As the Ebola epidemic shows no signs of dissipating, it is
probably time to change some common greeting customs. The standard greetings
depending on location, culture, and state of intoxication include handshakes,
hugs, kissing both cheeks, chest “bumps”, high five, low five, and multiple
variations on above.
With skin-to-skin
contact, spread of the virus is possible but unlikely, as the infected contact
is thought to require high illness severity accompanied by a high viral load. To avoid transmission, but continue the
formalities of social greeting, the suggestion has been made to switch to the
lightly closed fist “hand-bump.”
There
are two variations of this:
1.
The covered hand (where you pull your clothing
over your fist and then make contact.)
2.
The uncovered hand where you feign actual
contact, gesture, miss, and retain the psycho/social effect.
The Japanese culture with
traditional bowing has already solved this dilemma. Not sure that this will
translate to a more macho western culture.
There
has been much controversy in the news media about the proper way of avoiding
the spread of Ebola worldwide. The options of travel bans, closing air traffic,
quarantine, and testing stimulate expert opinion. These expert opinions are
extremely varied and seem to be based on political orientation to avoid panic
and medical need according to the CDC based on medical evidence according to
epidemiological techniques. At the present, there are shifting recommendations
on a daily basis. The 24-hour news
cycle, political correctness, and true lack of knowledge makes it look like
there is no black or white answers.
In large
part, these shifts reflect an imperfect science regarding the transmission of
this virus. The ease with which it
spreads in some situations (e.g. to healthcare workers) is offset by a variable
period of contagion (thought—but not guaranteed-to maximize at 21 days), an
ill-defined onset of viral shedding (headache? myalgias? rhinorrhea? low-grade
fever?), a degree of permeability to protective gear that is almost uncanny, as
well as an unknown capacity to mutate and circumvent measures being
established.
Moreover,
effective treatment is now generally agreed to depend on one dimension: supportive care with adequate hydration and electrolytes. It is almost cholera-like, and electrolyte
depletion is now thought to be the final common pathway to death. Quite likely, when the analytics are
complete, they will show that most of the deaths in W. Africa could have been prevented
with simple IV hydration. Not to mention
that much of the transmission there could have been averted by common-sense
burial practices*, along with mitigation of unnecessary fear. Yet, in those countries, at the height of the
disease, those infected (including many healthcare workers) were sent to the
back (rooms, tents, fields) and left alone, where they, of course, died. Treatments such as convalescent serum,
plasma, ZMapp were, in all successful cases, given along with good supportive
care, and full hydration. Hence, it was, to any cogent medical mind, the
hydration and support that made the difference.
Since cases are now being shown to recover just with fluids, the other
“treatments” were clearly superfluous.
The
probable truth is that there are no straightforward solutions to the problem of
stopping transmission. They become, and
are becoming more and more, epidemiologic and political decisions. The common sense approach of attacking and
isolating the problem at the source through quarantine and support sounds the
best but may not be the whole answer.
The
Ebola epidemic will ultimately probably be controlled or burn-out itself and
life will go on. In a prior blog (Life Imitates Art) it was stated that is
really hard to get things right without the necessary experience. The fact that
multiple communities and countries are trying different things will allow the
analysts to come up with a “game plan” in the future for the next uncontrolled
world-wide pandemic. We should consider the
present infection as a “test” of our preparedness and make the appropriate
adjustments.
*In one well-known case, when it
was thought the outbreak was just about under control, the body of a woman who
died from Ebola was taken from the hospital under gunpoint by relatives. Her remains were taken to their home, and the
practice of full contact mourning caused a resurgent outbreak in the area.
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