Ebola is only one fiend in the pantheon of human diseases.  This is my column in today’s Greenville News. 




Ebola Virus Disease is rampant in West Africa. So far, the death toll is around 2,296, which makes it one of the largest outbreaks ever. Ebola is what’s known as a ‘Hemorrhagic Fever Virus,’ and belongs to a large family of nasty viruses that are widespread around the world. There’s even one in the American Southwest known as Hantavirus, that lives in a species of mice. Yellow Fever, which killed so many before a vaccine was developed, was once widespread as far north as Detroit. Some of these viruses are extremely deadly and some less so, but all of them are dangerous and miserable to endure.

One of the common features of these illnesses is bleeding; that’s why they’re called ‘hemorrhagic fevers.’ They cause blood vessels to leak and clotting to work poorly; victims sometimes bleed under their skin, internally, or in the eye, mouth or nose. Those who die seem to die from shock; the bleeding itself isn’t necessarily the main cause of death.

So to summarize, a week or more after exposure to fluids from an infected person or animal, the Ebola victim develops aches, fever, chills, weakness, vomiting, diarrhea and progresses to liver failure, kidney failure and bleeding from various parts of the body. He or she then goes into shock and in many cases (depending on the outbreak) dies. Death rates have been as low as 25% and as high as the mid 90% range.

From the standpoint of modern medicine, and even popular culture, it’s a fascinating disease. Think about it. It’s exotic, and it comes from the jungles of Africa. It’s natural host is a fruit bat. It makes people bleed out of their eyes! This sort of disease gets press. Books are written. Movies are made. Reporters send back gruesome images of bodies covering sheets outside sun-baked hospitals.

In medicine, we sometimes characterize things like Ebola as ‘sexy.’ Not literally, of course. It’s our way of saying that they’re cool, fascinating, anything but mundane. Between hypertension and Ebola, we we may prefer to stand next to the first, but we’d rather hear about the second.

It’s evident in the fact that four Americans have been evacuated out of Africa for treatment in high level containment areas in the US. The experimental drug ZMapp was manufactured by a small company in California called Mapp Pharmaceuticals. It has not undergone formal trials, but seemed to be life-saving for two American missionary physicians who received it after being afflicted with Ebola.

It’s a wonderful time in medicine. Strange and deadly diseases can sometimes be stopped. It matters more now than ever because those same strange, ‘sexy’ diseases can now jump off the images on the web-page or newspaper, climb on an airplane and land in Atlanta, or Greenville, in about twelve hours. (Pay attention young GHS doctors!) We need flexibility and research to face such mobile terrors in a widely interconnected world.

However, we need perspective. While four Americans were evacuated to high-tech care in shiny hospitals, thousands of Africans still languish with little hope in countries with less than optimal hygiene, healthcare, food and water.

We also need to remember that for all the horrors of a disease where you bleed out of your eyes, other diseases, less fascinating, less worthy of books and television, continue to grind and crush humanity. Malaria infected an estimated 207 million human beings in 2012, resulting in 627,000 deaths. Among those were 1300 children dead of the disease each day. Read those numbers again and think of your family. Treatments are improving, but there’s a long way to go.

Vitamin A deficiency results in 250,000 to 500,000 cases of blindness in children each year, with about half of them dying within 12 months. Worldwide, some 35 million people have HIV. In 2013, 1.5 million died from AIDs. In America, in 2012, there were 21 million diagnosed diabetics. In 2010, there were over 300,00 people for whom diabetes was listed as the underlying or contributing cause of death.

I could go on and on, with death rates from hypertension and heart disease, pneumonia and influenza. It’s just easier to focus on the flashy and newsworthy. So much so that the suffering of millions, of billions, can seem like background noise.

But we would be wise to remember that even as we are intrigued by darkly fascinating tragedies, that background noise is the sound of human sorrow and loss on scales we can still scarcely imagine.

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