Blood poured from the man’s mouth and nose.
It was September 2014, five years into my time as CDC director and the peak of Sierra Leone's Ebola epidemic.
Our team was working their usual late shift in the Freetown office. The driver had been waiting outside. Minutes before departure, someone burst in: the driver was bleeding badly.
Ebola is a horrific disease, and it, along with Marburg, a similarly lethal viral disease, continues to spread unpredictably in parts of Africa. The virus destroys vital organs and causes uncontrollable bleeding. It can kill half the people it infects and spreads through blood and other body fluids. In an Ebola zone, with no safe equipment for resuscitation, our team could only keep distance and watch the man die.
This was horrifying. But it was also preventable.
Tests later showed he didn’t have Ebola. He had suffered a massive stroke from untreated high blood pressure. The stroke triggered seizures. The seizures made him bite his tongue, which had caused the bleeding. He was in his 50s and left a family with children behind.
Hypertension: The Silent Killer
Hypertension is the world's most neglected health problem. It kills more than ten million people every year—nearly one of every five deaths—yet attracts less than one dollar of every thousand spent on global health. People generally feel nothing until stroke or heart attack strikes. Many never reach hospitals.
The driver's death reminds us that silent killers can be deadlier than outbreaks that make headlines.
The world – particularly countries in Africa – has made progress stopping deadly outbreaks. Early this year, with the help of new vaccines and better treatment, both a Marburg virus and an Ebola outbreak were stopped swiftly by Rwanda and Uganda, respectively. A new study showed that with image-based screening and machine learning it may be possible to identify new treatments for Ebola. This is promising news. By seeing the invisible, it’s possible to uncover clues about how microbes harm us and how we can stop them. Although treatments have improved, these remain deadly viruses, including for front-line healthcare workers in Africa.
Part of the tragedy of high blood pressure is that for half a century we’ve known how to prevent and treat it. Deaths from hypertension are largely invisible precisely because they are so common. Many people assume – incorrectly – that increased blood pressure and the resulting premature deaths are a normal part of aging. This is the illusion of inevitability, and breaking that illusion is the second step in The Formula.
Better prevention and treatment of hypertension, which I also describe in The Formula for Better Health, can save more than a million lives a year. It can prevent heart attacks and strokes across the world. It could have prevented the driver’s death.
This is why we must see the invisible.
We must not only see the invisible through uncovering how viruses such as Ebola attack our bodies but also make visible the preventable diseases that kill millions each year.
Without tracking systems and effective control, silent killers such as hypertension, high lipids, lead poisoning, and liver disease will continue to spread and kill millions of people.
Public health has saved literally billions of lives. Once we see these silent killers and believe we can end these pandemics—as we ended smallpox and controlled diphtheria and tetanus—we can work together and overcome the political and economic barriers to health and create a future that allows millions of people, including you and your family, to enjoy longer, healthier lives.
Dr. Tom Frieden is author of The Formula for Better Health: How to Save Millions of Lives – Including Your Own.
The book draws on Frieden's four decades leading life-saving programs in the U.S. and globally. Frieden led New York City's control of multidrug-resistant tuberculosis, supported India's efforts that prevented more than 3 million tuberculosis deaths, and led efforts that reduced smoking in NYC.
As Director of the CDC (2009-2017), he led the agency's response that ended the Ebola epidemic. Dr. Frieden is President and CEO of Resolve to Save Lives, partnering locally and globally to find and scale solutions to the world's deadliest health threats.
Named one of TIME's 100 Most Influential People, he has published more than 300 scientific articles on improving health. His experience is, for the first time, translated into practical approaches for community and personal health in The Formula for Better Health.