How sporting events could be the mechanism Ebola needs to latch on in the United States
By Lance Rinker
Imagine places where a disease such as Ebola could have its pick of the litter among a potential victim pool in the tens of thousands of people. Now imagine such places exist. They do – we call them sports stadiums and arenas.
Ebola is extremely infectious but not extremely contagious. The reason it is infectious is because even the tiniest speck of the disease can cause illness in a person. The Centers for Disease Control and Prevention (CDC) consider Ebola to be moderately contagious because the virus is not transmitted through the air. Instead, you would need to come into direct contact with it to become infected.
The National Football League sent a newsletter outlining the basic facts about the Ebola virus to all team doctors and trainers for distribution to players and staff. The league said the newsletter was written by the Duke Infection Control Outreach Network (DICON), the league’s infectious disease consultants, and sent to the league’s 32 teams on Monday, Oct. 13.
According to this newsletter, perceptions of risk of acquiring Ebola have been skewed in many news articles about the importation of Ebola into the United States. Even if additional imported cases of Ebola occur in the future, this risk among persons not involved with the direct care of sick patients almost certainly will remain far lower than the risk of other rare causes of death such as dying from a dog bite or attack (1 in 104,000), lightning strikes (1 in 136,000) or a plane crash (1 in 1,100,000).
Obviously you can’t contract a disease as deadly as Ebola when it requires direct contact, so what does direct contact even mean?
If you come into contact with the bodily fluids of an infected person, or contaminated objects from an infected person, then you are at greater risk of contracting the virus.
Direct contact involves broken skin or mucous membranes in, for example, the eyes, nose, or mouth with:
• blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola
• objects (like needles and syringes) that have been contaminated with the virus
• infected animals
Ebola is not spread through the air or by water, or in general, by food. However, in Africa, Ebola may be spread as a result of handling bush meat (wild animals hunted for food) and contact with infected bats. There is no evidence that mosquitoes or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys, and apes) have shown the ability to become infected with and spread Ebola virus.
According to leading health experts with the CDC, the Ebola virus can survive on doorknobs and other hard surfaces for several hours, but can survive in bodily fluids for days or even weeks.
Naturally, healthcare providers caring for Ebola patients, including family and friends in close contact with Ebola patients, are at the highest risk of getting sick. During outbreaks the disease has the potential to spread quickly within healthcare settings where hospital staff members are not wearing appropriate protective equipment, including masks, gowns, gloves and eye protection.
How many professional or amateur sports stadiums do you know of where staff are covered head to toe in medical protective wear?
The problem with Ebola, and what makes it so dangerous to people with first-world ‘problems,’ is that early symptoms also are symptoms of other viral infections such as the common cold or flu. Those symptoms include fever, headache, body aches, cough, stomach pain, vomiting, and diarrhea.
The disease is disturbingly infectious in the sense that an Ebola patient is a significant risk: As the patient’s symptoms worsen, the patient can begin projectile vomiting and experiencing explosive diarrhea, bodily fluids that, if you come into contact with, could pose a major health risk in healthy persons.
According to a July New York Times article, the average wait time for a person to see their primary care physician right here in the Metroplex is one week. In other areas of the country such as Houston, Los Angeles or even our nation’s capital, the wait to see a doctor can be well over two weeks. That would give the Ebola virus plenty of time to go unchecked by a healthcare provider.
The time it takes from exposure to Ebola to actually getting sick, known as the incubation period, is anywhere from two to 21 days, but most people who are infected with Ebola will develop early symptoms eight to nine days after exposure to the virus, according to the CDC. Specific tests for antibodies against Ebola and viral DNA help doctors make a conclusive diagnosis.
Again, therein lies the problem.
While one infected person could infect one or two other people at a time, according to reproductive rates based on contact, all it would take is for one or two infected person to attend a major sporting event to potentially spread the disease to hundreds, thousands, or even tens of thousands of people.
Nassim Taleb, author of Fooled by Randomness and The Black Swan, explained to Business Insider last month that what people don’t understand about Ebola is the multiplication. Taleb said many people talking about the disease don’t “have a grasp of the severity of the multiplicative process.”
According to Taleb, the argument from some that the United States should be more worried about a disease like cancer, which has more stable rates of infection than Ebola does currently, is a logic he calls “the empiricism of the idiots.”
The idea that the growth of Ebola infection is nonlinear, so the number of other people being infected doubles every 20 days, is something that “… is much more rational to prevent it now than later,” he said. “If you have to overreact about something, this is the place to overreact.”
