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.

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

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