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THE CAREGIVERS’ DISEASE
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
A
frican people are dying of Ebola,
now by the thousands, with 10,000
new West African cases per week
expected by December, per the World
Health Organization (WHO). The CDC
has one model that projects the caseload
will top a million by February if effective
measures are not taken.
Meanwhile, as of late October six Americans have been infected, identified, treated,
and as of this writing, all have lived (Dr.
Craig Spencer of Harlem just now sick).
The Liberian citizen Mr. Thomas Duncan
flew here to meet his old flame to marry
her, and died in the attempt. As our own
Dr. Dan Varga, now of Texas Presbyterian, said in his very forthright and honest
apology and interviews, “We missed that
diagnosis” in the ER. Most of us would
have. Africa is Over There, and we are over
here. Most Americans think of Africa as a
big and dangerous and exotic place, but a
monolithic one. We think of it all as one big
conglomerate, the land of giraffes and lions
and gorillas and Zulus, and also the land of
Somalian pirates, Al-Shabaab terrorists, and
Boko Haram. It’s the land where Black Hawk
went down, and Nelson Mandela came up.
Most Americans don’t think of Africa as a
continent of many different cultures and
countries (in part because seemingly all of
their names changed) but as a place remote
and strange and full of poor and possibly
primitive people. In short, unless we have
taken pains to learn about the world, our
ignorance of Africa is massive.
Out of that ignorance comes prejudice,
and out of prejudice, hysteria. The Ebola virus is deadly. It should ignite fear. It
hides inside the cell, taking over its genetic
works and sending out decoy glycoproteins,
making interferon defenseless, making the
antibodies miss their targets. Eventually you
get septic, and die (about 50% case fatality
currently in the specialized Medecins Sans
Frontieres treatment wards in Sierra Leone), and that’s if you are lucky enough to
reach proper treatment early. If the only care
comes from your neighbor or family, the
case fatality rate is over 70%. Many, many
cases in the poorest areas of Sierra Leone
are not reported at all. Some aid workers
said “most” cases are not counted, for there
is no one to report to, and no place to go
for care, if you did. Entire extended families have died. When you care for a person
who is vomiting, weak, delirious and having
diarrhea, and you have only the clothes on
your back and maybe some gloves, it is very
hard to remain uninfected. When you bury
a person and it’s the custom to wash and
care for the body, you get infected too. The
first big outbreak in Sierra Leone, in fact,
stemmed from one huge funeral in Guinea,
where this epidemic began.
Therefore the first American response
was panic: absolute fear and suspicion and
blaming anyone and everyone from Africa
(no matter that it might be Ethiopia, not
Guinea). “Let’s ban all flights from Africa!”
they shouted. (The voice of reason said that
is absurd and will not help the aid effort).
“Well then, let’s ban all flights from the bad
countries, where people are sick!” (The voice
of reason pointed out that too will hurt the
aid effort and also lead to people doing endarounds and not being detected at all, at
our end). They said then, “OK let’s make
them land where we can control them!”
We did that, and in Newark locked up Kaci
Hickox, a nurse/epidemiologist who had
just arrived the long way home from medical relief work in Sierra Leone. She was told
she had a fever (she did not) and told she
was infectious (she was not) and locked in
an airport holding room for 7 hours without
food or water. She then was quarantined by
executive order of Gov. Christie insi