GERM
00:00:09.280 – 00:00:11.280
Mbote. My name is Germ.

WORM
00:00:11.280 – 00:00:12.160
I’m Worm.

GERM
00:00:12.240 – 00:00:26.640
Welcome to episode 105 of the Germ and Worm Travel Health podcast. Ebola, a big bowl of bad. It’s a big planet. See it in Good Health. I’m Dr. Paul Pottinger, also called Germ. I’m a professor of Infectious diseases at the University of Washington in Seattle.

WORM
00:00:26.970 – 00:00:34.490
I’m Dr. Chris Sanford, also known as Worm, associate professor in the Departments of Family Medicine and Global Health, also at the University of Washington.

GERM
00:00:34.810 – 00:01:45.440
We’re talking about Ebola today and all the bad things that come with it. The point is not to be frightened.

The point is to be knowledgeable and empowered, not only as a potential traveler, but also as a good global citizen. We’re going to talk about a number of aspects of Ebola, including how big was the 2014-16 West African Ebola epidemic?

What’s up with the current epidemic? How is it different from what we’ve seen recently? If I go to Africa, will I be quarantined?

And is it true that I need to fly home to the US through specific airports? If I visit Africa, may I receive an Ebola vaccine before I visit Uganda? If I get sick with Ebola, will I need to receive care in Kenya?

These questions and other topics related to Ebola a quick reminder to our listeners. Please contact us with your own travel health questions, your stories, and your tips for success.

If you want a clarification on something you’ve binged previously, we’d love to hear from you: germandworm.com or send us an email germandworm@gmail.com. Before we jump in. As always, our medical disclaimer.

This podcast is designed to inform, inspire and entertain, but you should not use this podcast as clinical care before you travel. Please see a qualified healthcare professional for recommendations specific to you and to your itinerary.

WORM
00:01:45.680 – 00:01:49.520
Yeah, Paul, start us off. Give us Ebola fundamentals.

GERM
00:01:50.080 – 00:04:45.360
There’s nothing fun about the fundamentals of Ebola. So the word Ebola, of course, this is a location, a river in central Central Africa where this particular infection was originally discovered.

It was discovered microbiologically by a wonderful physician called Dr. Peter Piot. You would think it’s pronounced Pee-oh, but he doesn’t go that way. He goes by Pee-ott.

Peter Piat is one of the real heroes in the world of virology, and that started when he was a young person.

I think he was in training as a microbiologist back in 1976, and he was able, when working in Europe, to examine the blood, a blood Specimen of someone who had been from Europe, living and working, I think actually in spiritual work or something. I think it was a nun. And this person got very sick and a specimen was sent back to the microbiology unit where Piot was working.

And he was able to look at the blood and try to figure out what was in there. The assumption was that this person had yellow fever, which is another very serious, potentially deadly viral infection.

Well, it was not yellow fever. It was not anything that had ever been seen before. It was a virus that was new, new to science.

He found this with something called transmission electron microscopy. It’s the finest kind of microscope that we have. And what he found was something that was unexpected. A virus that looked like a thread.

It looked like a piece of hair. In fact, the family of viruses is called the filovirus filo, meaning thread like. And there was nothing that had been seen like this previously.

He was able to make this discovery. Ultimately, the virus was called Ebola virus because that was close to the river where this person had originally been infected.

At this point, we actually have six different strains of Ebola that are described in medical science. So it’s not just that one that he found back in 1976, but it is an interesting story.

And if you want compelling read, he has written about this in a book called no Time to Lose. That’s part of his memoir of going through that process.

To his credit, although he was a laboratorian, Piot realized that you couldn’t figure this out from the lab. You had to go there. And so he did make that journey along with other colleagues.

This was certainly not his own and only work, but he did work with colleagues to go to the area where the outbreak was happening, to understand something about transmission, something about the clinical course, to try to intervene and develop more rapid testing. Fast forward all these decades later, we really do stand on the shoulders of Piot and his colleagues who did that original work.

And we’re grateful for what they have done. So, Chris, so let’s talk about this. Tell me a little bit more about the name. What do you think about that calling it Ebola virus disease?

WORM
00:04:45.600 – 00:05:06.750
Well, you know, that was the tradition for centuries, but doctors and physicians have changed their minds. We actually no longer name diseases after places. And I get it.

