The news is full of stories about the Ebola virus. An infected airline passenger has carried Ebola virus into Nigeria, spreading the disease to yet another country. The Peace Corps is evacuating volunteers from Guinea, Sierra Leone, and Liberia because of the threat of uncontrolled Ebola infection in these countries. Now two Americans who have been working with Ebola-infected natives in Liberia have also become infected and are being transported to the U.S. for treatment. Are fears of an Ebola outbreak in the U.S. grounded? Do you know what to look for?
Although Ebola is rare, it is deadly. Since the first outbreak in 1976, Ebola viruses have infected thousands of people, killing roughly 60 percent of them. Depending on the strain and origin of the virus, outbreaks can have a fatality rate of up to 90%. Most Ebola outbreaks have occurred in remote villages in Central and West Africa. Ebola infects humans through close contact with the organs, blood, secretions, or other bodily fluids of infected animals. The virus spreads from one human to another either through direct contact with the bodily fluids of an infected person or indirect contact with environments that have become contaminated with infected bodily fluids. The only good news is that Ebola is harder to transmit than some other viruses, such as SARS, measles, or influenza.
In the News
The current outbreak is grabbing media attention because it is the worst ever; so far, it has killed about 729 people. This outbreak involves the most deadly of the five Ebola virus strains, which killed 79 percent of its victims in previous outbreaks. By the end of July 2014, the World Health Organization (WHO) had reported 1,323 confirmed cases since the epidemic began in March. Ebola has surfaced in Sierra Leone, Guinea, Liberia, and now Nigeria.
Symptoms to Watch
Onset of symptoms occurs from two days to three weeks after contracting the virus. The infected person experiences flu-like symptoms that include fever with chills, sore throat, joint and muscle pain, headache, nausea, vomiting, and diarrhea. There may be agitation, confusion, fatigue, seizures, and sometimes coma. As the disease progresses, liver and kidney function may be compromised. When this occurs, bleeding from mucous membranes and puncture sites may occur in 40% to 50% of cases. Diffuse bleeding is rare. Victims are infectious as long as the virus remains in their blood and secretions.
Anyone who exhibits these symptoms and who has either been in one of the infected countries or has had contact with someone who has should be treated as a potential Ebola victim.
Diagnosis and Treatment
Even before a diagnosis is confirmed, anyone who is suspected of having Ebola virus must be isolated immediately, and care providers must observe strict barrier precautions that include medical-rated disposable face masks, gloves, goggles, and gowns. Ebola virus can be diagnosed definitively by several laboratory tests. Findings include low white blood cell and platelet counts and elevated liver enzymes. Any samples taken from infected patients are an extreme biohazard risk, so lab testing must be conducted under maximum biological containment conditions.
There is not yet any treatment specific to the Ebola virus. Treatment focuses on intensive supportive care and includes:
• balancing fluids and electrolytes to counter dehydration
• administering anticoagulants early in infection to prevent or control disseminated intravascular coagulation and administering procoagulants late in infection to control hemorrhaging
• maintaining oxygen levels
• managing pain
• administering antibiotics or antimycotics to treat secondary infections.
New drug therapies are being evaluated. Use of a monoclonal antibody is still experimental. Several vaccines are being tested, but none are available as yet. Current antiviral medications are not effective on Ebola. Despite the serious challenges that Ebola presents, early treatment can save lives. I.V. saline solution administered early in the course of the disease can help stabilize patients while their bodies fight the infection.
During treatment, invasive procedures should be conducted minimally and with caution on an infected patient because bodily fluids present a serious hazard for transmission.
Could It Happen Here?
Even before the news that the two infected Americans were being transported back to the U.S., many wondered if the Ebola virus could come to the U.S. With so many international travelers, it’s conceivable that airline passengers could contract the disease and fly into the U.S. before they even knew they were infected.
Even so, the risk of a major outbreak here is low. Because of our advanced health system—that includes significantly more resources, better training and infection control procedures, and sophisticated public health infrastructure—health care providers in the U.S. could probably contain the virus quickly and minimize its damage. Stricter adherence to isolation guidelines is one reason why the virus wouldn’t spread as quickly in the United States as it has in West Africa. Standard procedures to protect other patients and health care workers from the patient’s bodily fluids would be ordered immediately, and patients would remain in isolation until no longer contagious. This may seem an obvious precaution, but it doesn’t always happen this way in West Africa where several patients simply went missing.
In the U.S., public health officials could identify everyone who had come in contact with the infected person to be sure the contacts weren’t also infected. The inability to track contacts in West Africa because of the movement of people in and between countries has contributed to the spread of the virus. Thus, any outbreak here would be much less severe.