Ebola Hemorrhagic Fever is the scariest thing to threaten the human species in a long time, and that is not hysterical fear mongering. Those who know about these things are scared. Really scared. Worst of all, they are quietly scared, and that should tell us all something.
It’s not just that it’s a relentless killer with up to a 90% fatality rate, but because of incubation periods of weeks it is a nightmare to contain. The fact that this virus is out of control is only partly due to the third world conditions where it first began to spread. In places where hygienic standards, access to sufficient supportive health care and burial practices that insist on bathing a body by the family members, the spread of nearly any infectious agent is going to be significant.
Since those conditions don’t apply in the US or much of the Western world, there is very little chance we will face an unchecked epidemic here, the Centers for Disease Control and the World Health Organization assure us. But there are significant contributors to the growing threat of a truly global pandemic that require our attention, factors that we may already be too late to address.
Worst Case Scenario Imagined-Then Exceeded by Reality
As I was researching this latest and largest threat to a concentrated population and how that scenario will most likely ensure the virus becomes truly global, I never considered the events that took place and are taking place right now in Liberia. Proof once again that truth is always stranger than fiction.
Officials in Liberia, in an attempt to stem the spread, moved patients into quarantine in a hospital in Monrovia. From an abundance of fear and ignorance, somehow the conflicting ideas that a) Ebola is a hoax, and b) the government was intentionally trying to infect the local population by bringing in Ebola patients from elsewhere, the decision to attack and ransack the facility was made. The hospital was looted, the living and even the sick were dragged (or ran) out into the streets along with anything that could be carried off, reused or sold by a rampaging mob. Including bloody sheets and mattresses.
The thinking behind this defies understanding. The residents of a slum next to the hospital seem to be the guilty parties. Reports of how many sick are unaccounted for are still sketchy and contradictory, and what happens next is anyone’s guess. And worse than anything I had imagined.
In my nightmare scenario, Liberia, Guinea or even Sierra Leone, the countries with the greatest numbers of victims were not considered . I was worried about Lagos, Nigeria. Lagos is the most densely populated place in West Africa, and the place where the first case of an Ebola victim who traveled on a commercial flight while sick had died.
On July 20th, a man got off an airplane in Lagos, was taken to a hospital and died five days later. The doctor and nurse who initially treated him became sick. It is still unknown how many were exposed by either that initial patient or by the health care workers who treated him, but the number released, 70, is both big and scary and probably a low estimate.
For the man to have died five days after his arrival means he potentially exposed every person on that airplane, every person in the airports in both Liberia and Nigeria, every person with which he came into contact on his way to the airport. Then, there are all those with whom he was in contact prior to his decision to travel. This man, identified as Patrick Sawyer was a top government official in the Liberian Ministry of Finance, proof the disease is not limited to remote areas, slums or the families of victims or the medical workers treating the ever growing numbers.
The fact the man was a US citizen originally due only to stop briefly in Lagos for a conference on his way home to his family in Coon Rapids, Minnesota shows how closely the US came to having a viral bomb detonating in the heart of America.
In order to understand the depth of the danger in Nigeria, we need to understand exactly where in Lagos this occurred. First Consultants Hospital is located in Ikoyi, an area considered one of the best, safest and most popular with Western expats. The hospital sits in a neighborhood that in many respects resembles any European city with high rises, offices and shopping malls.
Not unlike many other urban areas around the world, to reach these ostensible safe havens of the rich, transiting through or past slums is required. The slums of Lagos are infamous, for their size and number, lack of any semblance of services and their lawlessness. Many were former refuse dumps; others are still actively receiving the waste and debris of their sky-scraper neighbors.
Residents do anything to earn a naira. The fortunate ones manage to sell what they’ve scavenged to their slightly better off neighbors, those who have earned a few more naira in the marketplaces. There, most customers are those on the next rung up the socio-economic ladder, taxi drivers, common laborers, maids and low paid office workers. In other words, those who drive, serve and otherwise interact with the denizens of those shiny sky-scrapers.