If some bad infection came out of Seattle, I really wouldn’t want it known globally as the Seattle disease. So, yeah, it was named that because it was close to the Ebola river. But times have changed.

GERM
00:05:07.310 – 00:07:48.820
Yeah, the Seattle disease. We’ve got a bunch of those. I’M trying to figure out what that would actually be over here.

You’re right, it has these racist overtones, it has jingoist overtones. We saw this with the person who’s currently president in the previous administration who was calling COVID 19 the “JYNA” virus. Or the Kung flu, all these vulgar names, right? So we try to get away from that whenever we can. Nevertheless, this time we still call Ebola virus by that particular name.

Now, it’s part of this group of illnesses that have traditionally been called vhf, the viral hemorrhagic fevers, even that there’s others in that family, including the Marburg virus, right? Well, Marburg’s a place in Germany. You don’t catch it in Germany, but that’s where they actually made the discovery.

So that’s how that name came around. Even that term of viral hemorrhagic fever, it’s problematic. These patients do not always have a major part of hemorrhage as their presentation.

The clinical illness with Ebola is utterly fascinating and it’s deadly serious business, Right? Because we have an infection that is very much a system wide whole body infection.

A lot of what we’ve learned about the actual biology of how this infection goes does date back to the West African experience of 2014-2016 and people getting sick and coming to care, surviving, thank goodness, and being studied in an ongoing fashion. Body fluids, tissues being sampled, following them over time.

You and I are friends with one of those survivors, Dr. Ian Crozier, who’s just a wonderful source of information about this very inspiring person. Not the only survivor by any means, but someone who was willing to volunteer to be studied over and over again.

And he’s written about this and it’s completely fascinating.

I mean, his eyes changed color because of the inflammation and for reasons we don’t fully understand, he had viable virus found in the seminal fluid for many, many months after he was infected. Is it possible that this could be a sexually transmitted infection, for example, in some circumstances?

So much of what we’re now coming to understand about that particular strain, called the Zaire strain, comes from Crozier and other people who’ve been willing to work with medical specialists, volunteer interior in their very living flesh and blood. And so we’re grateful to them. I would say this is a very dangerous situation.

If you catch this infection, your chance of surviving is certainly not zero, but it’s one of the deadlier infections because the support that’s required, honestly is difficult to do in these austere settings based on the risk of transmission. Let’s talk about that. How do you actually catch Ebola virus infection, please?

WORM
00:07:48.900 – 00:09:04.370
Right. Well, in a phrase, direct contact. And when I say that, I mean direct contact with blood or another bodily fluid.

What’s good about Ebola, if I can say anything is good, is how it’s not spread. It’s not airborne, it’s not respiratory, like, say, influenza, it’s not vector borne, so mosquitoes don’t spread it, thank goodness.

So unlike, say, dengue or malaria, mosquitoes don’t carry this. So it’s all about direct contact. And that has implications for who is at particularly high risk.

And there’s two groups who are just decimated by these infections. One is family members, because in a lot of these countries there’s a tradition of washing the body of the deceased family member.

And of course that involves water and blood and people get blood on their hands and they get Ebola, and many of them do poorly. The other group that is often decimated by this, of course, is healthcare workers.

Often among the highest fatality rates are the doctors and the nurses and the other people who take care of people. So transmission is direct contact.

That’s good if you’re a tourist, because if you’re on safari, even in a country with Ebola, you’re very unlikely to have direct contact with somebody with this. But if you’re a family member of somebody with it or a healthcare worker, it’s very bad news.

GERM
00:09:05.089 – 00:09:40.990
And there’s just so much vomiting, diarrhea, managing those infectious fluids from the patient, it can be done, but it’s a lot of work, especially when it’s sweltering hot. And, you know, frankly, the person who is working with that, Pat, understands that this is communicable disease.

And so that adds a level of stress and strain and sweat. It’s a very, very tall order. I’m going to follow up with another question, though. Chris, you mentioned a moment ago, it’s not vector borne.

You don’t catch it from the bite of a mosquito. Sorry, but where does this virus actually come from in the first place?

WORM
00:09:41.310 – 00:10:33.220
Well, it was unknown for a long time, but now the leading theory, which is getting more and more evidence, is that it resides in bats.

And the unfortunate thing about that is there’s a rule in tropical medicine which is that if there’s an animal reservoir for a disease, it cannot be eliminated. So, for example, smallpox, there was no animal reservoir. It in fact was eliminated.

