Blog | Monday, November 10, 2014

Ebola!!! What about everything else? Influenza for instance


Ebola virus has grabbed headlines since the epidemic started in West Africa nearly a year ago. The death toll is estimated at 4,500 people, and the epidemic continues to spread. One person infected in Liberia returned to Texas with the disease and died, infecting maybe 2 health care workers.

Ebola is a nasty virus, surely, with a case fatality rate of 80%. Overall health and nutrition as well as living conditions have an effect on how sick a person gets with it. We have no good treatments, though antibodies and other biologically based treatments are being used and may be rapidly developed to combat the disease.

But have we forgotten influenza? Influenza is a nasty virus, with a few marginally helpful treatments. Its symptoms are fever, headache, cough, sore throat, runny nose, sometimes also heart failure, respiratory failure and brain dysfunction. It will likely kill tens of thousands of Americans this season, mostly the very old and very young, but also perfectly healthy people.

How about other globally relevant diseases? One and a half million people in the world die of AIDS yearly, the same number of tuberculosis, about 700,000 of malaria and more than the total of all 3 of these of malnutrition.

So we can't do very much about Ebola at this point, other than perhaps support the overseas programs that are trying to help the affected West African countriesof Liberia, Sierra Leone, and Guinea. These

will probably have a more significant second wave of misery due to the economic devastation brought about by the epidemic. In the U.S., Ebola is not likely to be an issue of significance. Perhaps learning to don and doff HAZMAT suits will benefit us in some as yet unknown way. I am open to scorn and censure if I am wrong.

What should we do about influenza, since that routinely kills many thousands of us? Should we all get flu shots? I am not entirely convinced. I get them every year and induce my loved ones to do the same. The flu is utterly nasty, even if it doesn't kill you. It comes on like a freight train, with upper respiratory symptoms and intense misery. It hurts to move your eyes. You can barely think and you certainly can't work, at least after the first day when you go in and infect everyone else. The cough lasts weeks. You are infectious for at least a week. Old folks go from flu to pneumonia and sometimes die. Anything that will lessen my chance of getting it is welcome. Still, wholesale vaccination programs of healthy people do not statistically decrease hospitalizations or work loss, and 70 people must be vaccinated to avoid one case of influenza. This is per a large Cochrane Collaboration evaluation of many well designed studies.

As we enter influenza season probably the most important thing to do to avoid the disease is not to spread it. People with classic flu symptoms should not go to work or school, should not fly or travel in any public conveyance, and if they try, they should be sent home. Will we actually heed this advice? No, at least we haven't so far.

What about malaria and AIDS and tuberculosis and hunger? There are lots of great ideas out there, from newer medications to public health campaigns, promoting peace, helping women farmers, digging wells, curbing environmental abuses, that sort of thing. Committed and creative people are working all the time. We just aren't hearing much about them since apparently the most pressing global health issue right now is Ebola.

Janice Boughton, MD, ACP Member, practiced in the Seattle area for four years and in rural Idaho for 17 years before deciding to take a few years off to see more places, learn more about medicine and increase her knowledge base and perspective by practicing hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling. Disturbed by various aspects of the practice of medicine that make no sense and concerned about the cost of providing health care to every American, she blogs at Why is American Health Care So Expensive?, where this post originally appeared.