So, my nightmare goes something like this – One or more of the 70 who were exposed to the initial patient are taxi drivers, merchants with a stall in the market or street vendors. They return home to their slum and expose their family and neighbors. Some of their neighbors have stalls in the market, others are taxi drivers or laborers. When your family and neighbors start to feel sick, they don't exactly call off work.
If you don't work, your family doesn't eat today and risks not eating tomorrow, next week and beyond. The moment you don't show up, someone else will claim your stall in the market or square footage of pavement, your turn behind the wheel or your place on the job site. But now, each has infected all of his customers and fellow laborers and stall merchants who go home and infect their own families. By the time word trickles around of that first guy having Ebola, the circle of contagion has spread so wide, it includes more people than can be tracked.
Ebola has an incubation of up to three weeks. So, in a city crammed with 21 million, with an estimated 70% of that number living in slum-like conditions or in the slums themselves, tracking every interaction, every contact is simply not possible. Add in the fact that most slum-dwellers will remain in their shacks, living and dying literally inches from their neighbors, and the nightmarish scene comes into focus.
The second population that must be looked at is the community of expats and Westerners who visit and work in Lagos. Nigeria has one of the greatest deposits of gas and oil in the world, a fact that has drawn multinational companies from around the globe. The money pouring into Nigeria is more than sufficient to turn Lagos specifically and Nigeria as a whole into the jewel of Africa. Except for the fact it is also one of the most corrupt nations in the world, according to the UN and nearly every International Aid organization.
As rumors of new cases of Ebola spreads, those who can will, and already are fleeing to their home countries in Europe, the Middle and Far East and even the US. In order to do so, they take taxis to the airports where they are checked in and searched by others who shop at the street markets; markets that are staffed, supplied and/or frequented by residents of the slums. So, even if they avoided infection while in Lagos, there is a good chance they could contract it on the way out of the country. And they will have been living for up to three weeks back home, exposing how many others, before they even realize they are sick.
Now, all we need do is change the scene of my nightmare from Lagos to Monrovia, add in the intentional albeit through ignorance spread of infected persons and materials. Thankfully, there are significantly fewer residents of Monrovia who have the means or visas to jump on the next flight but that still leaves over a million people in that city alone at risk.
What qualifies as airborne?
Some will say this is alarmist and not recognizing the fact that Ebola is not airborne. The Centers for Disease Control and the World Health Organization have repeatedly assured us of this, comparing transmission of Ebola to AIDS/HIV. While it is true that Ebola does require direct contact, it is misleading to assume it is difficult to catch.
AIDS/HIV require blood, semen, breast milk or in rare cases saliva to come into direct contact with an open cut, wound or mucus membranes. Ebola uses those same methods of transmission but the virus is also secreted in sweat, tears, urine and feces. In addition, contrary to CDC and WHO assurances, there is evidence Ebola is in fact airborne.
The Public Health Agency of Canada’s Pathogen Safety Data Sheet states, “In the laboratory, infection through small-particle aerosols has been demonstrated in primates, and airborne spread among humans is strongly suspected, although it has not yet been conclusively demonstrated”.
In the UK, concerns over Ebola having gone airborne prompted this scary headline from The Telegraph, “Several Britons across the UK quarantined at home after returning from West Africa”.
While the CDC keeps assuring us the virus is not airborne, they have issued the following, “Interim Guidance about Ebola Infection for Airline Crews, Cleaning Personnel, and Cargo Personnel”. It states, in part, to issue respiratory masks “to reduce the number of droplets expelled into the air” by persons exhibiting or suspected of Ebola symptoms. This can be chalked up to an abundance of caution and is in fact standard infection control precaution for any respiratory illness.
Saying Ebola is not airborne but may be contracted by aerosol droplets is splitting a very fine hair. The simple truth is there is much that is not known about this version of Ebola.
