1. Opinion: Ebola-stricken American volunteers deserve special treatment
American missionary workers stricken with the deadly Ebola virus while aiding infected patients in West Africa deserve special treatment, according to a commentary being published early online in Annals of Internal Medicine. As the number of Ebola virus cases surpasses 1,600 in four African countries, public attention has focused on the two infected Americans who were airlifted out of Liberia to receive a highly experimental treatment in a state-of-the-art American hospital. Many observers are left wondering why the Americans were lifted out of Liberia when others were not and why they were given a drug that had never before been given to humans. According to Nancy E. Kass, ScD, a Phoebe R. Berman Professor of Bioethics and Public Health at the Berman Institute of Bioethics and Johns Hopkins Bloomberg School of Public Health, special treatment is due the American patients because very few health professionals would likely volunteer to enter West Africa to help care for Ebola patients during this outbreak. Their selfless act of caring for sick and contagious patients who have contracted an illness with a 60 percent fatality rate is above and beyond the usual norms of good ethical conduct. Just as it would be unethical to send doctors and nurses to Africa without HazMat suits, it would be ethically unconscionable not to assure them that they would be airlifted home should they contract the deadly virus. The author also supports limiting the use of the highly experimental treatment to these two American patients, for a "very important reason." The circumstances under which experimental medicines may be given are narrow and precise, and often worked out on an individual basis. It would be unethical to exploit the poor to test an experimental treatment during a public health outbreak.
2. Opinion: Ebola virus highly unlikely to spread in U.S.
Two American missionaries being treated for Ebola virus at Emory University Hospital in Atlanta, Ga. have prompted new fears that the deadly virus could spread in the United States. However, the author of a commentary being published in Annals of Internal Medicine says such concerns are unfounded. Even if cases are imported, the likelihood of further transmission beyond the index patient is close to zero, as hospital infection control practices are a very effective barrier. While highly infectious, Ebola is only acquired by direct contact with infected secretions, such as blood, sweat, and saliva. Most cases occur in those providing direct care to patients such as family members or health care professionals, but because bodies are still infectious after death, those involved with burial procedures may be at risk, as well. Because of modern air travel, infected persons could potentially carry the virus anywhere in the world (incubation is anywhere from 2 to 21 days). Therefore, the author warns that clinics, hospitals, and emergency rooms worldwide should be prepared to immediately isolate any patient who has a recent history of travel to West Africa and potential signs and symptoms of Ebola. These include sudden onset of fever, chills, myalgias, and malaise followed by flu-like symptoms, gastrointestinal symptoms, and finally hemorrhagic symptoms in the most severe cases. The author urges the public to utilize CDC, WHO, and other internet resources to stay abreast of new information on the current Ebola virus outbreak.