EBC African Viral Epidemic

“Left to their own devices, epidemic diseases tend to follow the same basic process: A virus or bacteria infects a host, who typically becomes sick and in many cases dies. Along the way, the host infects others.”

– Alan Huffman

 

Ebola is the newest category of highly deadly viral contagion which has made waves in the age of globalization by leaping over national borders all the way to the United States itself. While other categories of new viral infections like avian flu have emerged with no small amount of concern, Ebola can top even the famed Black Death with a lethality rate approaching 90%. White Coat Checklist has framed a consistent approach to topical issues to help medical school applicants frame an issue with both perspective and coherent respect:

  1. Historical Perspective & Implications
  2. Arguments In Favor
  3. Arguments Against
  4. Inclusive Response

The maturity and presence of self-control for a moment of thoughtful introspection will only grow in importance as health care systems and hospitals assume much more direct responsibility and financial risk for actual patient outcomes.

Historical Perspective & Implications

Appropriate factors for consideration include the following:

Where did Ebola first appear, and when?

What has yet to be understood about this mysterious disease?

To what extent has the limited health care infrastructure available in Africa contributed to Ebola’s high mortality rate?

How likely is the prospect of Ebola spreading beyond its natural habit into other parts of the world?

What does the U.S. health care system need to do differently to be more prepared for this health issue?

How do historical scenarios of past epidemic diseases point toward a path forward?

How serious should Ebola be treated as a global public health issue in Africa? What about in the United States?

Five species of the Ebola virus are known to date, four of which can actively infect human hosts and a fifth which is known only to infect apes. One strong species candidate for harboring disease reservoirs of Ebola is bats. The Ebola virus was discovered by Belgian scientists in 1976, named after a river flowing close to the first known infection site. The barriers to care for those first few patients were considerable: no vaccine, poor hygiene/health literacy standards, weak health care infrastructure, and local cultural practices which included the belief that disease could be caused by witchcraft and that the relatives should be shunned along with those taken ill all contributed to that first outbreak claiming several hundred lives. More recently, some West Africans also began to believe that Ebola was a scam by the Liberian government to attract foreign aid and cover up longstanding allegations of corruption, which lead to the disease running rampant int Liberia’s capital city of Monrovia. Highly involved funerary practices for the dead which include bathing and kissing the corpse were also likely culprits in fanning the 2014 outreach into an epidemic.

Arguments In Favor (‘Pro Major Clinical Research’)

  • Ebola vaccines didn’t even begin clinical trials until 2014, when that major outbreak finally crossed oceans into new regions of the world.
  • Ebola is one of the deadliest diseases known to exist, and we cannot afford to become complacent about such a serious public health issue.
  • Public mortality reports were very likely under-reported historically given the social stigma associated with an Ebola diagnosis.

Arguments Against (‘Anti Major Clinical Research’)

  • All diseases mutate to become less deadly over time, even HIV, since diseases that kill a host ultimately make re-infection less likely.
  • Based on current data, only a few thousand people have died from Ebola, far fewer than HIV, the flu, or many other more deadly diseases.
  • Ebola death rates can be significantly lower when patients do not overwhelm a fully resourced health care system.

Inclusive Response Examples

It’s entirely possible to use the evidence above to support several responses in an interview setting. The examples below attempts to illustrate the effective combination of both halves of the available arguments in combination with the historical perspective to offer a thoughtful response which demonstrates both personal reflection and active external engagement regarding the issue at hand.

Appropriate Response: In Favor, With Balanced Discussion of Topic

“Ebola is definitely a meaningful global health concern, even with the relatively low count of mortality experienced thus far. In a globalized world context, any disease can show up in the United States at any time, and our public health system has to be ready. That should include vaccine resources to help turn this health hazard into a less-feared menace. Even though all diseases become less deadly over time, Ebola is such a deadly viral agent that the risk of inaction is too high, especially since Ebola is already highly open to human transmission and has a mere 21-day incubation period. Given the immediate public health risk, the United States and other developed nations should seriously fund research toward the effective eradication of this deadly disease. We know for a fact that prior mortality counts were drastically under-reported because of the social stigma for families with members diagnosed with the disease – so using official statistics when public health resources are overwhelmed and citizens have little trust in their government carries little credibility.”

Appropriate Response: Personally Opposed, But Sensitive to Patients and Legally Compliant

“While Ebola is no laughing matter, it’s not first on my list in terms of public health funding. HIV/AIDS, the number one lethal virus with an estimated 36 million dead since the 1980s, also still lacks a vaccine. The flu kills an estimated 500,000 people a year; while flu vaccines exist, they also have to be tailored to specific strains in an elaborate guessing game every flu season. Private industry is already engaged in researching Ebola vaccines in earnest now that the immediate risk of viral infection crossing oceans has effectively created a paying market for such medications that didn’t previously exist without an immediate risk of harm in the United States and other developed countries. Funds that the United States might devote to such research would be better spent on either of the two diseases I’ve already referenced. If someone is specifically seeking to address Ebola health risks, they would be best served by supporting organizations like Doctors Without Borders or engaged directly in public health outreach to remove the social stigma currently attached to the disease itself so people are more likely to actually seek treatment upon falling ill thereby containing an outbreak. “

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