December 15, 2014
The 2014 outbreak of Ebola in West Africa has claimed thousands of lives and devastated the three hardest-hit countries -- Liberia, Sierra Leone and Guinea. Rapidly spreading and with a high fatality rate, this virus has sowed fear and panic across the region. Family members of those infected are shunned or worse. Even survivors -- who are not only no longer contagious, but are also immune to reinfection -- are ostracized.
In the U.S., where the joke is that more people have been married to Kim Kardashian than have been infected with Ebola, stigma and irrational fear are also endemic. Health care workers and other responders to the outbreak have been treated as pariahs -- calls for their quarantine were largely motivated by political posturing rather than by a desire for public health protection. Although there is no risk that an infected clinician who returned from West Africa could have left any infectious materials in the bowling alley he visited prior to developing symptoms, that establishment was given the full hazmat treatment -- at least Brooklyn can now boast the cleanest bowling alley in New York City.
This irrational fear of a deadly unknown rings all too familiar to many of us in the HIV care community who witnessed the dawning of the AIDS pandemic. The social distancing and the overreactive responses were all very real when that other virus originating from West Africa hit. In his memoir, My Own Country: A Doctor's Story, Abraham Verghese poignantly recorded the early days of the domestic HIV epidemic, when respirators used on patients with PCP were buried behind hospitals, bed sheets of AIDS patients were burned, and clinicians volunteered to treat infected patients and donned protective gear when they did so. Sound familiar? More recently, Verghese asked in a New York Times editorial why Ebola responders, putting themselves at risk to contain an infection that could spread to other continents, are being met with suspicion rather than praise. As he points out, this is not the way we respond to our other defenders, the military.
It is not too surprising that many of those heading toward the Ebola outbreak are veterans of the fight against HIV. Many clinicians drawn to HIV see clearly the parallels between that virus and this newer threat. Some are traveling to West Africa, while others are exploring treatment and prevention interventions, or readying their hospitals for cases that might emerge closer to home. These are people who long ago trumped fear with reason and purpose -- and they will reach out and help those who others shun.
What are some other top clinical developments of 2014? Read more of Dr. Wohl's picks.
David Alain Wohl, M.D., is an associate professor of medicine in the Division of Infectious Diseases at the University of North Carolina and site leader of the University of North Carolina AIDS Clinical Trials Unit at Chapel Hill.
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