Should We Worry About Ebola in the West?

In 1976, in a small village near the Ebola River in Zaire, an unusual disease was identified.  Symptoms initially were similar to the flu:  sudden fever, muscle pain, headache, weakness, and sore throat.  Later symptoms included nausea, vomiting, and diarrhea.  Some patients also experienced bleeding.  It was a horrible disease, and 280 of the 318 victims died.  The disease was named Ebola.

That same year, the identical symptoms showed up in Sudan, killing 151 of the 284 people infected.  Scientists discovered that these two outbreaks were caused by two different species of Ebolavirus.

Ebola TaxonomySince then, three other species have been identified.  The Ebolavirus identified in Reston, Virginia appears to be asymptomatic in humans.  Not so with the species discovered in the Tai Forest of the Ivory Coast.  The Ebolavirus discovered in Bundibugyo, Uganda, like the species discovered in Zaire and Sudan, can be fatal.

 

However, those who claim that Ebola Virus Disease (EVD)1 is 30%-90% deadly are playing fast and loose with the numbers.  Obviously there is a huge difference between 30% and 90%, and it behooves us to be more precise and truthful.  The mortality rate varies greatly depending on the species of Ebolavirus.  According to WHO, prior to this year, 78% of people infected with Ebolavirus-Zaire died, while none of the people infected with the Ebolavirus-Tai Forest or Ebolavirus-Reston died.  The mortality rate for those who contract Ebolavirus-Sudan is about 54%, and 32% for those infected with Ebolavirus-Bundibugyo.

Ebola Mortality

Doctors have been working on a vaccine, but none have yet been approved.  There is also progress being made on an experimental drug that might be used for treatment in the future. Meanwhile, doctors have discovered that supportive measures can make a big difference in patient outcomes.  As seen from this year’s statistics, providing IV fluids and oxygen, maintaining electrolyte balance and blood pressure, and treating complicating infections leads to many more survivors.  Despite the horror of the recent outbreak of Ebolavirus in areas of Africa that have never before known to be afflicted, the statistics look better than they have in the past.

EbolaMortalityYTD

Known natural reservoirs (hosts) of Ebolavirus are fruit bats.  They spread the disease, it is believed, through saliva and feces.  In particular, the bats eat part of a piece of fruit but leave the rest.  Wild animals (most notably primates such as monkeys) then eat the leftover fruit and thus contract the disease.  People, then, come in contact with infected animals and themselves become infected.  In Africa, eating “bush meat” is a risk factor for Ebolavirus, as is direct contact with infected animals or people.  Outbreaks have also occurred among those who attended funerals of victims (do not touch the deceased).  Symptoms begin within 2-21 days (usually 8-10) of exposure.

Unlike some other viruses, Ebola does not appear to be airborne.  Direct contact is required.  Family members who care for a sick loved one are the most likely victims. Healthcare workers are also at risk if they do not wear protective clothing.  Those who do not come in contact with an infected person or animal will not be infected.

Recently an American with Ebola was transported back to the United States for treatment, and there has been an outcry.  People have heard that Ebola is deadly; it’s even been classified as a possible weapon in germ warfare.  Therefore, these frightened people conclude, nobody with a known case of Ebola should receive state-of-the-art treatment in the U.S.

Their logic escapes me.  We permit free travel.  Any tourist or businessman could contract Ebola while in Africa and return home before symptoms begin.  Once symptoms occur, that person would expose family members and medical personnel.  Any number of people could become ill before an accurate diagnosis is made.  This is not hypothetical.  Consider Patrick Sawyer.  Mr. Sawyer visited Liberia and was on his way home, but stopped off in Nigeria where he fell ill and infected others before he died.  It is just by chance that he became sick while in Nigeria instead of on the airplane or after arriving home.  In another case, less-publicized, we consider a man currently in a New York hospital.  He became ill after returning home from a visit to Africa, and is in isolation.  Anyone can become infected while travelling and take the new disease home to unsuspecting family and friends.

Dr. Brantly and Mrs. Writebol, on the other hand, are not bringing a disease home and passing it along to anyone.  They were transported in a special airplane for the purpose of not spreading the disease.    After landing, Dr. Brantly was then moved to the hospital in a special vehicle designed to prevent contamination of others.  Finally, at the hospital he is carefully quarantined so that nobody else will become ill.  Mrs. Writebol is currently in transit, but the same precautions are planned.  The United States is far less likely to succumb to an Ebola outbreak introduced by Dr. Brantly or Mrs. Writebol than from miscellaneous travelers who return home unaware that they’ve brought along a new virus as a souvenir.

This is not idle speculation.  In 1994, a scientist contracted Ebola while performing an autopsy on a monkey.  That patient was treated in Switzerland, yet there was no outbreak in Switzerland.  The fact is that medical personnel in first world countries take precautions that aren’t as easy to take in many parts of Africa.  It is unlikely to become a problem outside the African continent.