But a lot of other diseases, when they’re not in people, they’re just hanging out in animals, often not making them sick. And in this case it appears to be in fruit bats. That’s not definitely proven, but it’s the way most people are leaning.

And you can’t take fruit bats out of the environment. They’re going to be there forever. So the implication of that, even when there’s no human Ebola, it’s not gone, it’s just taken a breather.

And people have contact with fruit bats in a number of different ways. So I think we’re going to see this outbreaks of Ebola for the foreseeable future.

GERM
00:10:33.460 – 00:11:31.070
And it’s not unique to Ebola, right? I mean, we’ve talked about fruit bats before. You know, this is a reservoir for coronaviruses, this is a reservoir for Nipah viruses.

They’re mammals like us, but they seem to tolerate these wide variety of viruses very well. They don’t drop like fruit off the tree. I mean, they’re still flying, doing their thing, even though they are potentially a source of infection.

So how it ultimately jumps from, let’s say, a fruit bat to a human being, I don’t think that’s well known. One of the leading theories, of course, is the bushmeat trade, that people are eager to nourish themselves and their families.

They’re looking for protein. Let’s eat a bat. That’s one way that this might happen, but it’s not established as the way or the only way that this happens.

And you’re right, until we torch the entire rainforest, we’re not going to get rid of this stuff. By the way, it feels like we are torching the rainforest, which I do not, I do not think is the way forward.

I think this is going to be a risk that stays with us for a long time.

WORM
00:11:37.230 – 00:11:45.690
So, Paul, most of us recall the really big Ebola outbreak in West Africa, 2014-16. Just how big was that and where was it?

GERM
00:11:46.560 – 00:12:44.220
Yeah, so in 14 to 16, actually, technically, I think starting in late 13 in guinea, there was an outbreak of Ebola virus disease that was in West Africa. So different from what we’re talking about in the current outbreak. And at that time the focus was in Liberia, in Sierra Leone in particular.

And yeah, ultimately the official tally is around 28,600 infections and 11,300 deaths. I’ll say that again, 28,600 infections, 11,300 deaths.

Almost exactly 50% of those people who were diagnosed through pretty careful case definitions ultimately died of that infection. That is what we would call a CFR, a case fatality rate.

Of about 50%, which is high, way higher than we would expect, for example, with COVID infection.

WORM
00:12:44.220 – 00:12:44.620
Right.

GERM
00:12:45.420 – 00:13:06.820
So that was very alarming, very difficult, and very different from what we see today. So the strain that was involved in that West African experience from about 10 years ago was the Zaire strain. That’s an important strain.

It’s one that we have come to respect and deal with, but different from what we have today.

WORM
00:13:06.820 – 00:13:07.140
Right.

GERM
00:13:07.140 – 00:14:34.180
The current strain that we are seeing coming out of Central Africa, including Congo and Uganda, this is the Bundibugyo. So it is. Bundibugyo is a filovirus. So it’s a cousin to the Zaire strain.

But it’s different enough that unfortunately, although it is spread the same way and although the illness that it creates we think will be similar, unfortunately we do not have an important countermeasure. We lack a vaccine for this current strain that’s different from West Africa.

A heroic story happened in about 10 years ago, right, Chris, where a vaccine was created and that vaccine could be deployed safely in a, in a ring idea.

So if you found a case, you could immediately immunize everyone who had the risk of recently being exposed to that person or who would be in their social orbit, and this ring of protection could be deployed again and again. It’s a vaccine that we need more of.

It’s a vaccine that was rare and in most cases very expensive, but it helped to make a difference in addition to other important countermeasures that we can talk about. My point is that in the current context with Bundibugyo, we do not have that important countermeasure. Let’s talk about that.

Where are we, please, with respect to the current outbreak? Chris, in terms of numbers, this outbreak.

WORM
00:14:34.180 – 00:14:52.390
Got really big, really fast. It’s alarming and frightening. As of May 29, there have been over 1200 suspected and confirmed cases and over 240 deaths.

So this is one of the biggest Ebola outbreaks in history and it has not yet peaked.

GERM
00:14:53.990 – 00:15:09.780
So as we record this, it’s now 31 May 2026.

By the time our listeners hear this, I’m going to go on a limb and say that the total case numbers will be north of 3,000 and probably higher than that. We will, but we’ll see unfortunately over the next couple weeks how this goes.

