The death of Ebola patient Thomas Eric Duncan on Wednesday morning comes as a shock, despite his infection with one of the most dangerous illnesses in the world. "When people get sick, we will recognize them. And the local health departments will go to action and do the same kind of thing as here," Dr. Robert Haley, chief of epidemiology at UT Southwestern, said last week.
That's not to minimize the seriousness of Ebola, but the reassurances that have been offered by the Centers for Disease Control and Prevention, Texas Health Presbyterian Hospital, the Department of State Health Services, Dallas County Health, and numerous other health officials, have put our minds at ease this week.
"This is not West Africa," Dr. David Lakey, commissioner of the Texas Department of State Health Services, said at a press conference last week. "This is a very sophisticated city, and a very sophisticated hospital." Not only are our chances incredibly low of contracting Ebola, but we have the best hospitals in the world to treat us if we do get sick.
But Ebola can be lethal in Dallas as well as Monrovia.
Dr. Jeffrey Kahn, an infectious diseases expert at UT Southwestern, says he is not surprised by the outcome of Duncan's case. Because there is no cure for Ebola, physicians must treat its symptoms rather than the root cause, and must simply let the virus take its course.
"There are a number of experimental treatments," he says. "But there's no specific therapy. And in the absence of clinical trials, it's impossible to know whether these therapies will be effective." Despite the commonly heard theme that early detection improves the outcome of the virus, Kahn clarifies that early detection is important from a public health perspective, rather than in the patient's treatment.
"The earlier in diagnosing it, the better chance you have of it not spreading in the community. The early diagnosis is really an issue for public health members. So early diagnosis at this point benefits the community not the patient," he says. "I'm not aware of any data which says whether early supportive therapy improves the outcome."
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Which means that for those close to Duncan who are now checking their temperature every hour, extremely early detection does not make the virus any less dangerous. "From what we know, fever is one of the presenting features. So the monitoring of the body temperature is one way to see if they're infected. If they are infected, they'll be taken to a hospital and given supportive therapy," says Kahn. Supportive therapy includes hydration, blood transfusions, and heart medication as needed. "But again," he continues, "that helps the community, not the individual."
So what actually went wrong in treating Thomas Eric Duncan? From the patient's perspective, rather than the public health view, absolutely nothing. Duncan was simply infected with Ebola, which is a deadly virus no matter where on Earth you are treated.
"We know Ebola is a very serious infection with a high fatality rate, and there's no specific therapy. That's true here, in Africa, everywhere," says Kahn. "The difference here is that we have better measures to prevent the spread. The advantage we have here are in public health measures." How good we are at implementing those measures, though, is another question..
"This is in most cases a fatal disease," Kahn says. "And until we have specific therapy it will remain, for the most part, a fatal disease. I think the take-home message is that with uncontrolled spread of the virus in Africa, that's not Africa's problem -- it's the world's problem. And the quicker you can get control of the outbreak in Africa, the quicker you can control it everywhere else."