Out-of-sight, out-of-mind epidemic

No known cure.

Those three words have rattled human history for centuries, long before the 14th century’s so-called “Black Death” bubonic plague, which killed an estimated 25 million Europeans — about half of that region’s population at the time.

With the emergence of Ebola virus, those three words are in the forefront again. While bubonic plague was caused by a bacterium transmitted largely by rats, Ebola is triggered by a virus. While this column is not the place for a short course in microbiology, a virus is a microscopic infectious agent that can only replicate in the living cells of other organisms, either plant or animal, with “animal” including humans. A virus invades living cells and, in effect, hijacks some of those cells’ molecular mechanisms in order to reproduce. The term “virus” is a derivative of the Greek word for “poison.” That it is.

While Ebola may be among the most insidious of the contemporary viral world — with an estimated 50 percent mortality — everyone has encountered less nefarious viruses. Viruses are as common as the so-called “common cold” and chicken pox, as well as its first cousin, shingles. No known cure. Viruses also are as potentially devastating as HIV/AIDS. Then there’s West Nile virus, which is transmitted by infected mosquitoes. West Nile has claimed the lives of thousands in the United States and has debilitated for life many thousand more since it first emerged in New York in 1999 and spread west, curiously not having much impact in Maine.

The U.S. Centers for Disease Control and Prevention (CDC) is now tracking two other emerging viruses. One is chikungunya fever. Like West Nile, it is transmitted by infected mosquitoes. Symptoms include fatigue, muscle pain, nausea, headache and rash. Rarely fatal, it disables those infected for a week to 10 days. As of Sept. 23, a total of 1,125 chikungunya virus disease cases were reported in the United Sates. Eleven locally-transmitted cases were reported in Florida. The other cases occurred in travelers returning from affected areas in the Caribbean, the Pacific Islands and Asia.

The other emerging virus that CDC is tracking is Enterovirus D68. From mid-August to Sept. 30, CDC or state public health laboratories have confirmed a total of 472 people in 41 states and the District of Columbia with respiratory illness caused by this virus. For now, many state health departments have reported increases in cases of severe respiratory illness in children. So far, no cases have been confirmed in Maine. Enteroviruses commonly circulate in summer and fall, so the CDC expects that E-D68 viral infections are expected to decline over the next few weeks, making way for the emergence of the influenza virus season.

While the recent confirmation of Ebola virus in a patient in Texas has attracted no shortage of media attention, Ebola is not considered by public health officials as highly infectious. It’s not an “airborne” bug, as is the common cold, as it involves transmission of bodily fluids. Nonetheless, virus delivery systems include airline flights from West Africa, where this virus has been brewing for months, to airports throughout the world, apparently including Dallas.

Ensuring that Ebola does not evolve into a major public health crisis in America requires the United States to join in an international effort to commit whatever funding and scrubs-on-the-ground medical expertise are required to nip this insidious and lethal bug at its bud, in Africa, where it is festering still. Unfortunately, there’s no drone missile for taking out Ebola. Unfortunately, front-lines health care workers are at high risk of infection when interacting with those infected by Ebola. Meanwhile, vaccines that can ward off this virus are encumbered in the United States by legally requisite “human trials” that will take months to determine what pharmaceutical pushback might prove effective.

Ebola now remains an out-of-sight, out-of-mind epidemic. It is a public health crisis that, until recently, was unfolding thousands of miles away and affecting no-income, third-world black people, not white folk like Joe 12-pack in Indianapolis, eager to climb into the Lazy-Boy, pop a cold one and watch the World Series.

Tom Walsh

Walsh, a Gouldsboro resident, is an award-winning medical and science writer.

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