5 Things You Need to Understand About Ebola

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Midway through October, Thomas Eric Duncan — who traveled from Liberia to the U.S. — became the first person to die of Ebola in America. At the time, officials expressed confidence in their ability to contain any spread and are cautioning against undue panic given the competence of the health care system within the United States, and the efforts already made to find and quarantine anyone exposed. Monday saw the second Ebola death in the United States; Surgeon Dr. Martin Salia, who contracted the virus while working in Sierra Leon, “passed away as a result of the advanced symptoms of the disease,” according to a statement released by the Nebraska Medical Center. And while Ebola has jumped into the top three health concerns of Americans, according to research conducted by Gallup, it is important to remember that (as before) there is no need for undue panic.

In August the World Health Organization (WHO) declared the Ebola outbreak in West Africa to be a Public Health Emergency of International Concern (PHEIC) stating that “the Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States; the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries.”

At the time, the organization also outlined a long list of advisory items specific to affected countries in Africa, but noted that for all states in general there “should be no general ban on international travel or trade,” that “the general public should be provided with accurate and relevant information on the Ebola outbreak,” and that “states should be prepared to facilitate the evacuation and repatriation of nationals … who have been exposed to Ebola.” These recommendations are particularly salient given the level of fear Ebola has inspired globally, even before the first case was found in the U.S.

Two American volunteers returned home under strict, CDC approved quarantine conditions for treatment. Public backlash resulted as mass fear of the disease led some to suggest that patients shouldn’t be allowed back into the country given the risks. Perhaps the the most oft referenced was Donald Trump, who tweeted:


It is for just this kind of panic that these “risks” need to be clearly outlined to prevent hysterical reactions and misinformation now that Ebola actually has arrived in the United States. The husband of one volunteer — Nancy Writebol, who is now being treated in the U.S. — told USA Today, “I’m grateful and happy that she’s in a place that enables her to receive the best care possible and that will give her every opportunity to get better and to recover.” But he added, “It’s just astonishing to see the reaction of people [to her return] and I think it exposes the underlying philosophy and worldview … where an individual is really of no account. We’re losing our humanity.”

America is not alone in its strong reaction to the disease. In London, a panic broke out over a 72-year-old woman from Sierra Leone who collapse after leaving a flight and later died. She’d demonstrated symptoms including vomiting and sweating, leading to the mass quarantine of all passengers and panic at the possibility of incoming individuals. Author Lola Okolosie of the U.K.-based Guardian writes that “Ebola has infected public discourse with a new xenophobia” upon returning to London after her time in Nigeria.

Fear is a natural response to the media coverage of Ebola, and as well to the genuine danger that the disease presents. So far 3,000 individuals have died from Ebola, and according to The Washington Post 6,500 cases were reported in Guinea, Liberia, and Sierra Leone.. The disease has a number of frightening aspects to it; the mortality rate is unusually high, and there is not treatment. So it’s even more important that we understand the facts about Ebola.

How Ebola infection works

Ebola is not passed through the air, but through secretions, saliva, semen (for up to seven weeks after recovery), spit, and so on, or through an intermediary surface or object coated with secretions. Mucus membranes must be exposed, including eyes and mouth most notably. This is common in medical facilities without proper precautions taking place, as has been seen in Africa. That is perhaps the most salient fact to keep in mind when considering an outbreak in the U.S. — proper medical procedure for those who have been brought home has been strictly and obsessively followed with careful quarantine.

And while lab conditions have shown that Ebola may be transmittable through aerosol, but the CDC reports this has never been shown “among humans in a real-world setting” and has not been a concern in this outbreak. So unlike many major disease outbreaks in history — specifically deadly flues — Ebola can’t be transmitted through the air. It also can’t be transmitted via food or water.

How contagious is it?

Ebola is considerably less contagious than many believe. Yes, it can be passed through mucus membranes and bodily fluids, but so can HIV and AIDS with the distinct difference that they are transmittable while the individual is a-symptomatic and take far longer to kill people, making transmission much more likely and diagnosis much less rapid. This is not the case with Ebola. While patients may take anywhere from two to twenty-one days to show symptoms, they are not contagious until they have begun showing symptoms, which are more commonly seen within eight to ten days, according to the CDC.

The Oxford Journal of Infectious Diseases published an assessment of transmission rate made in 2007, which reads that “the risk of transmission from fomites (a surface/object that could be coated with infectious material) in an isolation ward and from convalescent patients is low when currently recommended infection control guidelines for the viral hemorrhagic fevers are followed.”

Medical care within the United States

As Obama and public health officials are constantly emphasizing, according to The Wall Street Journal,What we do know is that the Ebola virus … is controllable if you have strong public-health infrastructure in place.”

Ebola is not something that is easily transmitted. That’s why, generally, outbreaks dissipate. But the key is identifying, quarantining, isolating those who contract it and making sure that practices are in place that avoid transmission,” said Obama on August 1. The Ebola situation in Western Africa is different from what nations with developed health care systems would face, where social issues, such as burial traditions and the fear of hospitals and health workers, make control more difficult.

Mortality rate

The fatality rate of Ebola is up to 90 percent. This is half of what is so terrifying about the disease: It constitutes a near certain death sentence from first consideration. But what’s important to understand is that early recognition and diagnosis greatly improves chances of individuals, decreasing mortality rate to about 60 percent. Also worth noting are the different health base-lines some sufferers in Africa face compared to nations with healthier overall individuals. The fatality rate is still high, but stronger immune systems at the outset aid in the individuals’ chances.

Ebola has killed at least 5,177 people primarily in Sierra Leone, Liberia and Guinea, according to the latest numbers from the World Health Organization. Comparatively, in the United States, eight of the past nine Ebola patients treated in the United States survived.

Chances of Ebola spreading within the United States

This is the last, and probably most vital, item to address, especially given recent news of the first case in Texas. The man in question is being carefully contained, and those he came into contact with have been found and are being tested and monitored in order to quarantine any spread. Even the paramedic and fire crew that brought the Texas patient to the hospital are being monitored and kept home for a twenty-one day period. “The bottom line here is that I have no doubt that we will control this importation, or this case of Ebola, so that it does not spread widely in this country,” said Thomas Frieden, the Director for the CDC, according to The Washington Post.

Meanwhile, other possible entrance points remain unlikely, even if one case has managed to reach Texas.The CDC has done a great deal of work on screening precautions, and travel warnings remain in effect. Given the choice of listening to Trump or to an infectious disease specialist, such as Kamran Khan of St. Michael’s in Toronto, I’d go with the latter. Khan told NPR that “The chance of Ebola spreading out of West Africa is very, very low.”

He explained that compared to diseases like SARS, Ebola is far less likely to be transmitted via the airlines when you look at how many are infected and how much those individuals travel from the areas of infection through major hubs. While Guinea has an international airport, Conakry is not Hong Kong or Chicago O’Hare, and the danger is not comparable. So while cases may come up, as they have in Texas, it does not mean a flood of Ebola infected individuals is likely to be seen in the U.S..

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