One of the primary reasons, beyond minimizing the death toll, to contain an outbreak is what happens to a virus as more and more people contract it.
Viruses have been called perfect killing machines. Their sole purpose is to replicate. Every time a virus is confronted with a new host, the chances that it will evolve increase exponentially. Viruses are inimitably adaptable, something we all know about that old perennial villain, influenza. Each strain is the result of an adaptation, the change designed to overcome factors that prevent or slow replication.
When Ebola occurred in small, remote villages, it’s opportunity for adaption was limited. Each person that was infected was genetically linked to the majority of victims. With a population comprised of diverse families, clans, tribes and races, the chances of the virus coming into contact with other viruses generally infecting people but with minimal or limited negative health consequences, the possibilities become the stuff of nightmares. All Ebola has to do is infect a person with the common rhino virus and have the it take on the transmittable characteristics of that generally non-fatal virus.
In other words, the thought that is keeping virologists the world over up at night is that Ebola will become as infectious as the common cold or influenza. Since it already can be contracted by droplets expelled by an infected person, I’m not sure what that difference will be. We are told that because the disease is so violently lethal, a sick person is less likely to go out in public, thereby minimizing the spread; it’s quick lethalness is what has and will inhibit it, we are assured.
On the other hand, it is also has a very sudden onset. Early symptoms do mimic a common cold with a headache and fever, maybe a cough. It is yet another piece of the puzzle that is not yet confirmed, but presenting symptoms seem to reflect the method of contraction. In any case, most people will not stay home and in bed just because of a headache, a little cough or even a low grade fever. How many of us have been surprised to find ourselves not feeling well, just sort of tired and achy only to realize we have a fever? At that point, we are relieved to know the cause of our general malaise but generally don’t go running home to bed.
With Ebola, it is not yet definitive how long those early, first symptoms last. Nor is it known if, or how much virus is being shed at that point. The word quick is used to describe the progression from mild to extreme symptoms, but even that is not the point at which many in sub-Saharan Africa will realize they have Ebola.
Suspected cases "unlikely" to be Ebola
High fever is also one of the symptoms of several other endemic diseases, illnesses with which the most affected population is quite familiar. Malaria, sleeping sickness, typhoid, yellow fever, tuberculosis, strep throat, meningitis, measles and dengue fever are just a few. Dengue fever can also mimic the later stages of Ebola at which point it is called dengue hemorrhagic fever. But, while dengue is sometimes fatal it is not directly transmittable from person to person. This is the reason we are told, repeatedly, that high fever, diarrhea, vomiting and even bleeding without the presence of a skin break aren’t necessarily proof a person has or had Ebola.
Because most of these and other diseases, with the notable exceptions of strep, measles, TB and meningitis are not contagious without assistance of another vector, like the mosquito, people suffering from them chronically don’t stay home or otherwise isolate themselves. It also explains why the practice of washing the dead body of a loved one, even one who succumbed to hemorrhagic dengue is not seen as dangerous, a practice that cultural norms insist on even in the middle of the current Ebola outbreak. In fact, because of the prevalence of hemorrhagic dengue, laboratory tests are required to confirm Ebola and differentiate it from these other deaths which are classified as not generally communicable.
One of the biggest, scariest parts of the threat Ebola poses is the incubation period of 2 to 21 days. We are repeatedly assured that individuals aren’t contagious unless or until they show signs of sickness. With one of the first signs being fever, which means sweating, that is not as encouraging as it sounds. As discussed above, those accustomed to a variety of generally nonfatal illnesses that present or include the symptom of fever aren’t likely to self-report much less self-isolate. Unless or until they are unable to move about on their own, they will continue with their daily activities, to include going to the market, their jobs and interacting with others.
Transmission from someone at the earliest first sign, the fever stage has not yet been proven, or if it has, that information has not been released. Unconfirmed reports state that American aid workers Dr. Kent Brantly and Nancy Writebol contracted the virus through contact with an infected man’s sweat-soaked arm.
