The current outbreak of Ebola virus disease has been all over the news lately, and of course, many rumors and much misinformation has been spread. Here are ten questions regarding the outbreak that will set the record straight about what is going on in West Africa:
What is Ebola virus disease?
Ebola virus disease (EVD) is an acute viral illness that used to be known as Ebola hemorrhagic fever. It is caused by three of the five species within the Ebolavirus genus. Two species are capable of infecting humans, but do not seem to cause illness - so you can catch it, but you won't notice it. The other three can cause variable degrees of illness. Unfortunately, the Zaire Ebola virus is the most deadly strain, and has been identified as the cause of the current outbreak. In previous outbreaks, this strain has had a 90% death rate.
Where did EVD originate?
It is not entirely clear where the virus originated, though it is thought that bats might harbor the virus in their intestinal tract. It is likely that the virus made the transmission to primates through ingestion. The first humans to be infected and spread the disease likely went hunting and ate an infected animal. Bats, pigs, and dogs are all believed to be reservoirs for the virus. The first human outbreaks were in Sudan. Out of the 284 people infected in the first outbreaks, 151 died from the disease; 53 percent.
What are the symptoms?
Once a person has contracted the Ebola virus, it can take up to 21 days to become symptomatic. The disease causes flu-like symptoms including aches, abdominal pain, fever, vomiting and diarrhea. This leads to dehydration, failure of the liver and kidneys, and hemorrhaging. Some patients may even go into “cytokine storm” in which the immune response is unregulated and an excessive amount of cytokine and immune cells damage tissues and organs, with potentially fatal results. However, there are many diseases that can cause these symptoms, so blood tests need to be done to rule out things like malaria, hepatitis, cholera, meningitis, and others.
How is it treated?
Well, it isn’t really. Not directly, anyway. I know this doesn’t sound very encouraging, but the best course of action is to give the patient support. Intravenous fluids will prevent dehydration, keeping the patient cool can mitigate the effects of the fever, pain relievers can add some degree of comfort, and health officials will also monitor oxygen levels as well as blood pressure. There is not currently a vaccine to prevent EVD.
What is the prognosis?
This question unfortunately does not have a clear answer. Some outlets have been claiming the death rate is anywhere from 50-90%, but that is a huge variation and isn’t necessarily an accurate figure to be used on a case-by-case basis. Prognosis is dependent on many factors, including the viral strain causing the infection, available medical care, and speed of diagnosis. Those that have the illness identified and receive treatment early stand a better chance of surviving the infection. Unfortunately, since the symptoms are rather generic and resemble so many other diseases, patients can be misdiagnosed, which could delay treatment.
How does it spread?
The virus can spread through contact of bodily fluids, which is a bit problematic given the amount of sweat, vomit, and diarrhea involved with caring for a patient. The virus can also be spread through semen up to seven weeks after the onset of disease, even once symptoms have abated. Ebola is also somewhat unique in that it is still virulent even after its host has died. This means that those who prepare the body for funereal customs must take extreme precautions.
What’s the deal with the current outbreak?
The outbreak was declared in March in Guinea. Since then, the disease has spread to Liberia, Sierra Leone, and Nigeria. Two Americans who had been infected while in Africa will be brought to Emory University Hospital in Atlanta in order to receive better treatment than what is available in West Africa, and will be subjected to a barrage of treatments in order to better understand the disease. As of the time of this writing (August 1) there have been 1,323 confirmed cases with 729 deaths (55% fatality rate) spread across four countries in West Africa. This is the largest EVD outbreak ever recorded. Sixty of the deaths have been of health care workers who were seeking to control the disease.
Should I be worried?
Though many in the developed world are understandably fearful of the disease, many health officials claim that the only reason this particular outbreak has grown as large as it has is because of where it hit. The areas that have been hit the hardest lack sufficient health care systems and are unable to provide necessary treatment for the patients or personal protective equipment for health care workers. Unsanitary conditions would allow the outbreak to grow incredibly rapidly.
For those living in developed countries, such as the US, it is not likely that the virus will spread. CDC Director Thomas Frieden has said that there is not the potential for Ebola to spread throughout the US like it has in West Africa. The virus can only be transmitted when someone is sick, and all major ports of entry have received quarantine stations to find travelers who may be ill. However, the CDC has issued a Level 3 travel warning to Guinea, Liberia, and Sierra Leone to prevent exposure. Even if it did manage to get across the Atlantic, it requires very unsanitary conditions to spread. It's very unlikely that ebola will ever spread in a developed country.
What research is being done to combat this disease?
In order to address the outbreak, the CDC will be sending 50 experts to some of the hardest-hit areas within the next 30 days. The World Health Organization has stated that the virus is spreading faster than they can contain it. In addition to the highly contagious nature of the virus itself, health officials are also working against cultural beliefs that have kept certain cases hidden, as some believe that the high fatality rate means that going into quarantine is a certain death. There are also cultural faith healing and burial practices that prevent some from seeking treatment and contribute to the spread of disease.
In April, it was announced that an antiviral molecule was effective against all strains of ebola in rodent models, though it is not ready for clinical testing. One of the Americans being flown to Atlanta, 59-year-old Nancy Writebol, has received an experimental treatment. Unfortunately, there was only enough for one. The other American, 33-year-old Dr. Kent Brantly, insisted that Writebol receive the treatment. However, Brantly received a unit of blood from a 14-year-old boy who Brantly had treated for EVD earlier this summer, potentially in the hopes that it contains antibodies to help eliminate the virus.
How can I protect myself?
The average person can basically eliminate their chances of contracting the virus by avoiding locations that have current EVD outbreaks. If you have traveled to that area within the last couple of weeks or have been exposed to someone who has, be sure to wash hands with warm soap and water, and avoid touching your eyes, nose, and mouth. You should also avoid contact with any of their bodily fluids (which is generally good advice anyway). If you have been exposed and begin to feel symptomatic, isolate yourself immediately and call for medical assistance.