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evidence based medicine, infectious diseases

Stop worrying about catching Ebola on a plane

Ebola paranoia reached new heights this week. Two health care workers infected is a very scary thing, but this should be mostly frightening for health care workers as caregivers are the people most at risk of catching Ebola.

The CDC has issued conflicting statements, which doesn’t help. When people are worried then need a strong lead. Waffling about who exactly should be quarantined and what that means, if they should fly, etc. doesn’t exactly instill confidence. In fact, it has triggered a fear-fueled version of six degrees of separation.

There has been a flurry of contacting travelers who may have been on the flights with Amber Vinson, the second health care worker who cared for Thomas Eric Duncan and subsequently tested positive for Ebola. Hundreds of people have been contacted. Planes have been decontaminated and seat fabric replaced. Even schools have closed for intensive cleaning. In Texas because students or teachers might have been on the same flight as Vinson. In Ohio because a staff member was on the plane that Vinson had been on. Not the same flight, the same plane.

A lab worker has been quarantined on a cruise ship and even though the person has no symptoms both Belize and Mexico are refusing to allow the person to be transported home through their country.

Each time someone over reacts out of “an abundance of caution” they falsely reinforce the idea that Ebola is easy to catch from someone who is not ill. And it isn’t. Ebola is only infectious when people are showing signs of symptoms and requires contact with bodily fluid.

Let’s look at the index patient, Mr. Duncan, because his path and what happened next should actually be reassuring to everyone (except, or course, his initial care at Dallas Presbyterian).

On September 15, 2014 is when Mr. Duncan helped care for a women who was very ill with Ebola. He tried to help her to the hospital. When her family could not get her admitted anywhere he helped carry her back home where she died a few hours later. As we know in the final stages of Ebola patients are essentially leaking fluids from every orifice, Mr. Duncan’s act of charity and compassion would have resulted in extensive contact with highly infectious body fluids.

On September 19th (the New York Times has constructed a timeline), he flew. Given he traveled from Monrovia, Liberia to Dallas it would have taken over 24 hours of travel time. If we take September 20th as the last time he touched an aircraft or walked in an airport we are now more than 21 days (the incubation period for Ebola) from Mr. Duncan’s three flights and no one has fallen ill.

Mr. Duncan first became ill on September 24th and went to the hospital September 25th. Because the health care workers in Texas Presbyterian Hospital couldn’t accurately match a travel history with symptoms (and yes, we should be harsh about the care he received at that hospital) Mr. Duncan was in an apartment with four other people for four days while he was contagious, when it should have been one. However, in the very early stages with Ebola it’s more like a bad flu. Spewing infected secretions comes a little later. His last contact with his household was September 28th. We are now 20 days from his last non-hospital contact and no one in his household has become sick. None of the 10 non household close contacts are sick either.

If no one in the 14 monitored contacts of Mr. Duncan falls sick by Sunday morning then he infected no close contacts. Despite living with four people while he was contagious for four days they have not fallen ill. And he certainly hasn’t infected anyone by flying on three planes, passing through three airports outside of Liberia, undoubtedly using several public restrooms including secretion-filled airplane lavatories, and touching several hundred if not more people along the way.

In fact, he was seen and treated in the ER on September 25th and would have been touched by at least one nurse and one doctor. Someone took his blood pressure, listened to his heart and lungs, and looked in his ears and then very likely used the equipment on someone else 15 minutes later after a cursory cleaning at best. He picked up medications from somewhere. He opened doors. He leaned against walls. He sat in chairs and on an exam table. All while he was sick with Ebola. It is more than 21 days from that contact in the ER while he was in the early stages on his illness and no one has Ebola. 

Who contracted Ebola from Mr. Duncan? Health care workers who cared for him when he was very, very ill with Ebola and producing large amounts of vomit and diarrhea. Likely bleeding from everywhere. The people who contracted Ebola were trying to help him as he was dying. Just as Mr. Duncan contracted it.

So don’t worry about flying and Ebola. I’m not.

But next time you fly do take your hand sanitizer, like I do, because you don’t want to catch the flu.

handsanitizer

 

***Post updated to detail the school closings. Thanks to Tara (see comments) for pointing out the difference in Ohio!***

Discussion

10 thoughts on “Stop worrying about catching Ebola on a plane

  1. This would be a good submission for the TED-recommended eboladeeply.org (since the fearmongering media don’t seem to be running these kinds of articles). Sums things up nicely and thanks!

    Posted by Beth | October 18, 2014, 1:06 pm
  2. Thanks, Jen. Good history, good analysis. Maybe fear is more contagious than ebola.

    Posted by bethhavey | October 18, 2014, 1:13 pm
  3. I’ll just add–it wasn’t schools of *children* who were on the flights. It was schools (in Ohio, at least) who had not even parents, but *contacts* of teachers/parents in the schools who were on the flights–so several degrees of separation from Vinson. And they still closed. It’s been insanity around here.

    Posted by Tara C. Smith (@aetiology) | October 18, 2014, 1:29 pm
  4. Still think I’ll lay low for awhile. Don’t want a cold either.
    Leslie

    Posted by swo8 | October 18, 2014, 2:08 pm
  5. Side note, I was surprised by Dr. Gunter’s comments on hand santizer, because I remember reading a lot of seemingly science-based negative press on these products about a year ago.

    So, thanks for prompting me to Google this and educate myself.

    http://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html

    Posted by David Chaplin-Loebell | October 18, 2014, 3:16 pm
  6. Ebola aside, cute bag!

    Posted by Anxious Mom | October 20, 2014, 5:24 pm

Trackbacks/Pingbacks

  1. Pingback: Ebola: Miscellaneous Notes - October 18, 2014

  2. Pingback: The New York/New Jersey Ebola quarantine will only stoke fear and paranoia | Dr. Jen Gunter - October 24, 2014

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