Many contend that is less scary than other options, as it is assumed that these two medical workers with their experience and first-hand knowledge of the virus used all the standard PPE (Personal Protection Equipment) and still got sick. Of course, the definition of PPE is open to interpretation meaning that masks and goggles may not have been available and part of their gear. If that is the case, we are again back to the specter of an airborne transmission.
Another theory is that Brantly and Writebol contracted the virus at the clinic from another worker during scrub-in or disinfecting. That is the most disturbing of all the proposed scenarios. It would infer that even in the presence of disinfecting agents, transmission occurred.
For all the information and assurances coming out about Ebola, the CDC has been suspiciously quiet on exactly how these two American medical workers contracted the disease. Perhaps an infected person came up to them and vomited blood all over them. Perhaps there was an accident with a used needle or improper handling of other infectious materials. Even if that is not the truth of the matter, it would be a reassuring lie and would go far in helping quiet the fears, hysteria and the conspiracy theorists.
Attributing fiction to fact
Researching this topic will uncover the most bizarre ideas about population control, the Government with a big G’s intention to use the threat of an outbreak here in the US to implement martial law and even more extremist paranoia. The fact President Obama signed executive order 13295, “Revised List of Quarantinable Communicable Diseases” two days before Brantley was brought to Emory Hospital in Atlanta has added gravitas to the accusations.
That order has existed since 2003, and is both frightening and reassuring in its implications. In short, it says that medical personnel, with the backing of the police and/or government can involuntarily quarantine people with suspected diseases. The addendum Obama signed added respiratory symptoms or illness to the list.
I want the government to have a plan. I want to know that a person with a communicable disease that will kill more than one half of those who get it will be not be allowed to walk out of a hospital. Or off an airplane. That person may just be scared, but they may also be an anarchist, terrorist or simply exist in the belief that their personal wants and needs trump the rest of society, which seems to be the tragic case of Patrick Sawyer.
According to his widow, and CCTV footage from the airport, Sawyer knew he was sick, probably suspected it was Ebola and intentionally fled Liberia. She states he didn’t trust the health care system in Liberia, the country of his birth and where he was a high-ranking government official. She believes this is why he knowingly made the trip to Lagos, a decision he has been criticized for as he is blamed for bringing the disease to that country.
Ignorance and fear have proven to be the most effective vectors for the current outbreak in West Africa. How else do we explain the mob looting a hospital with Ebola patients? How else do we explain the attacks on medical aid workers that were merely trying to track the outbreak in the early stages? Ignorance of the cause, fear of the government, aid workers and the belief people were being intentionally infected were drivers of the decision to simply cordon off entire villages. Of course, here in the US and the rest of the civilized world, such attitudes and actions are inconceivable.
Looting and rioting over perceived injustices simply doesn’t happen here. The National Guard hasn’t been called up in Missouri, vast swathes of the west side of Chicago aren’t still burnt-out shells, mobs don’t take to the streets to celebrate a hometown sports team’s victory by overturning cars and smashing store fronts. The quote, “A person is smart. People are dumb, panicky, dangerous animals” explains another favorite quote, “Never underestimate the power of stupid people in large groups”.
Do I want this administration to exercise the authority contained in Executive Order 13295? Absolutely not, any more than I would want the previous or any future administration to do so. But, given the alternative, I’m not sure what other option exists.
Here in the US, the CDC has repeatedly stated there are no confirmed cases at this time. As of August 17th, one woman in New Mexico is being tested for Ebola. She returned from a trip to Sierra Leone on August 5th, became ill and went to the hospital, immediately stating her fear that she had been exposed. Officials stated it is unlikely she has Ebola. Reference the above list of diseases, and that is a valid statement. It is unlikely any person in this country will contract Ebola, until someone does. It is an empty reassurance while it is technically true.
