Disease balancing act: Experts walk the line between informing and scaring the public

IOWA CITY — Television crews stalked a Dallas apartment last week where a man from Liberia became the first Ebola patient diagnosed on U.S. soil. National media outlets sent breaking news alerts Wednesday when that man — Thomas Eric Duncan — died on Wednesday.

In the past weeks, Facebook and Twitter feeds have been consumed with updates on new diagnoses and deaths around the world. And the University of Northern Iowa on Wednesday held a public information panel on the virus.

Travelers who come from West African countries will be handed questionnaires and have their temperatures taken at five of the busiest airports in this country, Josh Earnest, White House press secretary, said Wednesday.

Meanwhile, health experts in Iowa continue to push information about preparations that hospitals have made should someone with a questionable travel history present with flu-like symptoms.

And all the attention on what has become the deadliest Ebola epidemic in history has health care providers in Eastern Iowa and elsewhere struggling to juggle their obligation to inform the public with concerns over fueling hysteria.

'It's not that I want to downplay it — you have to take all the information into consideration — but it feels like the information is being passed so rapidly with so many people that it often becomes sort of an overreaction,' said Susie Poulton, director of health and student services for the Iowa City Community School District, which also has been monitoring news this fall on the Enterovirus D68 that has infected thousands of children across the country.

Local public health experts said the ease of communication and availability of information in today's global society explain, in part, why this Ebola outbreak and specific enterovirus are getting so much attention — and causing so much fear.

'I really think it has to do with the media and social media,' Poulton said. 'We need to put it all in perspective and rely on the experts in the field, the epidemiologists, and the folks in public health for their expertise and guidance.'

And the experts in Linn and Johnson counties said that while they are keeping abreast of the Ebola situation in West Africa and of cases popping up around the world, including in Texas, they are not overly concerned about it spreading widely in this country or in Iowa.

'I'm not losing sleep worried that we will have that kind of outbreak,' said Heather Meador, senior public health nurse for Linn County Public Health. 'There are so many more diseases out there that are more widespread and can be devastating.'

Meador said local health officials have extensive policies and procedures in place to prevent outbreaks of all types of communicable diseases that remain prevalent globally, such as measles, meningitis, polio, malaria, tuberculosis and Chikungunya fever.

Measles, for example, infects an estimated 20 million people worldwide every year, killing 122,000.

It was declared eliminated from the United States in 2000, meaning there no longer were continuous measles transmission for more than 12 months, but the U.S. Centers for Disease Control and Prevention earlier this year announced 288 cases of measles had been reported from Jan. 1 to May 23 — the largest number in the United States in that period of time since 1994.

'Ebola is one of many,' Meador said, 'and we are always on the lookout.'

That doesn't mean more cases of Ebola won't occur in the United States. They could, Meador said. But, if they do, the U.S. health care system and infrastructure is set up to handle them.

'The health care infrastructure in the United States and West Africa are so vastly different,' she said. 'That's why we have so many people going over there. They don't know how to do this. But we do.'

'Hard to even compare'

To date, the recent Ebola outbreak in West African has infected more than 7,400 people and killed more than 3,400 in Guinea, Liberia and Sierra Leone — the hardest hit nations. Cases such as the one in Dallas have started turning up in other countries involving infected individuals from West Africa.

The United States is deploying about 4,000 service members to the African region to help combat Ebola, which causes hemorrhagic fever marked by bleeding and organ failure. This specific outbreak so far is killing about 55 percent of those infected, and it spreads through bodily fluids and only when symptoms are present.

Long before Ebola rose in the public consciousness, Meador said, U.S. health care providers were on the lookout for infectious diseases and practicing protocols, such as notifying public health officials, quarantining patients, isolating them and tracing contacts to find others who might have been infected.

'We have all of that in place, and we use that on a regular basis,' Meador said.

This country's hygiene practices and level of sanitation also are 'vastly different' than in West Africa, Meador noted.

'It's so hard to even compare,' she said.

Still, Linn County Public Health has been working closely with UnityPoint Health-St. Luke's Hospital and Mercy Medical Center in Cedar Rapids to make sure health care providers follow proper procedures — such as asking patients about their travel history when they come in with flu-like symptoms.

So far, no patients have been tested for Ebola in Linn or Johnson counties, officials said. The University of Iowa Hospitals and Clinics has seen three patients who answered 'yes' when asked if they had traveled outside the country before becoming sick.

But they all had traveled to Europe, said Douglas Van Daele, UIHC chief medical information officer. If someone with flu symptoms were to report travel from West Africa, Van Daele said, that would trigger an alert to the physician, who then would isolate the patient and contact public health officials about further screening.

A patient would be kept in an isolation unit until a test either confirms or denies Ebola, Van Daele said. And if the disease is present, the UIHC would treat the patient 'to the best of our ability.'

'I wouldn't anticipate those patients being transported,' he said. 'If we can support and take care of the patients, we would.'

It's unlikely, however, the UIHC would be chosen as a treatment facility for Ebola patients being brought over from West Africa — including several American health care providers and journalists who were brought home to receive treatment, Van Daele said.

'I think this is certainly not something the public should be alarmed about,' he said. 'We have very good systems in place to actually treat patients when come in and are at risk.'

In fact, UIHC workers began asking about travel history weeks before it was recommended.

'We certainly have done a lot of work to prepare for any patients that may make their way to Iowa,' Van Daele said.

No cause for alarm 'at the moment'

As for the recent outbreak of Enterovirus D68, Van Daele said, that hits 'a little closer to home.' It has been more widespread in the United States and has sparked parent fears after several children reportedly died from causes associated with the illness.

Still, Van Daele said, 'It's not something that should cause alarm at the moment.'

The virus has not been as prevalent in this area, he said, and many patients who contract the virus suffer only mild symptoms. He said fears about these types of illnesses have been getting more attention of late, in part, because of the news media and social media.

'And we have a much more mobile population than ever before,' he said.

Meador, with Linn County Public Health, said she thinks people also are scared of the unknown. But Doug Beardsley, director of Johnson County Public Health, said he thinks the U.S. response to Ebola so far should come as a comfort.

'There have been no secondary transmissions of any patients who have been treated in the U.S.,' he said. 'That lends to the fact that our hospitals know how to isolate and handle infectious diseases.'

University of Iowa President Sally Mason addressed the issue Wednesday, saying the university has not limited travel among its staff and students but has cautioned them on what to watch for. And, Mason said, the university does not have any programs, such as study abroad partnerships, in West Africa.

UI sophomore Morgan Commet said she isn't too concerned for her safety right now, but she thinks many people are because they're aware of the toll it's taking in Africa, and because the disease is new to many of them.

'I think many people are going toward hysteria because they don't know much about it,' Commet said.

Whether she becomes more concerned — to the point of changing her daily habits and contacts — depends on how nation handles the first case in Dallas.

'Right now I'm not too worried,' she said. 'But if the cases become more pronounced, I will be.'