After a long day of work last month, I had seen over 20 young patients and their parents, finished teaching rounds, read uncountable notes on many charts, and had written at least one note on every child. I was packing up to go home when my resident physician called to say that she had to admit a teenager from the Emergency Department. He was in respiratory distress with a high fever, but was not critical. She then gave a history of the patient that aroused my interest and quickened my step towards the ER.
He was a very accomplished young man who had flown into Texas from Saudi Arabia 10 days before. His father was an oil executive who was giving some talks in the United States and our young man had been in San Antonio, New York City and now Philadelphia. Since the beginning of the year, he had also been skiing in Switzerland, debating in Turkey, and vacationing in Qatar. On the long flight from Saudi Arabia, he had been sitting next to a Saudi national who had a severe cough. Our patient developed a bad cough and fever in Texas, and in spite of taking three different antibiotics, steroids and Albuterol, he had gotten worse and required some oxygen in our ER.
I went to the ER and carefully scrubbed, gowned and masked. I examined this 14-year-old who was quite articulate with perfect English, but who could not stop coughing. He looked ill. We arranged for him to be admitted to a negative air flow room to protect other patients and treated him as if he had Middle Eastern Respiratory Syndrome (MERS). I was on the phone with the doctors from our infectious disease section, the doctor on call for the Philadelphia Public Health Department and he, in turn, was on the phone with the Centers for Disease Control and Prevention.
Our patient very slowly got better. We never proved what he had in spite of extensive testing, although he did have a lobar pneumonia on an X-ray study. We mainly helped his body get itself better with oxygen, nutrition, intravenous fluids, and time. Did he have MERS? I think so, but we probably will not know until he is completely better and he develops immunity to the disease and that doctors can test his blood for that specific immunity.
As you can see from this story, the world is very small. So far this year, I have seen an infant exposed to measles when a visitor from England who was not immunized developed measles while staying at the baby’s house. We had to pre-treat by giving the vaccine to prevent this often fatal disease in one so young. I have seen several children with tuberculosis acquired from either a foreign visitor exposure or from travel overseas. I have seen malaria acquired on a trip to South Asia. Polio is re-occurring in Africa and South Asia from ignorance, anger and disruption of the distribution of vaccine and wild polio virus has been found in sewers in countries such as Israel and Egypt that have not actually seen cases yet.
I have a 4-year-old grand-daughter who has been in 19 countries, and her 2-year-old cousin lives in Europe and has been to 15 countries already. I have a son who caught malaria in India. Oceans do not protect you when one can fly anywhere in the world in 30 hours.
Now we read every day about the Ebola crisis in West Africa. Ebola, a deadly viral hemorrhagic fever, is very infectious, has a 50 percent death rate and can lie dormant for three weeks between exposure and symptoms while the soon to be ill person spreads it around. Health care workers are at high risk of contracting this from their patients and the CDC recently issued rules for isolating these patients and their medical specimens.
No matter how much one tries to isolate oneself from the illness and troubles of the outside world, these problems can come and grab you. We all have to work together. At least get immunized for those diseases we can prevent, not just to protect you and your children, but also to protect everyone else.