Officials have carefully explained that the chances of an outbreak like we are seeing in Africa are extremely remote. Part of that is due to our standard medical practices of consistent use of proper PPE, part is due to the relatively easy accessibility to proper isolation protocols. The biggest factor in our favor is of course, American’s penchant for running to the Doctor every time we sneeze.
However, the populations most at risk in this country do not live or react in the ways we assume. For example, in the Minneapolis area which is home to the largest concentration of Liberians outside of Africa, community members are more likely to turn to their culture, traditional healers and herbs than to Western medicines. Distrust of government is another cultural norm they have carried from the home country and fears of discrimination are already taking root, with apparent cause.
Officials and community leaders are sending what many see as a mixed message. While assuring residents there have been no cases here in the US, it was also announced that police and fire personnel will be wearing eye protection, masks and gloves when responding to calls for flu-like symptoms in Brooklyn Center, the Minneapolis suburb, one of the area towns that is collectively home to more than 30,000 Liberians. Already, reports are coming in of people being sent home from their jobs for sneezing, leaving some to wonder how much they can trust the government of their new home to properly care for them if an outbreak were to occur.
By the numbers
If we look at the current death toll and compare it to the average annual fatality rate of influenza, all this does seem to be a serious but relatively minor issue. But, it’s not the numbers that are worrisome, it is the percentages.
In undeveloped areas, death rates from illnesses that are easily survivable in the US are disproportionately high. Where Ebola is concerned, it is not the raw numbers but the fatality rate the is the true indicator. The percentage that paints the clearest picture is the number of health care workers who have died. The risk of exposure and incidence of infection is higher because of the nature of the job, but so too should be the survivor rate. And it is. But, we are still talking about a more than 50% fatality rate, even with supportive care.
As of August 19th, of 170 laboratory confirmed cases of infected health care workers, more than 81 have died. This is much better than the 90% death rate of those who have not received care or received it too late. But this death rate exceeds the bubonic plague of the Middle Ages, an event that changed the course of human history and far exceeds any influenza outbreak.
The 1918 Influenza outbreak killed more than fifty million people, with some estimates as high as 100 million. Even that horrifying number represented a mere 2.5-5% mortality rate of those infected, which is estimated to be 500 million. Part of the reason for the spread of what has been viewed as the worst pandemic in human history was the mobility of the population. Think of what the death toll would have been if air travel existed. Or if the Spanish Flu death rate mirrored Ebola.
The most frightening aspect of all is we haven’t even seen the tip of the iceberg. This current outbreak is believed to have begun on December 6, 2013 in Guinea. The CDC doesn’t list tracking of this outbreak until March, and as of August 19th counts 1,229 deaths, the number that has been confirmed by laboratory analysis. Still, that doesn’t seem like a lot, until you factor how cases are geographically and exponentially spreading in recent weeks. And once again, compare the death toll to the infection rate.
Now, add in the 29 confirmed cases in that hospital in Monrovia, 17 of whom may or may not be accounted for; reports of either four or ten were found with their families and forcibly returned to quarantine. It is safe to assume that those four families, as well as the uncounted others exposed to the fleeing patients and the looted, contaminated items were not practicing proper medical isolation, and we begin to get a picture of what is coming. Assurances by the Liberian government that they have the situation under control are at best premature.
Dr. Joanne Liu, President of Doctors Without Borders has stated it will likely be six months before this current outbreak will be under control. That statement was made before news of the attack on the clinic in Liberia was released. Now, she says that without assistance from other organizations and NGO's, "we will not be able to contain the Ebola epidemic".
The point of all this is not to be unnecessarily alarmist. Some things are really as bad as we fear, or could become so very quickly. There have been calls to suspend all air traffic in and out of Guinea, Sierra Leone and Liberia, with Nigeria being hesitantly added to that list. India has announced it has established a quarantine zone for all travelers from infected areas. The WHO has called for exit screening at international airports, seaports and major land crossings, steps many say should be mandated not requested. That may or may not be possible, nor is it realistic to quarantine all US-bound passengers who have been in or through these countries. On the other hand, if this is what ends up being necessary, perhaps acting sooner rather than later is better.
