the more it spreads.
The most important this to note is that victims of the virus do not reanimate as zombies after 6-12 hours. This is good news.

Posted by: Garnel Ironheart | Oct 2, 2014 2:43:23 AM

The media in the US always seem to use any excuse to promote panic. Ebola is the latest,where the facts aren`t allowed to get in the way of sensationalism. Glad you came out OK Dave.

Posted by: ED | Oct 2, 2014 4:23:44 AM

I'm very happy that you're OK. Must have been incredibly stressful waiting. I think you've made an unsupported logical leap here, though: "if the most knowledgeable physician in the country and his staff had taken all necessary precautions and had been infected anyway, there was something that wasn't completely understood about how transmission was taking place." I think it's far more likely that, despite their best efforts to take all necessary precautions, some error was made; a glove was punctured, or some such, and that allowed unintentional direct contact with a patient's bodily fluids. When you spend a 12-hour shift surrounded by dangerous pathogens, and you do so for days and weeks on end, and you do so without being encased from head to toe in a hazmat suit, the risk escalates.

Posted by: bratschegirl | Oct 8, 2014 1:59:16 AM

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