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Opinion | The Checkup With Dr. Wen: Do we need to worry about Ebola now?

Leana Wen Worldwide Speakers Group
Thought Leader: Leana Wen
October 13, 2022
Source: Link

You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. 

As covid-19 numbers finally decrease and new monkeypox infections level off, Uganda is in the midst of an Ebola outbreak, with a reported 63 infections and 29 deaths thus far. The Biden administration has already responded to the potential threat to Americans by diverting travelers from Uganda to five airports for enhanced screening.

Is Ebola a virus Americans should now worry about? The answer is no — and yes.

On the one hand, there are no suspected cases of Ebola in the United States at this time. Ebola is not a new disease; it’s been studied, and the world has dealt with it, for decades. We know how to recognize it, how to isolate infected individuals and how to prevent the virus from spreading.

Ebola is spread through direct contact with blood and other bodily fluids. It is not airborne, and only symptomatic people can transmit it. Ebola is therefore much easier to contain compared with the coronavirus, which can be spread by asymptomatic people and through microscopic droplets in the air.

That’s the good news. Here’s the bad: Ebola is a terrifying disease. Initial symptoms include fever, vomiting, body aches and fatigue. As the virus spreads, it damages organs and stops blood clotting. Patients suffer severe, uncontrollable bleeding including from their eyes, nose, ears, mouth and rectum.

Ebola has a fatality rate of about 50 percent, which means about half of the people who contract the disease will die from it. And here’s another major worry: The strain that’s causing the outbreak in Uganda is one for which we don’t have a vaccine or treatment.

This outbreak has also already claimed the lives of four health-care workers. At least six more have been infected. Uganda faces a shortage of health-care professionals that’s been exacerbated by covid-19. Even before the pandemic, the government’s health response was hindered by malaria, HIV and other existing health challenges. Addressing this shortage has taken on even more urgency, as has the need for sufficient masks, face shields, gowns, gloves and other protective equipment to keep the existing workforce from falling ill.

As we have learned with covid and monkeypox, the key to containment for any contagious disease is to identify and isolate all those infected and to find their contacts to “box in” the virus. There is a limited time frame to do so. The more spread has occurred, the harder the virus will be to rein in.

Already, five districts throughout Uganda have detected Ebola cases. The virus might well be spreading to neighboring countries such as Kenya, Tanzania and the Democratic Republic of Congo. Travel screenings can help detect cases that find their way to the United States, but it’s far better to intervene at the source — to stop transmission in the country of origin

What the United States and other wealthy countries must do is send equipment and workers now, with the understanding that doing so will prevent far more costly interventions down the line if Ebola were to come to our shores. We also must fund and assist with the testing of vaccines and treatments.

Doing so is the right thing for humanitarian reasons. And it’s in our own self-interest because safeguarding our country’s health and security requires a global public health response.

“I recently caught covid. I’m fully vaccinated, plus two boosters. How soon after testing negative can I get the third booster and the flu shot? I’m 74 years old and have some complicating medical issues.” – Richard from California

Technically, you can receive the vaccines as early as 10 days after the diagnosis of covid, as long as you no longer have fevers. I would wait a bit longer to get your coronavirus booster — at least three months — to allow your body to develop antibodies that would complement the protection of vaccination.

However, you are not protected from flu after just having had covid. I’d suggest that you receive the influenza vaccine soon (before the end of October) and then schedule the updated coronavirus booster in about three months.

“When I made my mammogram appointment, I was told by the scheduling lady to wait on my booster (the new one) until after my mammogram. I assume she is reading off something from the radiologist. What is the reason?” – Carol from Oregon

Some people mount a strong immune response to the coronavirus vaccine that includes swelling in their lymph nodes. If they get a mammogram right after the inoculation, there could be a false positive, indicating that there may be a problem when it’s just the temporary effects of the vaccine.

The coronavirus vaccine is not the only one that can cause this response. Some other vaccines, such as the shingles vaccine, might do this as well.

In the winter of 2021, the Society of Breast Imaging released guidelines recommending a four to six week delay between receiving a vaccine and getting a screening mammogram. There have since been studies that show enlarged lymph nodes may persist for longer than this period, and there may be harm associated with delaying cancer screenings.

As a result, the Society of Breast Imaging updated its guidelines in 2022 and no longer recommends a delay between a vaccine and a screening mammogram. Instead, radiologists could ask patients when they last received a vaccine and in which arm.

Some radiology offices might still be following the earlier, more conservative guidelines. That seems to be the case with your radiologist. If your mammogram is coming up in the next few weeks anyway, I think it’s reasonable to delay your vaccines until right after your cancer screening. But in general, people should not postpone their preventive checkups or their vaccinations.

“I have received both initial vaccines and two boosters. My last booster was in April. I will be visiting a newborn grandson at Christmas. Should I delay my bivalent booster until a few weeks prior to my December visit, or have the booster now and another one in late November/early December?” – Patricia from New York

Congratulations in advance on the birth of your grandson!

A lot of people want to time their covid booster for just before a time when they could be exposed to greater risk from others. It sounds like you are trying to do the opposite — that is, you want to get the booster so that you reduce your risk of getting covid and passing it on to the baby.

If that’s the case, you could evaluate your age and risk factors for severe covid. If you are susceptible to severe outcomes and have a high risk of exposure on a daily basis, you could get your updated booster now. You wouldn’t be eligible for another booster before seeing the baby, but you could reduce your risk of contracting covid by masking in crowded indoor settings and testing before visiting your grandson.

There’s another option, which is what you said: You could wait a few weeks before your December visit to get boosted. You would have maximal protection during the visit, and if you were most concerned about your exposure from other people (i.e., you’re worried about getting covid from the family you’re staying with), then this option would be the most sensible. But if you are most concerned about exposing the newborn, I think the first option — including taking additional precautions before and during your visit — would be better.
What I’m reading

Only about 1 in 3 adults surveyed by the Kaiser Family Foundation said last month that they have either already received the updated coronavirus booster or plan to do so. The rates were higher among older individuals, though less than half of Americans 65 and older said that they have gotten it or intend to do so soon. Awareness also remains low, with about half of adults replying that they had heard “a little” or “nothing at all” about the new booster. This underscores the necessity of a coordinated public education campaign before another surge hits.

New data from Centers for Disease Control and Prevention shows that unvaccinated people are 14 times more likely to contract monkeypox than people who had at least one dose of the Jynneos vaccine. This is compelling, though early, research to understand how protective the vaccine is in real-world settings. Those vaccinated could still contract monkeypox, but the risk appears far lower compared with those not yet vaccinated.

Using CDC data, David Leonhardt and colleagues at the New York Times analyzed covid death rates by racial groups. They found that while Black and Hispanic individuals had far higher death rates than White Americans in early surges, the gap has substantially decreased. The compelling charts in the article illustrate that covid-19 exacerbated underlying disparities and that intentional attention to reduce disparities can succeed.

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