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Staying Safe in South Sudan (Guardians Part 4)

Posted by Richard Conniff on April 17, 2013

So how do people like Dr. Clarke stay healthy in places like Lusaka or, another of his recent postings, South Sudan? And what can they teach the rest of us? You can protect yourself plenty of ways, epidemiologists say, and we’ll detail some of them below. But it’s worth remembering that what happens in the farthest corners of the earth may be at least as important to your survival. The viral diseases that make headlines—AIDS, SARS, Ebola, and so on—almost always spill over from other species when people hunt animals for meat, turn them into pets, or otherwise make contact in ways that disturb habitats and disrupt the natural order. That’s happening far more rapidly now than at any time in our history, and we have few clues to what trouble we may stir up next. Scientists have so far identified about 2,000 virus species. But at least 3,000 more remain unidentified, and then there’s fungi and bacteria. The trick is to keep the bad stuff from spilling over into the human population.

“The old approach 10 years ago was that you just waited until lots of people started dying,” says William Karesh, D.V.M., a veteran of past Ebola outbreaks who now works with EcoHealth Alliance in New York City. “And then a lot of foreigners would show up wearing what looked like space suits, and that would just terrify everybody locally. A lot of them would run away because they didn’t know. Their family members were being taken away alive and never coming back. They were dying.”

The villagers who lived told stories that weren’t much different from those stories about spaceship abductions. But they were real. “Then somebody said, why don’t we talk to them between outbreaks? Why don’t we talk to them all the time? And that’s the solution—regular engagement and education,” says Dr. Karesh. So the strategy now is to have a continuing epidemiological presence out in the disease hot spots, teaching local people both to minimize environmental disturbances and to recognize trouble when it comes. Now, he says, if they run across a dead animal in the forest, they report it to health authorities instead of eating it. Local people have become the advance guards of surveillance.

CDC virus hunter Stuart Nichol

CDC virus hunter Stuart Nichol (Photo: Jamie Chung)

Outsiders still pour in to respond to an outbreak, but the approach now is more precise and less panicky. At the CDC, Stuart Nichol, Ph.D., had just come back from an Ebola outbreak. Nichol downplayed the Hollywood “hot zone” reputation of hemorrhagic diseases: “Most of the cases that show up are not bleeding from every orifice. They are not melting down.”

But that actually makes diagnosis more difficult because the typical symptoms could just as easily be caused by common flu. So the response now is to set up a small field lab in the thick of an epidemic for rapid diagnosis. Patients are tested in the morning, “and by 5 o’clock in the evening we can tell people whether they’ll be going into the isolation ward or going home,” says Nichol, chief of the CDC’s Viral Special Pathogens Branch. “The basic approach to containing one of these outbreaks is to remove the infected people from the community and place them into isolation wards, to stop those chains of transmission.”

Is that enough? All of last year’s hemorrhagic fever outbreaks were limited to a few dozen cases, rather than the hundreds in past outbreaks. But the trouble with prevention is that you never know if you’ve done enough.

It’s still possible, says Nichol, that someone with Ebola or Marburg could catch a jet to New York or some other great megalopolitan splotch of light and start a chain of human-to-human transmission. “Would it kill a lot of people? Probably not. But the report of 10, 20, 100 cases in New York would cause significant panic. So we can’t be complacent.”

What about keeping yourself safe as an individual traveler in what can seem like a scary world? Epidemiologists going out on a posting typically consult the CDC’s own Yellow Book, the bible of recommended vaccines and medicines for countries worldwide. (Check out your destination at cdc.gov/travel.) For frequent flyers, the Yellow Book is now available as an iPhone app. (There’s also an app called Outbreaks Near Me, from an infectious-disease mapping service the CDC relies on.)

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