Sunday, August 17, 2014

Local Public Health and Ebola? Really?

The outbreak of Ebola Virus Disease in West Africa, which has killed over 1,000 people, is undeniably a terrible tragedy. Yet it can seem remote at the present time, with few lessons for us. In fact, there are at least two things we can glean from thinking about Ebola: 1) If things go badly Ebola could threaten us, and steps are already being taken to make sure we are prepared.  2) Ebola is spreading because of the weakness of the public health system in West Africa. North America has its own crop of deadly contagious diseases like diphtheria, polio, etc. but we do not have many outbreaks of these today because of our public health system, especially vaccinations.

The spread of Ebola is alarming and is causing public health officials to worry it will rage out of control.  On the ground reports indicate that quarantines are not working. People are able to move away from infected areas, bringing the disease with them. One of the possible scenarios with this disease is that it could spread throughout much of Africa. If that happens, then, there is even the chance the disease could leap out of Africa and cause sporadic outbreaks in other places in the world that lack effective public health services. Then it would only be a matter of time until cases appear here. In fact, a virus with some similarities to Ebola, MERS-CoV, has caused many infections in the Arabian Peninsula, but also numerous cases in places like Europe, the US and elsewhere.

No, I don't think a large-scale Ebola outbreak is possible in Michigan.  We have good public health services that would race ahead of the infection and put it out.  And local public health is very much a part of the team that would quash an outbreak if an Ebola case appeared. But complacency isn't an adequate response. In fact, we just completed training for a similar situation.

Here's the scoop:  MMDHD's Medical Director, Bob Graham, actually serves three local health departments.  In addition to us he is also Medical Director of the Central Michigan District Health Department (CMDHD) and District Health Department #10 (DHD#10). Doc, as everyone calls him, worked with the Communicable Disease and Emergency Preparedness staffs in the three departments to organize a training on responding to MERS-CoV that was held on July 30th in Mt. Pleasant. MERS-CoV is the nasty coronavirus that has killed nearly 300 people in the Arabian Peninsula. Like Ebola, it has a high mortality rate and poses a significant risk to health care workers. So training and preparation are critical to being able to respond appropriately.

The training focused on awareness of the travel history of people with symptoms, proper infection control in the event you could have a case and the initiation of surveillance and contact tracing to find any other cases immediately.  In addition to local public health, attendees represented laboratories, hospitals, emergency departments and transport, and the State. This is the team that will stop MERS-CoV, or Ebola, if we get it.

Why did we do training on MERS-CoV in Mid-Michigan? Because we live in a global village. It will always be that way from now on. We have students and their families from the Middle East studying in places like Central Michigan University, Ferris State and elsewhere, not to mention people from that part of the world who just love Pure Michigan and have settled among us, bringing us their skills and knowledge. In Mid-Michigan the West African diaspora is smaller, but it is there.

Before I leave this topic I have to make a couple of more observations.  We have tolerated an inadequate, underfunded public health system in West Africa, and now the worst is happening.  When this outbreak is over, we will need to fix this problem, as big as it is, or things like this will just keep happening.

Even though terrible diseases like diphtheria or polio are present in the US, we don't have outbreaks, because most people are vaccinated against these diseases. People in West Africa really wish there was a vaccine against Ebola.Learn from them. Let's appreciate our public health system and take care of it.  For it to work we all need to do our part. Get your vaccinations, people!

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