Tuesday, October 28, 2014

Ebola, AIDS: alike only in our hysteria

A haemorrhagic fever like Ebola seems uniquely terrifying: a high proportion of infected persons die quickly, leaking blood carrying the virus from every orifice. How could observers, even distant ones, not recoil in horror?

But any older gay San Franciscan recognizes all too well some elements of this country's response to Ebola. There's a terrible "here we go again" feeling watching the US flub the emerging pandemic. Once again, instead of responding to a disease threat by implementing and refining practical, science-based measures, politicians dither and citizens panic. We've seen this before: almost a decade into the AIDS crisis, North Carolina Senator Jesse Helms led the charge for quarantine for persons with the markers of AIDS. The disease becomes an excuse for preexisting prejudices against gay people and anyone considered "other" to manifest. There are too many true tales of AIDS panic like the North Yorkshire health department that buried an AIDS patient in a concrete coffin; the child confined to a glass booth in her school room; and the motorist who ran over a pedestrian and asked an AIDS service agency whether he should decontaminate his car.

Today, people who have spent a lifetime working to change HIV/AIDS from a death sentence to chronic health condition are begging New York Governor Andrew Cuomo and New Jersey Governor Chris Christie to back off from abetting panic with their ill-considered quarantines.

“We have not forgotten how HIV/AIDS was at first largely ignored when it appeared to affect only marginalized communities or the stigma generated once fear of the virus took hold in the larger populations,” [five members] of Cuomo’s End of AIDS task force wrote in a letter urging the governor to remove the mandatory quarantine. “We have watched with growing concern,” the letter continued, “as Ebola virus disease was ignored far too long while confined to some of the poorest countries in the world, and how it has now led to hysteria here in the United States, based on only a very small number of cases.”

Ebola is not AIDS repeated. These days, it is hard to remember that for nearly a decade, we simply didn't know what caused AIDS (the HIV virus) or precisely how the disease was transmitted. And even once the virus was identified, testing "positive" -- showing the signs of an immune response to the virus -- was simply a death sentence. There were therapies that sometimes prolonged life, but people with HIV were going to die of it. (Actually there turned out to be a few very rare people who lived on with HIV, but we did not know that then.) And then -- it felt very sudden to those of us living in centers of the epidemic -- drug therapies were invented that made survival possible. Response to AIDS shifted to identifying persons who are infected and ensuring they receive and can afford the drugs.

The Ebola crisis is different from the AIDS crisis. Public health authorities come into this epidemic way further along in their competence. Scientists know what causes Ebola; there's a test that identifies its virus. The incubation period (21 days) and the onset of the infectious stage (visible symptoms) have been pinpointed. And although the death rate is horrendous, most especially in extremely poor West Africa where there are no modern medical facilities, everyone who gets Ebola does not die. World Health Organization estimates an average fatality rate of 50 percent.

Dr. Paul Farmer, chief strategist and co-founder of Partners in Health, warns of the special horror of Ebola in just the sort of place the current outbreak has been concentrated:

... The attempt to treat Ebola patients in a weak health system – or at home – has been strongly linked to the transmission of the virus. In several West African hospitals, Ebola has ripped through the professional staff: health professionals, nurses’ aides, morgue attendants. Understaffed and undersupplied, front-line health workers in West Africa have good reason to be afraid. We who aim to help them, though better equipped, are afraid too. The others at great risk, obviously enough, are the primary caregivers of the sick: not health professionals but family members, especially women.

Ebola is more a symptom of a weak healthcare system than anything else.

Farmer offers a mantra for what is needed to contain the epidemic: "staff, stuff, space and systems." (By stuff he means protective equipment for health workers and basic medical supplies.) And he makes a bold claim:

An Ebola diagnosis need not be a death sentence. Here’s my assertion as an infectious disease specialist: if patients are promptly diagnosed and receive aggressive supportive care – including fluid resuscitation, electrolyte replacement and blood products – the great majority, as many as 90 per cent, should survive.

My emphasis. I'm ready to believe Farmer. Just today, the second nurse who caught the disease from the Liberian victim who brought Ebola to Dallas has been released from the hospital, cured. (In the picture, President Obama shows genuine leadership by hugging the first Dallas nurse declared cured. If only posturing pols would stop trying to drown him out!)

If we don't want to live with Ebola popping up all over the world, causing havoc and misery in the poor countries where it can seed itself, we need to offer the wealth of this country to stopping it now in West Africa -- whatever that takes. Blustering for political points isn't going to serve anyone. Diseases don't respond to hot air.

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