Two years ago there was an Ebola outbreak in Uganda. At the time, CNN raise the question, “Could the Ebola outbreak spread to the U.S.?”  The answer then was that it’s possible but unlikely.  Today the answer is the same.  Ebolavirus is spread through direct contact, making it much more difficult to spread than influenza or the common cold.  People must directly touch an infected person’s skin, clothes, linens, or body fluids to contract the disease.  Use some common sense.  Don’t pick up fruit off the forest floor and eat it.  Don’t play with monkeys (dead or alive).  Don’t eat bush meat.  And, if you absolutely must touch other people’s body fluids, employ a protective barrier.

Ebola In Africa

Edit to add: the virus responsible for the outbreak in West Africa is 97% similar to the Zaire strain, but due to the differences is being called a sixth strain: Guinea.  It appears that the first victim was a two-year-old in the forests of Guinea, and that the disease was then spread by a travelling health-care worker.  High mortality rates in Guinea were due to initial lack of recognition of the disease.

________

1 formerly called Ebola Hemorrhagic Fever (EHF)
2 Zaire’s name changed to Democratic Republic of the Congo; it’s the same country

Resources:

Scribe Jobs

On the off chance that readers know someone who knows someone, Yakima Valley Memorial Hospital is hiring scribes.  The training is intense; it’s not for the faint-hearted, but is a tremendous opportunity for future med students.  Apply here.

Scribes allow doctors to focus on the patient, rather than on documentation.  The doctor takes the history and does the exam, while the scribe documents everything.  From the patient-side of things, it can be nice to hear little tidbits of what the doctor tells the scribe to include.  If it gives the doctor more time with patients, everyone benefits.

A Day in the Life – Now

Contrasting what my life is like now, compared to when I was diagnosed, the difference is striking. Please read Part 1 first.

Things aren’t perfect now, but they’re so much better than back when RA first made its appearance.

In the mornings I wake and can stand up without crying out in pain. Jumping into the shower, washing, dressing, and all the rest are so much easier than back then.  It’s not perfect, and sometimes my shoulders make showering and dressing take a little extra time, but I no longer need to sit down in the shower, and it doesn’t take twenty minutes just to get up in the morning.

Note that I didn’t say “get out of bed in the morning.”  That’s because, due to my back, I’m sleeping in a recliner instead of my bed.  This situation needs to change, but in the grand scheme of things, it’s minor.  I’m in a house, not under a bridge or in a car.  My back has improved some, and eventually I’ll return to sleeping in my bed.

Once I’m dressed, I’ll quickly check Facebook, but have too much to do to spend much time on the computer.  Heading downstairs, I realize that my knees don’t hurt like they used to.  Those little things are so easy to take for granted.

Quickly I grab a bite to eat, then check my in-box.  That’s where my kids stack all their schoolwork for me to check.  When I’m lucky, everything is checked and back on the appropriate shelves before the kids wake up.

I’d like to say that I exercise every morning, and I did for a while, but once the garden is in the ground, formal “exercise” fades away until fall when I no longer am doing work outside.  I fully intend to resume my exercise routine after the garden has been harvested and preserved.  For now, there’s a kitchen full of either clean dishes to put away or dirty dishes to wash, and a mountain of clothes in the laundry room.  There are animals to feed, eggs to gather, children to tend, and it seems there aren’t enough hours in the day.

The kids need to get their schoolwork done by lunchtime. Science experiments can take place in the early afternoon after lunch.  Here is where I really notice a difference. Before I got my diagnosis and effective treatment, my day was mostly done by noon. I was exhausted and couldn’t do anything else.  Now, things are different.

For most of the school  year we leave the house at 1:45 because my son plays sports and needs to be dropped at the high school for practice, then I must return at 4:00 to pick him up — except on game days, when timing is different and the whole family piles into the car so we can watch the team play. We attend all home games as well as away games that are within an hour of our house.

To some people, that might sound perfectly normal.  Six years ago it would not have been possible.  Now I can do things in the afternoon and evening without sleeping the next two days away.  I can do more than three things in a day, and don’t have to run all errands before lunchtime.

If you want more examples, consider last month (when I had zero posts). June’s schedule was different than the main school year, partly because the public schools were dismissed, and partly because sports coaches are crazy.  To tell the truth, it wouldn’t have been possible if my RA wasn’t mostly well controlled.

I am now a chauffer.  Three days a week, my son has driver’s ed from 10:00 until noon, and it’s a forty-five minute drive to get there. Then there’s summer basketball, with games played Monday and Wednesday nights, and team practice Tuesday and Thursday nights, plus travel to tournaments on the weekends. This child also has a lawn care job for which he needs transportation.

My other son is playing on a select basketball team and all-stars baseball team, which means he has weekly practices for both teams, and has weekend tournaments in far-flung cities. This requires driving. Lots of driving.  Fortunately I have two daughters who are wonderful young ladies. They agreed to help with transportation.

Before RA I never would have agreed to letting our sons have so many activities.  Now I view things differently.  This is not forever.  Since they are able to do these things now, they should take advantage of the opportunities because they might not be there in the future.  Both boys are learning how to judge what’s realistic, and this is a good age to learn not to overcommit themselves.  This has been a fantastic experience for them.

Busy? Absolutely!  And there is no way I could possibly have done it six years ago.  I am so fortunate that my doctor believes in treating RA aggressively so that I can have a life, and blessed beyond belief that I am one of those who respond well to treatment.