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iiw fry r dh . Kes Gilhome ofm/Amm a g g megfi ll og like to frequent resorts in exotic locations and workers who labor on development projects in remote sites are particularly at risk. Dr. Tulu advises such travelers against swimming in freshwater lakes in Africa, for example. “They might think they are okay, but there are parasites there which carry diseases like schistosomiasis,” he said. Symptoms of that disease, caused by tiny worms, include diarrhea and anemia; in rare instances, if the worms burrow into the brain or the spinal cord, victims can also suffer seizures or paralysis. It’s fairly common among refugees who have settled in Dallas. To Dr. Tulu’s mind, the greatest imaginable public health disaster would be one in which some strange communicable disease infiltrated Dallas, and then went unnoticed for a considerable length of time. “The worst-case scenario is, you have a certain disease that isn’t recognized early on,” said Dr. Tulu, and it has spread very much by the time it is discovered, so that it is too late to control it.” Of course if the illness happened to be highly contagious, things could spiral out of control very quickly. For a few days last fall, Dr. Tulu actually feared that might have happened. 0 n the night the woman with Ebola symptoms was admitted to the Medical City E.R., Dr. Johnson summoned three of the hospital’s physicians to consult with himspecialists in internal medicine, hematol ogy, and infectious disease. They discussed the possibility that the woman had AIDS. Dr. Steven Seidenfeld, the hospital’s infectious disease specialist, knew that HIV infection rates in parts ofAfrica were more than 30 percent. But this didn’t look like any AIDS case that the doctors had ever seen. Even if the woman was HIV-positive, they figured she must have an acute infection on top of that, given her raging fever and all the bleeding. Word of “the Ebola lady” spread through the ranks of the Medical City staff faster than any virus ever could. The supervisor of the orderlies called Miller, the infectious disease control nurse, at 6:15 on Sunday morning: Was it safe to clean the room the Ebola patient had been in down in the E.R.? Miller assured the supervisor that regular medical disinfectants would kill even Ebola. Meanwhile, similar fears were compromising the work of the hospital’s laboratory. Technicians there decided not to continue examining specimens from the woman, because they feared that the Ebola virus might permanently contaminate their equipment. Hospital staffers were failing to perform their jobs according to regulations, due to the irrational fears now blooming in their minds. Later that day, Seidenfeld was able to elicit a far more complete history. The woman said that she had never traveled to Uganda. In fact, during the month that she spent in Africa, she never left Zimbabwe’s capitol city of Harare at all. She had, however, taken a rather meandering journey home. Dr. Seidenfeld listened with dawning horror as the woman related that from Harare, she had flown to Cairo, Egypt, where she had waited for 16 hours, then caught a plane to Newark, New Jersey. From there, the woman had taken a Greyhound bus to Dallas. She had started to feel sick on the flight to Newark, and had vomited in the plane’s bathroom. Her condition had worsened on the trip to Dallas; she had vomited repeatedly in the bus’s bathroom, and for the first time had noticed blood in her vomit and urine. A stunned Dr. Seidenfeld had visions of countless people getting on and off the Greyhound bus at every stop along its route from Newark to Dallas. He couldn’t even begin to calculate how many individuals the woman might have infected herself, let alone how many other people those individuals might have gone on to infect across the eastern and central parts of the United States. If this woman had Ebola, then it sounded as though she had probably spewn the virus over scores of people in a dozen different states. He might have an exploding public health catastrophe on his hands. Dr. Seidenfeld broke the news about the bus trip to Dr. Tulu in 10 THE TEXAS OBSERVER 7/20/01