“No, Dr. Bentley, we are in no way prepared for Ebola.”

Pippa Abston, MD, PhD, is considered by many, to be the preeminent, board-certified general pediatric physician in the Tennessee Valley, and is author of the following commentary, written in response to a news item entitled “Ebola hasn’t surfaced in Alabama but state ready, Gov. Bentley says,” published October 08, 2014 at 9:03 AM, updated October 08, 2014 at 12:59 PM at http://www.al.com/news/index.ssf/2014/10/gov_robert_bentley_on_ebola_vi.html.

In his press conference, Governor Bentley said, “In the event that Ebola spreads to Alabama, we are ready and we are prepared to respond.”

Thursday, 9October2014, 6:18am

By Pippa Abston, MD, PhD

Alabama Governor, Dr. Robert Bentley, MD (a retired dermatologist) holds a Press Conference Wednesday, 08 October 2014 purporting to assert state readiness for the Ebola virus.

No, Dr. Bentley, we are in no way prepared.

First and most seriously, people lack insurance or have high co-pays/ deductibles, so they will delay going to the doctor or ER and expose others in the meantime.

Second, our public health infrastructure is underfunded and understaffed.

A couple of years ago I let the local HD (Health Department) know about a new viral syndrome I was seeing, which needed to be identified because some strains had caused deadly epidemics. They weren’t interested.

I got ADPH (Alabama Department of Public Health) to respond and we did identify a new coxsackie virus which caused several hospitalizations but fortunately was not as bad as some other strains. However, during the early monitoring period, when there was still uncertainty about severity, there was a ludicrous snafu. The HD had no courier to collect samples from hospitals or offices. The hospital would not transport to the HD. The HD only wanted samples from the sickest patients, in the hospital, but because of the courier issue we had to send the samples ourselves from clinic after patients were discharged, with our own staff. Which (samples, not staff) were promptly destroyed by the HD because they had not come from the hospital. Is that preparedness?

Third, Texas notwithstanding, there will still be human error and a learning curve.

Just yesterday I was joking with an excellent pediatrician friend that I had performed another magical miracle cure– kid who had a fever/ sick looking at home who was instantly not sick on arrival to the office. We do that all the time– it is like the car that only works when you take it to the mechanic. Parents think we don’t believe them, but we do! Anyway, I mentioned that I had still remembered to ask about travel and my friend looked completely puzzled– asked ‘why, what did that have to do with anything?’

Yeah, we are prepared…

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-Secondary Responses-

PA: The time to prepare for these things is WELL before we even know about them. Once an epidemic is underway, it is too late to build infrastructure.

Q: What about the flu? Is Alabama ready for the flu? It kills way more people than Ebola has.

PA: No– when we have bad flu there are not enough hospital beds and again, people with financial strain go to work instead of to the doctor.

Comment: I’m one of countless folks I know who couldn’t take flu symptoms to a doctor. If Bentley was really concerned about public health, he’d have accepted Medicaid expansion.

PA: There are some differences with flu worth noting though. For one, it is contagious for a full day prior to symptoms, unlike Ebola which isn’t contagious until the person is sick. Flu is much more easily transmitted. Best way to cut risk is with vaccine. And flu doesn’t kill anywhere near the percentage of ill people. With Ebola or similar illnesses, a strong public health system could actually prevent spread. With flu it would be more about vaccines and treatment of complications. Ebola itself isn’t even necessarily the only such infection we could choose to prepare for, by funding public health. Something new could happen any time, anywhere.

PA: Oh, by prepared I guess he means we are going to be surrounded by men in hazmat suits if we get airsick. I get it now. http://www.al.com/…/10/passenger_with_symptoms_of_ebo.html

Q: Dr. Abston, could you explain to your commenters and readers that the R-naught number and high mortality rate of the disease as well as the low communicability is right now the primary defense strategy the CDC is counting on? And that’s not exactly a bad thing. Could you also go into detail that so far we have not exceeded the “outbreak” of ebola in the US from 1990. There were 4 cases then. Some of your commenters are very concerned about Ebola. Proper education is key and the Media is doing a very poor job of that.

PA: The problem is that Alabama is both a first world AND a third world country all rolled into one. The tendency for pathogens to become less virulent as they become more transmissable seems to rely on first world infrastructures that are spotty here. Many rural counties have completely lost their hospitals to closings in the past several years. We still have people without even modern plumbing in this state, more than you would think. We have a certain amount of earned suspicion of law enforcement and public authorities, due to targeting of poor and minority communities for arrest. These things are no good in a high virulence pathogen situation, when you do not want people to rely on each other for health care as happens now– when you want them to trust those in charge. And having the firemen surround airplanes in hazmat suits probably isn’t that helpful.

Preventing Ebola from becoming epidemic here, in virulent form, depends mainly on getting it under control internationally, because it would take several incidents like the Texas one to kindle anything that would take off and be significant. But the longer it goes unchecked in Africa, the more such incidents we will see. Travel bans are unlikely to help that situation, from what I have read. This is the largest African outbreak, and it may actually already be a sign of higher contagiousness and lower virulence– since only half the patients who were sick enough to seek care have died, not 90%. But half is still an awful lot. Eventually, if Ewald is correct, it will be all over the place– much more contagious and much less serious. However there very well may be intermediate periods in which it is pretty bad, especially in areas like Alabama.

I don’t think anyone needs to be in a panic. However I stand by my statement that we are not prepared and that our ongoing wrong-headed policies have created conditions that do put us all at risk for this type of epidemic, if not Ebola then something else, something home-grown. We already have an ongoing epidemic of deaths from everyday infections and illnesses, due to lack of healthcare. If it takes fear of a virus to realize we would do better to have everyone with healthcare and basic decent living conditions– a first world country– I’ll take it. I don’t think I am overstating the situation. As a pediatrician, I know I am in the group most likely besides family to get exposed if that happens. Kids have an interesting tendency to do things like grab your face mask and rip it off. I had a child with autism in clinic today who made a crow’s nest of my hair and nearly ripped off my earrings before I could disentangle him, all the while spitting in my face and blowing. I’ll have what he’s having, lol, in a few days. Heck, I’m probably already immune to Ebola and don’t know it.

If anyone is interested in how the virulence/ contagiousness thing works, this is one of the best layperson books to explain it. http://smile.amazon.com/Plague-Time-Germ-Theory-Disease/dp/0385721846/ref=smi_www_rcolv2_go_smi?_encoding=UTF8&%2AVersion%2A=1&%2Aentries%2A=0