For some time, The Democratic Republic of Congo has been in the throes of a deadly epidemic: Ebola. I wrote a lot about the Ebola virus during the 2014 epidemic in West Africa and even wrote a book (Skyhorse Publishing) about the disease. In the well-publicized West Africa event, more than 11,000 people died. This time, more than 2,000 have succumbed to the virus since 2018 with nary a mention in the media.
Highly contagious, this outbreak of Ebola has about a 60% death rate. Treatment has been difficult due to warring factions in the areas affected, but public outcry led to the administration of more than 200,000 doses of a recently-approved vaccine. A surprising small number of cases have turned up in neighboring countries like Uganda, but many believe those statistics may be unreliable. Indeed, a 34-year old physician died just recently in Tanzania of an Ebola-like syndrome.
The World Health Organization believes the outbreak is dying
out, and hopefully, that’s true. It’s important, however, to be able to
recognize Ebola and other hemorrhagic fevers.
WHAT IS EBOLA?
Ebola virus is a member of the Filoviridae virus family. It was first reported in 1976 in the Democratic Republic of Congo, where it resulted in 431 deaths out of 602 known cases. Ebola is named after the river where the first victims were identified. It has several variants, and has, like most viruses, the capacity to mutate.
WHAT DO WE KNOW?
More than we did in 2014, but exactly how Ebola managed to infect its first human victim is poorly understood. Primates like monkeys and apes are possible agents of transmission (also called vectors), although bats may be more likely to transmit the disease. The virus can even be transmitted to dogs, although they don’t seem to get sick. All of these animals are eaten in the areas affected.
Ebola appears to be transmitted through saliva and other
bodily fluids, even sweat. The practice of relatives and workers in West Africa
washing a body before burial may have helped spread the disease in 2014. The
virus can live on surfaces for a number of days, unless those surfaces have
been cleaned with soap and water or chlorine bleach solution.
A 2012 Canadian study (since deleted) suggested that the virus may also be transmitted in air droplets. Given the highly contagious nature of the disease, this would be big trouble if true, but the proof isn’t there. Ebola virus is thought to be highly unlikely to be transmitted by simply breathing the air in the same room as a patient. Could a victim’s cough or sneeze send infectious saliva or blood flying? It would seem logical…
WHAT EBOLA DOES
What does Ebola virus do to its victims? Ebola causes a
hemorrhagic fever with a 25-90% death rate, much higher than even the worst of
the influenza pandemics of the past century. Compare this to the 2.5% death
rate from the great Spanish flu pandemic of 1918, and 0.1% from routine
Symptoms begin presenting about 2-21 days after exposure.
Ebola patients develop the sudden onset of what first appears to be the flu:
Aches and pains, cough, sore throat, shortness of breath, fever and chills, and
malaise are commonly seen early. Nausea occurs, often accompanied by abdominal
pain, diarrhea, and vomiting.
Later on, the central nervous system becomes affected:
Severe headaches, altered mental status, and seizures ensue, sometimes
resulting in the patient going into a coma.
As the disease progresses, disorders in blood clotting are
• Broken blood vessels in the skin
• Bloody vomit or sputum
• Spontaneous nosebleeds
• Bleeding from gums
• Blood in bowel movements
Once the victim reaches this stage, the likelihood of
survival is slim. Multiple organ failure and dehydration leading to shock are the
usual causes of death.
It’s thought that Ebola doesn’t spread until a victim develops symptoms. As the illness progresses, however, bodily fluids from diarrhea, vomiting, and bleeding become very contagious. Poor hygiene, lack of IV fluids, and political unrest/corruption impede the progress of medical authorities to tame the outbreak.
There is no specific treatment for Ebola (nor a lot of other viruses). IV hydration seems to have the best chance of decreasing the death rate if administered early. A new vaccine has recently been approved for prevention purposes; the World Health Organization considers it to be the most promising way to avoid the numbers seen in the 2014 epidemic. It should be noted that Ebola is not uniformly fatal; a decent percentage will survive, although some have long-term issues with sight or hearing.
Why should an epidemic in Africa matter to citizens of
countries thousands of miles away? With air travel making it possible to go
around the world in 24 hours, every epidemic should be carefully watched.
Before an epidemic, whether it’s Ebola or the flu, hits your
area, you should have a plan in mind. If modern medical facilities are
overwhelmed, this plan should involve:
1. Choosing a well-ventilated isolation room to protect the healthy
away from the infected
2. Learning to identify symptoms of the infection (as
described above with Ebola)
3. Being strict about hygiene, washing, and disinfecting.
4. Stockpiling food and medical supplies, including
dedicated eating utensils, bedding, waste disposal materials, etc. for the
5. Having a means of communication if the grid goes down
(hand-cranked radios, etc.)
6. Considering safe ways to dispose of infected materials.
7. Obtaining sets of personal protection gear
8. Limiting exposure to crowds unless wearing a face mask
Having learned lessons from previous outbreaks, our existing medical infrastructure is better equipped than before; stricter protocols are in place than in 2014. Being prepared, however, will help a community deal with infectious disease outbreaks effectively if that infrastructure is ever challenged by sheer numbers.
Joe Alton, M.D.
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