WORM
00:15:09.860 – 00:15:43.200
Yeah, and just I want to mention that my hat is off in respect people who are taking care of these people, both family members and healthcare workers. When Paul and I taught in East Africa, I talked with some of the docs who were working in the Ebola clinics in Sierra Leone and elsewhere.

And it’s just hot, miserable work. For one thing, if you get Ebola, you have a high chance of dying. But even aside from that, you’re in this suit, it’s already hot and humid.

Then you get in this thing and it’s just incredibly hot and humid, and your mask fogs up and your stethoscope doesn’t work very, very well. So I think there’s just a lot of heroes putting themselves at risk taking.

GERM
00:15:43.200 – 00:17:11.050
Care of these people, even in the most advanced clinical settings.

I’m thinking about some of the biocontainment units that we have here in the United States where doctors, nurses, many healthcare workers put in a ton of sweat equity taking care of some expatriates who had come back to the United States. You know, the level of care that’s involved is just tremendous. It was interesting.

There was a lot of confusion early on because a lot of those doctors and nurses, you know, they were wearing, you know, what you might call the full hazmat experience. And that included PAPRs, which are powered air purifying respirators, the little air conditioner that you have over a hood.

And, you know, the thought was, my gosh, we do that for tuberculosis. Are they worried that Ebola is becoming airborne? No, that is not the issue.

The issue is that it’s just so damn hot when you’re trying to protect yourself in a full suit so you don’t get. Get soiled with stool and vomit and urine, that it’s just hard to do the work. So that’s basically. They were being used as personal air conditioners.

That technology is extremely rare in these important areas where people are doing even more of the work. So even when it’s air conditioned, Chris, and even when things are good, the doctors and nurses doing this work, it’s. It’s a chore.

This is an infection that is dangerous to the people who have it and is very, very big drain on the healthcare system for those who need to respond. And so it’s another reason why we just need to take this, this topic seriously.

WORM
00:17:11.210 – 00:17:57.030
And as you mentioned, we both know Ian Crozier. He was taking care of people back in that 14 to 16 epidemic. And even though he wore all the right protection gear, he got Ebola.

And he actually, we flew him to Seattle to give a talk at a conference, and it was fascinating. He came about as close to dying as you can come. And not dying. I think he was in the ICU for about two months.

And when he showed his blood results, his labs, they were more consistent with a dead person person than with someone who would get better. As Paul mentioned, he was featured in the New York Times, one of his eyes changed color and then he recovered.

So I guess he was unlucky to get it and lucky not to die from it. But again, this is just something that can be devastating to the healthcare teams.

GERM
00:17:57.350 – 00:18:15.250
Yeah, it’s exactly right. And so let’s talk about that a little bit. When it comes to the prevention side, what can people do to reduce their chance of getting it?

If there is not a vaccine for this particular strain, should they get the other vaccine just in case? What do we think about that?

WORM
00:18:15.730 – 00:19:05.470
Good question. The other vaccine for Zayre has been shown to be effective and safe, but only protective. Of course, for the Zaire variety.

The main thing is not to have direct contact with people who either have Ebola or potentially have Ebola.

So again, if you’re a tourist, you know, you’re going on safari in east or West Africa, I won’t say it’s a non issue because there’s going to be some, you know, quarantine and restriction things, but your risk is very low. You’re not going to get it by taking pictures of a lion. But if you’re a healthcare worker, then it’s a super big deal.

Or if you’re staying with the family and maybe somebody gets sick and you’re not sure what they’re sick with. Well, if it’s an Ebola endemic area, that needs to be something you consider.

But again, the fact that it’s direct contact and not airborne really will guide your decisions in terms of what you avoid.

GERM
00:19:05.790 – 00:20:33.510
I think that’s right.

And you know, with respect to the West African experience, that vaccine not available to tourists, even those who are going to West Africa, it’s really reserved. It’s such a rare vaccine. It’s really reserved for those who are dealing with an actual outbreak and epidemic.

And unfortunately, we do not think that the current strain, Bundabudjo, is going to respond to whatever kind of B cell immunity we could generate with that other vaccine. Anyway, so this is about being smart, about what we do. You know, some of our listeners may be volunteer volunteers, including in the medical field.

And so in.

