The Ebola Scare

My hope is that a little research into ebola can help calm some of the hysterics going on about this right now, so here is what I have been able to dig up with a little research.

Ebola Virus History
- Fruit bats are believed to be the original carrier for this virus in nature. 
- First identified outbreak occurred in 1976 in South Sudan and Zaire, so this is not a new disease, and from then through 2013 there were only 1,716 total cases reported. 
- In the 2014 West African outbreak, Guinea, Sierra Leone, and Liberia have had most of the 9,216 cases from which some 4,555 people have died. 

Ebola Infection
- Incubation period — how long until symptoms begin show up — is 2-21 days (average 8-10). People are not contagious during this incubation period. So, even after contracting the virus, it cannot be spread until the person begins to show symptoms. 
- Symptoms include: Fever of 100.9+, Sore Throat, Severe headache, Muscle pain, Weakness, Diarrhea, Vomiting, Abdominal (stomach) pain, Rash, Unexplained bleeding internally (bruising) or externally may occur 5-7 days into the symptoms. 
- These symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days. 
- Death from ebola occurs from low blood pressure, usually from 6-16 days after symptoms appear. 
- In order to confirm a case, samples of suspected cases are sent off to the CDC for testing, which takes a total of 2 days to confirm whether or not it is ebola. 

Confirmed Cases within the United States 
- Dr. Kent Brantly - flown from Liberia to Emory hospital in Atlanta, Georgia Aug. 2 where he was successfully treated in isolation by 5 doctors and 21 nurses for 19 days until his release on August 21st, 2014. 
- Nancy Writebol was flown out of Liberia on Aug. 5 to Emory hospital in Atlanta, Georgia where she was successfully treated and released. 
- Thomas Eric Duncan, a Liberian man, was treated unsuccessfully at Texas Health Presbyterian Hospital and died October 8th, 2014. 
- Nina Pham (infected by Duncan) is being treated at a National Institutes of Health isolation unit in Maryland. 
- Amber Vinson (infected by Duncan) is being treated at Emory hospital in Atlanta, Georgia. 

How Ebola Spreads 
- Ebola is classified as a bio-saftey level 4 agent, and 
- Ebola spreads either from person to person through bodily fluids, or from animal to person. Mammals can contract ebola, and bats in Africa are suspected to be the original source of it. 
- The virus spreads when fluids (blood, vomit, saliva, diarrhea, etc) from an infected person’s body enter another person’s body (thru any bodily orifice: mouth, nose, eyes, ears, etc.) the same as with the flu or cold virus. However, ebola can be transmitted sexually by male survivors for up to 2 months after the virus. 
- Example: a patient could vomit on the floor and someone cleaning this up without proper precautions could get some accidentally rubbed into their nose and become infected. This is isolation and proper decontamination for nurses and Drs coming out of here is essential. This is also why the spread in Africa has been so problematic, because of lack of facilities and procedures to handle true isolation with decontamination. 
- Before you panic however, consider, for a moment the spread of those who have been infected in America. Two American citizens, Dr. Brantly, and Nancy Writebol both were flown to the U.S. without infecting anyone along the way because precautions were taken. They were treated successfully without any spread of ebola, and have no been released from the hospital with no infections. One Liberian man, came to the U.S. while infected with Ebola; he shared a plane with many people, apparently saw people in relatively close contact in airports all before his symptoms showed up. He returned to his place of residence where he stayed in close contact, living with 3 other people as his symptoms began to develop: fever, diarrhea, vomiting, etc.  He went to the hospital a first time and was sent home, again having close contact with many people. He then later returned to the hospital, was admitted, finally tested for Ebola, confirmed and then treated. During this time he contact closely MANY people, and even lived with them, but only 2 nurses out of all of these people he contact along the way have become infected. This shows that it is transmitted through bodily fluids, and infection is avoidable if proper precautions are taken.  

Stopping the spread of Ebola
- However, anywhere that takes proper precautions to prevent contact with the fluids, and to appropriately decontaminate caregivers after contact with patients can successfully avoid spreading to others. A good example is a Firestone plant turned hospital in Harbel, Liberia that has successfully treated many with no further spread by simply using their own chemical hazmat suits and a simple but powerful decontamination process. [1]
- The bottom line is that while Ebola has spread rapidly in Africa it is the caregivers, including: family members, Doctors and Nurses who are the most at risk as they have continual contact with fluids and so careful decontamination processes are necessary to ensure no further spreading. Obviously, this is impossible for many families in Africa as there are not enough quarantine units available and so the sad situation continues as it has. 
- What about the two nurses infected at Texas Health Presbyterian Hospital? So far, there are two claims going on to explain this, and each needs to be evaluated to see which is most likely to be true given circumstances. The CDC has claimed that they did not correctly follow protocol and thus became infected. However, anonymous statements from Texas Health Presbyterian Hospital nurses tell a different story. They show that basically no one was prepared for this and they received several changing CDC messages that were confusing at best. The end result was that these 2 nurses were indeed following CDC protocol as they knew it (which at the time didn’t include full face masks) and thus they were risk at a critical time when Duncan’s bodily fluids were all over the place. So, essentially, negligence and lack of preparation is what caused 2 nurses to become infected in Dallas.[2] 
- Emory hospital is Atlanta, where Dr. Brantly and Ms. Writebol were treated is a good example of how adequately prepared facilities can successfully quarantine the spread of Ebola. 
- “Ebolaviruses can be eliminated with heat (heating for 30 to 60 minutes at 60 °C or boiling for 5 minutes). To disinfect surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder), and other suitable disinfectants at appropriate concentrations can be used.” [3]

Ebola Treatment: 
- Recovery from Ebola depends on good supportive clinical care (IV’s for fluids, etc.) and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years. 
- Antiviral drugs have been used effectively in some places. Favipiravir, an antiviral flu medication was used to treat a French nun, but actual effectiveness of this drug in treatment is currently speculative. BCX4430 is a broad-spectrum small molecule antiviral drug that still needs human trials. 
- An ebola vaccine is undergoing human trials currently with 60 volunteers testing it for side effects. GlaxoSmithKline has already produced 10,000 injections in preparation for getting it approved. If it is approved, it will help tremendously in West Africa as it is given to health-care workers. It would also be streamlined for use in other countries soon after as well.[4]
- Experimental antibody drug ZMapp an antibody cocktail (made by MAPP biopharmaceutical - a business with only 9 employees) was used to treat Dr. Kent Brantly & nurse Nancy Writebol. The actual effectiveness of this drug in their treatment is currently speculative. 
- A serum has been made from the transfused blood of an ebola survivor to help treat victims with some success, but quantities of such blood are in very limited supply. 

The bottom line about Ebola is this: it is not the I Am Legend virus that cannot be stopped. It can be, it has been and new treatments seem to be coming along that will help to stop the spread tremendously in the next year. 

[1] Firestone Did What Governments Have Not: Stopped Ebola In Its Tracks. <http://www.npr.org/blogs/goatsandsoda/2014/10/06/354054915/firestone-did-what-governments-have-not-stopped-ebola-in-its-tracks>
[2] Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United. <http://www.nationalnursesunited.org/blog/entry/statement-by-registered-nurses-at-texas-health-presbyterian-hospital-in-dal/> 
[3] Ebola Virus <http://en.wikipedia.org/wiki/Ebola_virus_disease>
[4]  First British volunteer injected with trial Ebola vaccine in Oxford <http://www.theguardian.com/society/2014/sep/17/ruth-atkins-first-british-volunteer-injected-trial-ebola-vaccine-oxford>