Currently, there is no vaccine for the Ebola virus and the only medication being made available to some patients is an experimental, antibody based medication, according to David C. Pigott, MD. He is a professor of emergency medicine at the University of Alabama-Birmingham and published a 2005 review of the Ebola virus in Critical Care Clinics Journal.
That experimental drug is called ZMapp, made by Mapp Biopharmaceutical, and Pigott said the U.S. Food and Drug Administration has yet to approve any treatment for Ebola in humans. Developed in early 2014, ZMapp is produced in plants and has not yet been found to be safe for use in people, according to the manufacturer.
Researchers from the National Institute of Health report the vaccines currently in development have been effective at preventing Ebola infections in animal studies, but nothing more. The research itself is not without controversy, as
animal rights groups are offended that apes are being used for Ebola vaccine research purposes when their populations are dwindling and in danger of extinction.
At this stage of the game, the only way to effectively test out the experimental drugs on humans is if someone were to volunteer to be injected with the vaccine containing the Ebola virus and take a wait and see approach. So far, no one has stepped forward to volunteer.
However, Pigott said people are not at risk of infection unless they come into direct contact with bodily fluids of an infected person, the more dangerous being vomiting, secretions from coughing or sneezing, or sweat from a fever.
At any major sporting event there are countless numbers of people who cough, sneeze, vomit and sweat in close proximity to a group of other event-goers. With the virus being capable of surviving for several hours on door knobs or other hard surfaces, and add in the fact that the virus can sustain itself in bodily fluids for at least several days, opportunities are rampant for the virus to spread.
How often are you bumping into others at packed stadiums?
What about the public restrooms; are you using those?
Have you ever sat next to someone who is coughing or sneezing throughout the event?
You may not be able to contract the virus from someone who currently isn’t showing visible signs of Ebola, but in a packed house at a sporting event, how many people do you come into physical contact with in some form who would make you confident in saying your own personal odds of contracting the virus are nil?
The NFL, at the recommendation of DICON, believes there is no reason to screen players or staff to make sure they have not had close contact with anyone who traveled to or from areas where Ebola is now endemic.
We do recommend that medical personnel educate their players and staff about the need to inform club medical personnel in the unlikely event that they actually have such contact. This information can then be used along with consultation with local public health departments and local infectious disease experts to assess whether any further actions are needed. – NFL Newsletter sent to all 32 teams
The World Health Organization said in mid-October the Ebola infection rate could soon reach 10,000 a week as world leaders prepared to hold talks on the crisis at the United Nations.
WHO assistant director general Bruce Aylward, describing his figures as a working forecast, said the epidemic “could reach 5,000 to 10,000 cases per week by the first week of December.
That forecast has since been updated to reflect a reach of upwards of 20,000 people around that same timeframe.
More than 5,000 people have lost their lives as a result of the virus, from more than 9,000 recorded cases of infection so far. The epidemic continues to spiral out of control in the three hardest-hit West African countries of Liberia, Sierra Leone and Guinea.
Ebola was first discovered in 1976, with outbreaks surfacing from time to time ever since. While current figures suggest a survival rate of 50 percent in disease stricken countries, the true impact isn’t as easily noticed. In the current outbreak, nearly 70 percent of those infected have died, according to the CDC.
Ebola may be relatively new in the United States, in the sense that this is the first serious outbreak the public has been aware of, but it should not be taken lightly. With just a handful of Americans infected with Ebola, millions of others are already infected with panic and fear.
More than half of U.S. adults worry that there will be a large-scale Ebola outbreak across the next year, according to a recent Harvard poll. Those numbers have climbed from an earlier Harvard poll, which found that about 40 percent of American adults this summer were worried about an Ebola outbreak.
In an effort to protect U.S. public health, the CDC now is building up its capacity for testing and surveillance, in conjunction with educating health workers and training medical responders, flight crews and airport workers on how to report a sick passenger to the CDC in case isolation becomes necessary.
At the end of the day, there certainly is cause for concern with one of the most dangerous diseases on the planet gaining a foothold in the United States through sports. But at the same time, scientists and public health officials have repeatedly urged Americans not to panic about Ebola.
The following websites and agencies provide up-to-date information about the epidemiology and transmission of Ebola virus:
• cdc.gov/vhf/ebola/index.html
• globalhealth.duke.edu/ebola
• who.int/csr/disease/ebola/en/