If you are one of those amazing and inspiring folks who hears about human suffering in these austere settings and you want to go and do something about it, you know, that intuition and that calling we really admire, this is one where you need to be super duper planned. You need to plan it out. You need to be prepared.

You really just should not go to areas that are coping with these problems and expect to simply show up and make a difference. I mean, you probably could do all kinds of great things.

But in all sincerity, one of the greatest things you can do is not become another case, not become another burden to what are already very, very severely strained health care systems. Already strained before an Ebola virus outbreak, by the way, so much less in the current context. So if you want to help, please find a way to do so.

But showing up unannounced and uninvited is not the way to do that.

WORM
00:20:33.510 – 00:20:49.390
Right. And I’ve made the same point with disaster response. If you go by yourself and hang out your shingles, you’re more likely to become a liability.

The only way to do any good either with Ebola or a disaster is to join a team that has logistics and communications and appropriate protection gear.

GERM
00:20:50.270 – 00:21:40.780
Exactly right. And that’s the sort of thing you would plan for today in case there’s another outbreak in the future.

This, now is not the time to just jump in like that. Let’s talk about this. Let’s say someone wants to travel to Africa, Chris. Not to do medical relief work, but let’s say we’re going safari.

In fact, we have a question here from Greg in Puyallup, Washington. Hope you’re both doing well. I was discussing with my family whether or not it’s a good time for an African safari.

Initially we were planning on visiting the lowland gorillas, but given their location near DRC and the Ebola outbreak, we have decided against that. That has led us to choose a safari in South Africa. At least we are talking about it. There is some family concern about Ebola virus and its pro.

Although South Africa seems relatively far away, would it be safe for us to visit South Africa?

WORM
00:21:42.860 – 00:22:27.790
Short answer, yes, you could go to South Africa and there should be no issues with coming back.

On May 15, the CDC issued a health notice for people going either to Uganda or the DRC because a small number of cases have been found now in uganda, adjacent to DRC.

And on May 18, the CDC issued a 30 day prohibition on non Americans entering the United States who’ve been in the drc, Uganda or South Sudan for the preceding three weeks.

So, yeah, South Africa go, but if you go and stay either in DRC or Uganda, yeah, you could be banned from reentry into the US So I think maybe this year, it’s a good year for Safari to switch to South Africa, which is just what you’re planning on doing.

GERM
00:22:28.270 – 00:28:41.730
Yeah, agree. And so if you’re not a US citizen, you’re not allowed to come in with only limited exceptions.

If you’ve been to DRC, Uganda, South Sudan in the last 21 days.

What if you are a US citizen or so called green card holder on May 21, US government has announced that you may return to the United States, but you have to be screened and they want you to come in through Dulles International Airport.

That’s the one that’s down in Virginia, that’s one of our big international airports for Washington D.C. the idea is that if you have been in one of those locations within the last, we think, 21 days, they want you to come in through D.C. so that they can screen you to see if you are currently having symptoms, nausea, vomiting, fever, lack of energy, etc.

And they also presumably are going to get a lot of information about you so they can track you so that if you do develop symptoms subsequently, they’ll know who you are, how to get a hold of you, etc. So that’s really unusual to have a limited number of locations that you’re allowed to come into the United States, even as a US passport holder.

But that is at least at the moment that we’re doing this recording, that is what is required. So what I’m seeing here is really two different standards, right?

There’s the standard if you’re not a US citizen, where you’re just not even allowed in, in effect you will quarantine from outside of our borders.

Whereas if you are a US citizen, what I’m seeing here is that if you have no symptoms, you’re allowed to come to the United States and then you would be monitored for some period of time. But the details of what that monitoring involve are not clear to me.

So this questioner, Greg, was wondering about being quarantined back in the United States. That’s possible, I think what should not be possible from South Africa as he is going to do.

But even if you’re coming from one of these nations of higher frequency of the infection, it’s possible that CDC could say, hey, things have changed, we think you’re high risk, we want you to stay home and self monitor, for example. But I’m not yet aware of such an example, so I can’t give you the details of exactly what to do.

I think the key is yet again, if you are willing to go or you must go to one of these countries, you should be Flexible.

Even upon return, do not expect to come back through any old airport and do not expect to go back to your any old job or occupation or life that you had before.

This would mean paying a price in terms of your freedom to move around, your freedom of privacy for at least, you know, a period of 21 to 30 days after you return. Okay, And Chris, here’s another question that we’ve received, which is, what if I’m overseas and I get sick with Ebola?