This, ultimately, is what we are looking at as a distinct possibility. Beyond the disruption to international commerce and business, these steps pose serious ethical questions. With air, sea and land travel severely curtailed or even halted, goods and supplies, and the commerce necessary to purchase them would be impacted with catastrophic results. But, while Ebola has the potential take out more than half the inhabitants of the entire planet in the balance, there may be no good options. Ebola is not the first scary, modern plague threat, but it is the most viable. And it has the potential to evolve into the greatest humanitarian crisis the world has ever seen.
Despite cautiously optimistic-sounding statements by the WHO such as, the situation in Guinea is "less alarming", the spread is continuing predominantly unchecked across West Africa. In addition to those in areas contiguous to the epicenter, cases have been reported in South Africa, Saudi Arabia and Spain, with suspected or feared cases in France, the UK, Russia, Abu Dhabi and even here in the US. Everywhere, the accusation has been that governments have been slow to respond and health care infrastructure has not been sufficient or simply non-existent.
In many areas, supplies and supportive medical equipment have run out, if there was any there to begin with. Fear, ignorance and insistence on certain burial practices have contributed to the spread. Entire villages have been decimated by the disease and the few survivors are now succumbing to starvation and all the other endemic disease due to the road blocks, cordons and quarantines of entire areas. And it is still spreading. Despite the Liberian government's statements, it is only a matter of time until Monrovia is listed as a new epicenter, with Lagos sure to follow.
Still, the news isn’t all bad
Supportive care in this case is little more than hydration and early treatment, though these simple steps can dramatically improve survival rates. New antivirals, such as the much touted ZMAPP that was given to the two American aid workers transferred to Emory in Atlanta show promise. Yet, even that is not a miracle drug or guaranteed cure. One of three doctors in Liberia who received the experimental drug has died. Labs around the world are scrambling to find anything that even slows the virus, and a vaccine is still a pipe dream months or years in the future.
In the interim, reliance on the simplest forms of care and quick diagnosis offer the best hope. News that the US government has deployed a rapid assay test for Ebola to National Guard troops in all 50 states is both heartening and cause for further concern. Quickly confirming Ebola as opposed to other less deadly and contagious diseases will be critical in conserving limited resources. The fact that our government appears to be prepared makes one wonder if more could not have been done in the past months to prevent the current crisis. If-or when-Ebola reaches our shores, this will be a question that won't be easily or comfortably answered.
Currently, laboratory confirmation of Ebola requires 24-48 hours. If it can be determined in 30-45 minutes that a person does not have Ebola, pressure for quarantine space will be alleviated. As it stands now, even in the hardest hit areas, PPE and sufficiently secure isolation space is lacking, causing some Ebola patients to be treated in less than ideal conditions. Which raises the specter of more contaminations, creating the need for even more care, with fewer and fewer supplies and caregivers.
This lack of personnel and equipment has been blamed for the initial spread of the disease, and the deaths of those who brought their family members to aid stations and clinics. It is standard practice in remote areas and villages for family members to remain with the sick, providing the care one would normally see delivered by nurses and other trained health care workers in the West. Relatives feed, bathe, change sheets when fresh bedding can be had and generally try to keep their loved ones clean and comfortable, all with absolutely no protective gear. Not even a gown or gloves, much less the recommended face mask, eye googles and quarantine isolation tents.
This is yet another reason for the CDC, WHO and other’s claims that the type of outbreak seen in West Africa is virtually impossible in more developed nations. It would be inconceivable to think a nursing mother would sit at the bedside of another sick family member here in the US, exposing herself and her infant. Yet this is exactly what was and shockingly still is happening. So, once again, while the offered assurances are valid, they are based on premises and scenarios so foreign to our standard of care as to be little more than empty and hollow statements.
