Is it safe to travel? Should we cancel our long-planned family safari in Botswana? Can I get Ebola from an airplane seat? For the last two decades, I've been helping people find the best doctors, treatments and medical information -- and I've never seen the kind of health panic among clients like I do now. (Yes, No and Extraordinarily unlikely are the short answers to these questions, by the way).
For expert advice, I checked in with Dr. Michael Callahan, an associate physician in the Division of Infectious Diseases at Massachusetts General Hospital/Harvard Medical School. Callahan ran one of the Department of Defense programs for mass-casualty infections; he's personally cared for over 400 Ebola patients; and he recently returned from building an Ebola unit in Monrovia. "Sitting directly next to somebody on an airplane who's sneezing is unpleasant and might pose a health risk," Callahan says. "But not for Ebola, because Ebola patients aren't sneezing. Even at the onset of fever, Ebola patients are minimally infectious. By the time they are a danger to others, they are very, very sick. They're making lots of trips to the bathroom, they've been throwing up and they're dehydrated. They're not the people that are on your aircraft."
In fact, you're more apt to get food poisoning, malaria or dengue while abroad. And that's your real problem because the initial symptoms (fever, vomiting, diarrhea) of many of the most common preventable infections mimic those of Ebola. Five airports in the U.S., and, many more globally, have begun enhanced passenger screening to weed out sick passengers for quarantine -- which could mean you or someone in your family if you become sick with similar symptoms at the airport or on a plane. Here are seven ways for travelers to create their own health-security bubble. Tips #3 though 6 are developed for travel to resource-constrained regions.
1. Stop worrying about the air on your plane. Contrary to popular belief, the air on the vast majority of planes is very safe. Next time you're sitting on the tarmac waiting for take off, watch the little specks of dust in the atmosphere. As soon as the system kicks in, they're sucked upwards into a HEPA-grade filtration system that removes more than 99 percent of bacteria and viruses. Then clean air -- about 50 percent filtered and recycled and 50 percent from the outside -- is circulated through the cabin. "That system takes care of droplets of flu, SARS, MERS and more," says Callahan. "The air on a plane is not where contamination comes from." When Callahan directed DARPA studies of aircraft in Asia, in which they sampled the air and swabbed common touch-surfaces (door handles, faucets and tableware), researchers found influenza, cold viruses and bacteria that can cause diarrhea on the plane's surfaces but not in the air.
2. And start worrying about your hands. Everyone knows the classic way to catch a virus: A sick person with poor hygiene leaves a little blood, saliva, mucus, vomit, urine or fecal matter on a light switch, handrail, dollar bill, etc. Then you touch that surface and bring your hand to your eyelid, nose or mouth. Think about this whenever you enter a public bathroom: as you touch the flush lever, faucet tap or door handle, you risk transferring pathogens to the cell phone you bring to your face, the coffee cup you raise to your lips or the child resting in your lap.
"People are grossly contaminated on their hands," Callahan says. "Which is why we are rigorous about the use of antiviral hand cleaners, which work beautifully -- especially on clean hands." Soap and water alone don't totally sterilize the viruses on your hands, they just make them fall off; and antivirals don't work as well if the virus is protected by organic matter, like blood and dirt on your hands and under your nails.
Dried Ebola on a doorknob or countertop surface can survive for minutes to hours; but when the virus is protected in a coating of body fluids, it can last up to several days at room temperature. Common household bleach will kill Ebola and just about everything else, but the most practical way to stay safe while traveling is to wash your hands with soap and water and then follow up with antiviral hand cleaner. Keep a small bottle of it in your pocket, purse or waistband, and use it after every time you touch a public surface. You don't need much -- just a nickel-size dollop in the palm. Rub it in, up to your cuffs, until your hands are cool and dry. Be sure to use a brand that has at least 62.5 percent ethyl alcohol -- the magic number required to kill almost all viruses (including Ebola).
"And pick one that doesn't have a lot of aloe or emollients," Callahan says. "Those just help protect the virus by coating it in a nice shellac of skin products. This is not a beauty product. It's got a job to do."