Is it true that I’m going to have to go to Kenya? Can’t I come home to one of the biocontainment units? And the quick answer, I’ll jump in on this and you give me your opinion.

So what are the biocontainment units in the United States of America? We do have a small number of places around the country that are considered to be there.

Thirteen of these, they’re federally funded facilities spread around the country. They’re called the Regional Emerging Special Pathogen Treatment Centers, or respects. And these are biocontainment units.

These are hospitals that have all the right people, all the right equipment and the right infrastructure to take care of people who are very seriously sick and need very seriously not to come into contact with other people.

So that’s the kind of thing that you’ve seen in Hollywood movies and reading the books, people wearing the total body suits but still being able to take care of people who are sick. So I’m going to say it again. There’s 13 of these around the country and we’re proud of them.

They’re in Nebraska, they’re in Maryland, Texas, Georgia, New York City. There’s a number of them. They’re amazing, they’re great. And it takes a ton of time, energy, money and training to do this.

Even just being set up, as I recall from 2015, being set up here in Seattle, Seattle as an assessment center, not just to do the long term treatment, just to decide who is and is not actually infected and then potentially ship them off to one of these other 13 centers. It was just a huge drain on our system. We’re proud to do it and we can handle that.

The point is this idea of imagining you’re going to come home and end up in one of these centers, that’s a possibility. But you can’t just walk in, you can’t check yourself in. And the number of them is so small by comparison to the many thousands of potential patients.

Thus comes this unexpected, for me, unexpected move by the US Government who announced recently that they are setting up a pop up Hospital? Yes, in Kenya being staffed by doctors of US origin and reserved for the treatment of US patients.

So that if someone is a US citizen or presumably a green card holder, who the hell knows what this government’s going to do?

But if you’re a US passport holder and you happen to get sick with what is proven or could be Ebola virus disease, you could be cared for in this temporary new hospital in Nairobi. It’s a very controversial move. Right. Because we already have these wonderful centers here in the United States.

Why not bring people home where they can get the highest level of care? That’s what we’ve always done in the past.

Well, on the one hand we could say it’s expensive, it’s a huge drain on our system, which is already a broken healthcare system in my opinion. So maybe it makes sense to do things closer to home. I would simply say that, you know, creating hospital is a lot of work.

What’s the burden on the local healthcare facility? Just because something’s hard to do in the US does it mean that it’s going to be easier to do it in Nairobi? I don’t think so.

So this is not clear to me.

I think on the one hand the air transport piece can be slightly better because the flight is less, but that airplane that still has to go from, let’s say from Entebbe over, you know, to Nairobi, that’s still a big deal for them. That particular flight, maybe that air ambulance should be doing something else in East Africa to care for the people who are there.

So it’s a problem.

This is dynamic and I have not seen firm reports yet of what that hospital even really looks like, what its capacity is going to be and who’s going to do the work, who’s paying for it and how long they’re going to be on duty there.

WORM
00:28:41.970 – 00:29:26.590
Yeah, shooting from the hip when you’re a layperson in terms of public health measures is problematic.

So it may make sense to a non medical person to say, oh, let’s just keep it all there, but the care may not be as good and that may actually facilitate spread. I’m not sure either Related topic is intuition may say, oh, there’s an outbreak of Ebola, let’s close the borders.

But actually that’s against official advice. What we find is if you close the official borders, people still travel, but they go in an unscreened way.

So it’s actually better for disease control and minimizing the spread to keep the borders open. So again, I am sorry that currently some non medical people are making large global policy decisions.

GERM
00:29:27.230 – 00:30:13.240
Imagine that. Well, you know, to me, there’s a certain racism with it. There’s a xenophobic aspect to it, all kinds of problematic issues with this.

The virus doesn’t care. I should emphasize that the virus doesn’t care what skin color you got. Virus doesn’t care what language you speak. It’s just ready to infect you.

And so, as always, you know, these questions of microbiology and public health, they. They transcend human culture and. And our totally artificial international borders.

So I think there’s all kinds of ways for us to do better with our response here. I want to ask you for your hot take on the hot zone.

Chris, this book called the Hot Zone, the Preston book from years ago, I think that was talking about viral hemorrhagic fever. And what did you think of that book? Some of our listeners may have read it or be considering reading it now.

