Somewhere in the American imagination, just steps away from a full-on zombie apocalypse, lies the threat of an Ebola pandemic. And over the past few decades, that’s basically where it’s stayed. But now, with the first large-scale outbreak in West Africa – the worst since the virus was discovered in 1976 – and the first patient, who was diagnosed with Ebola, the question arises: What do we need to know?
When Ebola first appeared in West Africa, the virus soon spread to urban areas and the infrastructure to control the emerging epidemic simply did not exist. “There were small clinics that were quickly overrun with Ebola patients,” said Daniel Epstein, a spokesman for the World Health Organization. “And a lot of health workers became infected because they didn’t necessarily know that these patients had Ebola.”
The early symptoms of the virus – sudden fever, aches, pains, sometimes a sore throat – look very similar to malaria, a far more common (and less contagious) disease. Healthcare workers thought they knew what they were dealing with; By the time they realized it was Ebola, it was already too late. “In one hospital,” says Epstein, “there were 28 nurses treating Ebola patients. 25 of them died.”
Why the danger remains limited
It is important to remember that the chance of contracting Ebola is generally zero. The virus cannot be transmitted through the air and the risk of it becoming an airborne virus is minimal. Plus, patients aren’t contagious until they show symptoms – so you don’t have to worry about people appearing perfectly healthy next to you on the train (although if someone is sweating and sneezing, it might be time to change carriages). However, there are five things to know about the Ebola virus and the international response to this unprecedented situation:
The key to stopping the spread of Ebola is not to close borders – but to keep them open.
This may seem counterintuitive, but both the WHO and the CDC stressed that border closures would only make the situation worse. “We need to get people in and out of Liberia, Sierra Leone and Guinea if we are to have any hope of stopping the outbreak,” Epstein says. “Foreign medical teams, supplies, lab samples – you name it.” Not only should countries not be isolated, villages with many suspected Ebola cases should not be completely sealed off either. “It is very difficult to provide support and monitoring in communities that are under quarantine,” says Dr. Vinay Gupta, a captain in the US Air Force Medical Corps and a fellow at Brigham & Women’s Hospital at Harvard Medical School. “When quarantined, medical care cannot be provided effectively. What is needed are good public health measures and an understanding of how the disease is transmitted.”
Why caution alone is not enough
Ebola is not airborne, but that doesn’t mean simply not touching infected people is enough to stay safe.
Unlike influenza or tuberculosis, Ebola is not airborne – it requires a “relevant contact” in which a body fluid from a symptomatic Ebola patient “breaks through a body barrier,” explains Dr. Gupta. This can be mucus, tears, urine, blood or vomit that not only touches the skin but gets into an opening or a wound. So does that mean no high-fives and no hugs, otherwise you’re safe? “It’s important,” says Dr. Gupta, “that you can become infected if you are within about one meter of an infected person and they cough. Then there is a possibility of coming into contact with the sputum, which is considered direct contact.”
That’s why medical workers in the affected regions wear protective suits: every mucous membrane in the body must be protected. With a disease like Ebola, whose mortality rate is now around 70 percent, it is better to be safe than sorry. “These precautionary measures are extremely difficult for doctors in Liberia or Sierra Leone to implement,” says Dr. Gupta, citing one of the reasons why the disease spread so quickly in its early phase. “You can’t just put on a mask and a gown.”
Only the most severe – fatal – cases reach the final hemorrhagic stage, in which internal and external bleeding occurs
In its final stages, when a patient is nearing death, Ebola causes veins to collapse, organs to fail and causes internal and external bleeding. Typically two to 10 days after exposure to the virus, an infected person begins to show symptoms: fever and aches, which could be anything from a cold to the flu to malaria. Even the second phase of symptoms can be misdiagnosed: vomiting, diarrhea and rapid loss of fluid from the body.
What is truly frightening is the third, hemorrhagic phase, in which the body loses the ability to clot blood. “In general, even in the United States, once someone reaches this stage they are essentially lost. There’s nothing more they can do.” Although Ebola is not the only disease that causes such shocking symptoms – as Dr. Gupta explains that MRSA or severe pneumonia can cause the same septic shock – but the real threat lies in how quickly Ebola does it. “Other illnesses may develop over five to seven days,” says Dr. Gupta, “whereas with Ebola, it happens within a day or two.”
How help is still possible
There are indeed ways to help those infected, and the global health community is prepared.
A typical Ebola case looks something like this: A few days after infection and incubation, a patient begins to show symptoms – fever, headache, nausea. A mild flu turns into vomiting and diarrhea immediately or within a day, and if nothing is done, the disease progresses within one to three days to the hemorrhagic stage, in which internal and external bleeding leads to a quick and painful death.
But like Dr. Gupta explains, there are some simple steps doctors can take to prevent this third stage from occurring in the first place. “Because Ebola is a virus, there’s not much you can do therapeutically – the treatment is purely supportive,” he says. In an intensive care unit, doctors can monitor blood pressure, administer fluids that patients are rapidly losing, and essentially monitor them until they are out of danger. The problem in West Africa was the complete lack of intensive care – when basic things like infusions are not available, supportive care becomes much more difficult. “This infrastructure is completely missing,” explains Dr. Gupta. “That’s why the focus is on building hospitals, shelters and sanitation facilities.”
Despite our best efforts, there is still a lot we don’t know
“We don’t understand exactly at the molecular level why Ebola does what it does,” explains Dr. Gupta. “We see the effects and recognize that the virus causes clinical symptoms that we would also see in other serious illnesses. But we don’t know exactly why it triggers certain reactions in the body.” This is also one reason why neither a vaccine nor a cure have been developed yet. According to Epstein from the WHO, this is also because there have so far been few opportunities to research the disease.
“Ebola was limited to isolated outbreaks in rural regions of Africa,” he says. “For example, we know that fruit bats are probably the hosts – but via the exact transmission route? We assume that saliva plays a role, but we are not 100 percent sure.” Until a treatment is found, the global health community’s only option is to provide the best possible support to those infected. “Not everyone will experience the classic Hollywood course of the disease,” says Dr. Gupta. “Frankly, it can be avoided.”
