Saturday, October 25, 2014


Why You Won't Catch Ebola On The New York City Subway

Ebola has come to New York City. A heroic physician who returned to the city last Friday after treating patients in Guinea with Médecins Sans Frontières has tested positive for the disease. The doctor, identified in press reports as Craig Spencer, is a reminder that even some of the most stringent protocols for creating barriers against the virus, like the full-body coverings and bleach spray-downs used by the aid group he worked for, cannot always protect health care workers.

If the Ebola virus can be transmitted so easily to health care workers taking care of patients, should people in New York worry about catching the disease from Spencer? He reportedly called in his illness when he woke up with a fever of 103 degrees Fahrenheit, but the night before, when he was  feeling faint, he used the subway, went to a bowling alley, and used the car service Uber. The New York City Department of Health says that “disease detectives” are searching for all of the people who might have come into contact with him. Should people be worried that they might have been exposed to Ebola on a subway car?

No, says William Schaffner, chairman of the Department of Preventive Medicine at the Vanderbilt University School of Medicine and a top expert on infectious disease.

“I think the risk is close to zero. I would even say it’s zero because none of those people had any contact with his body fluids,” Schaffner says. “I would feel no concern had I been standing next to him on the subway.”

The reason, Schaffner says, is because when patients first become sick with Ebola, there simply isn’t that much virus in their bodies. “It’s very hard to transmit the virus in those first days of illness,” he says. “As the illness progresses, for sure the viral load in the body increases. It can get into the skin cells or onto the surface of your skin. That’s when people are near death.”

The risk of transmission is not constant, he says. It gets worse and worse as patients get sicker and sicker. When they are very sick, Ebola is very much like cholera, with large volumes of fluid flooding out of the body as diarrhea or vomit.

Those fluids are teeming with virus, and that is what health care workers are exposed to. Case in point: Two nurses at Texas Presbyterian Hospital in Dallas who treated Thomas Eric Duncan when his case of Ebola was full blown caught the virus. By contrast, Duncan’s family did not become ill even though they lived with him at close quarters early in his infection.

How likely is it that this Ebola infection will spread to anyone else in New York? “I think we’re not likely to see cases at all,” says Schaffner.

One more bit of good news: the prognosis for Dr. Spencer may be good. So far, of the Ebola patients treated in the United States, only Duncan has died. The reason, says Schaffner, is that all of the other patients were diagnosed early in their illness and treated with regimens that include trying to replace all the fluid that had left their bodies and restore the balance of key electrolytes. In Africa, 70% of patients with Ebola are dying. In the U.S., it may be that well more than 70% of patients survive. Says Schaffner: “I’m optimistic that this guy is going to do OK." (source Forbes)
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