Of course this, or any disease for that matter, would not spread here in the US the way it has in West Africa. Being able to contain an outbreak if one should occur (or, when) depends in large part on the populations access to adequate care. And on the mobility and concentration of that community. Still, while it is a near guarantee people won’t be required to provide food and care for their own loved ones in a hospital here, the average resident of an American city comes into contact with more people in a single day than someone from a remote village in Africa will in years.
What to do
According to all the experts who are constantly reassuring us, there is nothing to fear. While that statement is not entirely true, it isn’t completely false either. The key word is nothing. When faced with a situation over which you have no control, there is wisdom in not worrying; worrying about a thing will not make it less of a problem.
The chances are honestly slim that we will see a rash of cases much less an outbreak on American soil anytime soon. But, given how the situation in West Africa can be realistically categorized as beyond anyone’s ability to control, sooner or later we will see cases of Ebola here in the US. It is simply inevitable. What is not inevitable is the complete decimation of the country with death counts in the millions.
Because of that long incubation period, the spread of the disease is relatively slow. It is accelerated exponentially, of course, with each additional case. Some forecast models predict Ebola will arrive here in the next months, others state it is possibly already here. Either way, the fact that we are entering cooler weather is both a boon and yet another cause for concern.
As temperatures drop, people go about publicly with less skin exposed. Gloves and scarves meant to keep us warm will also help minimize exposure to potentially infectious aerosol droplets and contact with the virus expressed in the sweat of a bare arm or hand. But, people also congregate indoors more, increasing interpersonal contact.
Common sense tells us that for the general public and all except those who have reason to believe they are exposed to an infected person, either because of their job as a health care worker or association with someone who has traveled from an infected area, we really don’t have cause for undue concern. One often overlooked consideration is the fact that every year, we get better at minimizing the spread of the common cold due to conscientious reliance on the simple act of hand washing during flu season.
How many times have we all been in a meeting or other social situation with someone who declines to shake hands and sits apart from others because they fear they have a cold? It is common and usual to see someone sneezing into the crook of their arm, whip out a tissue and immediately follow that with a bottle of hand sanitizer. In fact, those few who don’t follow these new norms of social behavior are quickly admonished, even by strangers on a bus or train.
I’m only being half sarcastic when I say that I look forward to the death of that time-honored social custom of shaking hands with everyone we meet. It has been proven and known that simple ritual is responsible for the transmission of most communicable diseases in this day and age, yet we persist in it.
I’ve been teased for years about my near-fanatical refusal to touch nearly any surface in public, particularly anything in a bathroom used by anyone other than my own family members. It’s actually become a running joke how I can successfully complete a transaction in a public restroom without touching anything, even the lock on the door. I’ve been known to leave a restroom and go in search of another if there aren’t paper towels, tissue or something to use as a buffer between me and what I imagine as a veritable petri dish full of every known and unknown virus, bacterium and general yuckiness.
The other social custom I would not be sad to see go away is hugging. To me, that is an expression appropriate only with those to whom I am related or particularly close. I’ve been considered stand-offish because when I sense the desire for a hug coming over someone, I quickly stick out my hand for a warm, sincere shake. Once handshakes go away, a smile, bob of the head and words will have to suffice. Funny, but to my mind, these all seem like the best things we can do in the event of an Ebola outbreak as well.
It is not my custom to cite sources, as this is a blog, meaning an opinion. I'm proud of my reputation for writing factually and presenting multiple sides of an argument or situation. I research and verify every statement I make that is presented as fact, to the best of my ability. I can be wrong in my conclusions, overlook a key piece or source of information, but I have and will never simply fabricate something and call it a fact. It may be true, correct and even Truth with a capital T, but it will be presented as the natural (to me at least) continuation or conclusion of verified facts. In other words, my carefully considered, well researched opinion. But, as this is an evolving situation with as much rumor as fact floating around, below are some of the dozens of sources I used. Make of them what you will.
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