The front page of the Friday, November 7 issue of USA Today carried a story about fears relating to the lab specimens from Ebola patients—and the equipment used to analyze them.  David DeRose, MD, MPH, author of the newly released book, Evading Ebola (available on quickly penned a response to the cover story.  The USA Today editors decided not to publish Dr. DeRose’s OpEd piece.  Although we don’t know their motives, it seems like they missed an opportunity to highlight the very important issue of “inapparent infection” that DeRose discusses in his Evading Ebola.  Please tell me what you think.

    Now here’s Dr. DeRose’s rejected submission:  “Inapparent Infection” Facts Inject Sanity into Ebola Dialogue
    by David DeRose, MD, MPH (Board-certified specialist in Internal Medicine and Preventive Medicine, author of the newly-released Evading Ebola)

    Health professional and lay Americans alike continue to be on edge about the exotic and deadly Ebola virus as eloquently testified by the recent USA Today cover story, “Latest Ebola Fear: Safety of Lab Equipment” (November 7, 2014).  The excellent reporting actually reveals how we public health professionals have backed ourselves into a corner by failing to talk about perhaps the best news about the Ebola virus, namely its ability to cause “inapparent infection.”
    Let me explain.  An inapparent infection occurs when a person becomes infected with a disease-causing microbe yet never becomes overtly ill.  For years, health professionals have been dealing with the practical implications of this reality as it relates to the influenza virus.  You see, if someone with a healthy immune system is infected with the flu virus, he or she may well develop an “inapparent infection.”  In other words, many health care providers who “never get the flu” have inapparent infections.  Although such infected individuals may feel fine, they are indeed infected and have the capacity to infect others.  For this reason, most hospitals mandate flu vaccines (or the use of masks during flu season) for all their providers.  Vaccination is designed to decrease the likelihood of health professionals developing inapparent infections and subsequently exposing their already-ill patients to the flu.

    What we health professionals have failed to adequately communicate to the masses is this:  Ebola also can cause inapparent infections.  I believe a proper societal response to Ebola cannot ignore this important truth.  To address this gap I recently released the book, Evading Ebola.

    Consider some salient evidence and insights from that source.  In the aftermath of a 1996 outbreak of Ebola in Gabon, Africa, researchers examined close contacts of those who suffered from overt Ebola infection.  They identified 24 individuals, all of whom had been exposed to infectious secretions (feces, vomit, saliva, sweat, or blood).   Remarkably, none of them became ill.  Furthermore, blood testing revealed that eleven had been infected with Ebola—but never became clinically ill.  In other words, nearly half had inapparent infections.  The implications of this study are very encouraging:  humans can have high-risk exposures to Ebola and not become infected.  Additionally, even if infected, those presumably with strong immune systems can fight the virus off—without ever becoming sick.

    Quarantining or destroying lab equipment used on Ebola patients, thus misses an important point.  Individuals, especially those recently arrived from West Africa, may come to the US with inapparent Ebola infection and access our health care system.  Their blood may be infectious, but no one takes any special Ebola precautions, because those patients are asymptomatic and undiagnosed.  Yes, viral loads are magnitudes higher in individuals with clinical Ebola infection, but it is theoretically possible for those who are merely carriers of the Ebola infection to contaminate lab equipment at low levels.  All of this argues for the practice of universal precautions, treating all blood as if it could potentially harbor infectious agents such as Ebola, HIV, of Hepatitis C virus—not case-by-case scenarios.

    Furthermore, this dialogue introduces the “dark side” of inapparent Ebola infection—perhaps betraying the reason why the subject has yet to be broached in the public arena.  Although the evidence indicates humans are far less susceptible to serious Ebola infection than most have assumed, we are probably at higher risk of exposure than most have gathered.    Indeed, because of the extent of the current West African epidemic, the virus is probably circulating more than most of us are willing to admit.
    Yes, we should do all we can with public health measures. We should continue strict quarantine practices with Ebola patients.  We should carefully sanitize lab equipment.   However, at the end of the day, in the context of the on-going epidemic, our confidence should not rest solely on the performance of government agencies and health care providers.
    It’s time for all of us to live an “Ebola-Aware Lifestyle,” paying careful attention to hygiene (think especially of hand washing), and keeping our immune systems fit through practices like moderate exercise, sensible eating, adequate sleep, and smoking cessation.

    Whether every vestige of the virus is destroyed from lab equipment, health care environments, or public conveyances is perhaps not the most important issue.  The “game-changing” perspective, educated by the science bearing on inapparent infections, seems to be this:  Even if exposed, most of us likely can evade Ebola, through proper hygiene and healthy lifestyle practices—at least in terms of clinical disease. |

    Notes:  Dr. DeRose, a board-certified specialist in both Internal Medicine and Preventive Medicine also holds a Masters degree in Public Health.  DeRose has been maintaining a limited clinical practice in Northern California while running Compass Health Consulting, Inc.  He is the author of Evading Ebola, currently available as a Kindle eBook, and soon to be released in print.  He is also known for his work as host and executive producer of American Indian Living, a syndicated health radio show heard on over 140 stations coast-to-coast.