3. Curb your culinary adventurism. Traveler's diarrhea (or TD) is the most common health problem for Americans abroad, especially to resource-constrained regions, and it can be caused by a number of common pathogens in food and water. "Anything that's cooked through is going to kill Ebola, so that's not a concern," says Callahan. "But many food- and water-borne cases of TD are due to bacterial toxins that can survive cooking. Typically, if you are vomiting within minutes to three hours of a meal, you can blame a bacterial toxin." Due diligence here includes avoiding raw or undercooked meat; washing and peeling fresh fruits and vegetables yourself; no eating unpasteurized cheeses and milks; and staying away from street food. Ebola is generally not spread through food.
4. Learn a few clean-water tricks. These clean-water tricks will dramatically reduce bacterial and viral infections, particularly in resource-constrained regions. They're not relevant for Ebola, which cannot survive in water more than a few minutes at most.
In Africa, counterfeit water bottles are a real problem. Inspect the rim of the bottle: Counterfeiters will heat-seal the plastic rings on the neck, melting them back together to make it look like a new, unopened bottle. But if you squeeze it and air gaps and bubbles emerge, that's not a safe water supply. Another telltale sign: Fake labels that look laser-printed. "You can't ever peel off an Evian label in one piece. It falls apart," says Callahan. "The manufacturer purposely does this, in part to prevent counterfeiting of their bottles in Africa."
To sterilize tap water for drinking, four drops of bleach per one liter of water will do the trick. In desperate measures, running the tap until it's about 140-degrees Fahrenheit (so hot that you can only stand it for one second) will greatly reduce (but not eliminate) bacteria in water. (And if you can boil it, that's even better). "It's too hot for most pathogens to maintain their metabolism against the thermo stress so they die," Callahan says.
5. Up your antibodies like a pro. Many countries are experiencing an increase in pertussis, diphtheria, measles and chickenpox -- all of which can be prevented with vaccine boosters recommended by the CDC such as Tdap (tetanus/diphtheria/pertussis), MMR and VZV. If you follow the CDC travel recommendations, you are good to go, but some high net worth globetrotters also follow what's called an Executive Vaccine Itinerary. You won't find a list of these regimens on any website, says Callahan, but depending on your age, personal medical risks and the known health issues of your destination cities, these measures may also include oral typhoid, meningococcal and rabies vaccine and anti-malarials.
"You don't need to vaccinate with everything available, because vaccines have a potential downside of lost work days from having a sore arm or being feverish," Callahan says. But above all, do not leave home without getting a flu shot. Influenza consistently causes fever in returning travelers from Africa and rural Asia, and when you are boarding a plane is not the time to be feverish.
6. Arm yourself with the right antibiotics. If you do get sick abroad, medications for stand-by treatment may help you nip it in the bud so you can fly without causing panic among fellow passengers. And this becomes exceedingly important if you are passing through places like the United Arab Emirates (many Kenyan and Tanzanian safari groups transfer through UAE airports), where they are terrified of Ebola. If you show up at the Dubai airport with a fever, it doesn't matter where you're coming from -- you will be quarantined, and any arguments about your civil liberties will fall on deaf ears. Administered under the direction of a physician and depending on where you're going, azithromycin (aka Z-Pak) and rifimixin for food and water-borne diseases (E.coli, salmonella, typhoid fever) and doxycycline for tick-borne diseases may also be good to have, Callahan says.
7. Avoid the stupid stuff. Now's not the time to wake up in a foreign medical center, with pins in your leg from surgery, and a blood bag hanging by your bed. Upping your hospital-avoidance strategies includes simple things like using local drivers instead of renting a car; not renting motorcycles and mopeds, especially if you don't already drive them at home; no windsurfing over coral reefs. In other words: no risky behaviors.
That includes romantic misadventures. "It's amazing the amount of bad judgment folks can muster when they get off a plane," Callahan says. "In addition to the remorse that they usually feel, they might get a fever or a lump in their groin on their way back home, and there's a whole new problem to worry about." In fact, among men who have recovered from Ebola, the virus can still be present in their semen for up to three months. "We now suspect that Ebola is a sexually transmitted disease as well," Callahan says. "We just never had enough survivors to find that out."
Most Americans have a better shot at winning the lottery than catching Ebola while traveling. But the ripple effects of the outbreak can still ruin your plans in other ways. Getting your shots, avoiding risky behaviors and being vigilant about hand hygiene will help keep you safe and prevent unnecessary delays and fears for everyone.
The WorldPost sent this blog to Dr. Callahan to verify his quotes and references to research findings, and he confirmed their accuracy.