WORM
00:30:13.720 – 00:31:08.500
Yes, you refer to the hot A Terrifying True Story by Richard Preston, 1994 for I read it and, you know, I think it gets a little bit of the blame for sensationalizing this disease. It was a good read. The guy is a good writer, and it was largely factually true.

But it has some phrases in it like it said, when you get this disease, it liquefies your internal organs and it doesn’t do that. That was very kind of yellow journalism in my mind. And I think this gave the public undue fear for this disease.

Yeah, it’s a bad disease, but I think this book tried to make it sound like even a bigger and worse threat than it really was. So, as I say, it’s a big deal if you live in an affected area, if you’re a healthcare worker, if you’re a family member, if somebody who’s got this.

But in terms of this becoming a worldwide contagion, the odds are not high at all that that will happen.

GERM
00:31:09.300 – 00:31:24.740
I think we are likely to get some cases in the good old US of A. And I think we can handle it and deal with it. And civilization as we know it will not come to and end, although civilization as we know it today.

I think we could use a reset, but let’s not do it through Ebola virus disease.

WORM
00:31:24.740 – 00:32:00.740
Right? Right. Well, this thing causes panic.

And as I mentioned, when we talked about disaster response a few episodes ago, I worked at the CDC for a couple of weeks just manning the phone lines during that big 2014-16 outbreak. And some people who called were just panicked and unreasonable with their panic. They heard the word Ebola and Most of their brain left their head.

So there’s a lot of terror here.

And a lot of what I think docs need to do is just sort of real world test and let people know, no, this is not a thing that’s going to take out communities far away from the small areas where the outbreak is occurring.

GERM
00:32:00.900 – 00:33:19.620
I remember coming home, we were teaching on that East African diploma course. I happen to be based in Moshi, Tanzania. Came home that particular year, it was either 14 or 15, and had a good trip and was fine.

And my daughter had a checkup at her pediatrician’s office the next day after I came home. And, you know, she was being screened. Have you ever, have you recently visited West Africa?

And she said, no, but my dad just got back from Tanzania and it caused panic. They put a mask on her, they moved her into a different room. And her wonderful pediatrician, Dr. Kathy Rissi, like my hero.

And she just said, you know what? We’ve been trained how to ask these questions. We’ve never been told what to do with the answer.

And by the way, Tanzania is, you know, is far enough from that stuff. West Africa, it’s like farther from West Africa than it is to New York City. So you’re good. I agree with you.

We need to move past the fear, but also recognize this is a serious condition. It’s a social disease in a way. Right. This is, as always with these epidemics.

Right, Chris, if we could just get our act together and, and invest in taking care of people who have this and prevent its spread, we would all do better. I said it before and I’ll say it again. We need a World Health Organization to help take care of this. Wouldn’t it be great if we invested in that?

WORM
00:33:20.100 – 00:34:01.490
Yeah. And this is something where a relatively small amount of money could do a tremendous amount of good.

If you can isolate and find the cases and treat them in a safe way, then you’re going to minimize spread. And this is so simple.

I feel like I don’t have to say it, but when you do things like pull all the US Money out of the World Health Organization, that allows something that’s relatively small to become potentially huge. So I’m just horrified at the current cutback on USAID and other international organizations by the US Administration. Foreign.

GERM
00:34:05.970 – 00:34:37.830
Thank you so much for joining us here on episode 105 of Germ and Worm. As always, we welcome your questions on travel health. Just send them along or with tips for travel success.

If you want a clarification on something you’ve heard previously. We’d love to hear from you. Germandworm.com or send us an email.Germandworm@gmail.com Please join us next week for episode 106, Health Tips for the Menopausal Training Traveler with Dr. Karen Tang. If you’ve enjoyed this episode, please subscribe, rate us favorably on your device, and spread the word with friends, family and on social media.

Those are free ways to support this podcast. I’m Germ.

WORM
00:34:37.830 – 00:34:40.390
I’m Worm. It’s a big planet. See it in good health.

GERM
00:34:40.390 – 00:35:01.999
We look forward to seeing you next time.

This podcast is designed to inform, inspire, and entertain, but it does not establish a doctor patient relationship and so it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure.

The opinions in this podcast belong to Dr. Sanford and Dr. Pottinger alone and do not necessarily represent the opinion of the University of Washington or UW Medicine.