The worst ebola outbreak in history is currently ravaging West Africa, and it might be coming to the U.S. Okay, it's probably not. But it might be. But it's probably not. But oh god what if it is?!? What do we do? This is not the Dawn of the Planet of the Apes; this is real life, ok? But those screenwriters consulted with scientists to construct a feasible premise! We're all gonna die!
As a paranoid hypochondriac who read The Hot Zone during study hall in sixth grade and was so disgusted by the part about the guy vomiting partially coagulated blood all over an airplane that I almost threw up on my crush, Craig, but instead stole away to the band room and hid in the tuba locker and wept quietly until the end of the period (true story!), this ebola business has me a little spooked. It has a lot of people a little spooked, because a lot of people don't know very much about what ebola is, how it looks, how it can be spread, why it's spreading and whether or not we're all going to die. A lot of people watch too much TV.
So, to quell our paranoid fears, I sought the expertise of Dr. Tim Lahey of Dartmouth Medical School; Dr. M, a Ph.D and expert in pandemics who, due to the nature of her work, cannot share her real name (awesome); and Dr. S, a doctor with a masters in public health and a background in international healthcare. We fired our most paranoid hypochondriac questions about the ebola pandemic at them. Here's what they had to say.
Dr. Lahey: Ebola has killed around 60% of people in the current outbreak. In some mortality has been as high as 90%.
Dr. S: The current outbreak is caused by the Zaire strain of the virus - the most deadly of the 5 known variations of Ebola. This makes these conversations very high stakes.
How quickly does Ebola set in? What are the symptoms? How many days to people suffer from innocuous seeming symptoms before they have full-blown fucking Ebola?
Dr. M: The symptoms include:
Early/Mid stage - fever, joint/muscle pain, weakness, sore throat, headache, chills, abdominal pain with diarrhea and vomiting, rash, impaired kidney and liver function
Hemorrhagic/Late stage - kidney and liver failure, difficulty breathing, internal bleeding, external bleeding, reddening of eyes, vomiting blood, shock, and death.
Dr. S: Once patients are symptomatic, death can follow days later. Some of the initial symptoms include fever, muscle aches, headaches, diarrhea, and sore throats. Sound familiar? That's because Ebola initially presents like every acute viral illness you've ever had. Inexplicably, one of the symptoms is also hiccups. So feel free to get all worked up next time the spoon-full-of-sugar trick doesn't work.
Patients then develop a rash and show signs of kidney and liver impairment. Not surprisingly, the most recognizable symptom – hemorrhaging out of every orifice – is a very bad sign, but what actually kills you is multiple organ dysfunction.
When a patient first presents with the non specific symptoms, the doctors start by ruling out things like yellow fever, malaria, and cholera. When a two year old girl passed away from a mysterious infection last December, no one considered the Ebola virus, previously thought to be a disease of Central Africa. Several of her family members died soon after, followed by the medical professionals who had cared for them. As bodies were moved for burial, further outbreak clusters were found throughout the region. It wasn't until March – almost 4 months after the first known victim died – that they identified the Ebola virus as the cause.
Dr. Lahey: Some patients develop the dreaded hemorrhagic symptoms of Ebola, like vomiting blood or bleeding from the eyes. Ebola can go from "how do you do" to full hell in hours.
What's fascinating is that we know that Ebola virus can be isolated from the semen at 61 days after initial infection. I'm fairly sure this important information will lead to a cure.
How dangerous is flying Ebola into the country? Couldn't this be inviting disaster?
Dr. Lahey: I'm not worried about bringing a patient with known Ebola into the country under strict isolation precautions including a high tech containment facility at Emory. With proper infection control measures, the virus can be contained and the folks at CDC and Emory know what they're doing.
Dr. M: The individual being flown in will be under very restrictive isolation. I'm not too concerned about it.
Dr. S: Please take off your tinfoil hat. No, we are not inviting disaster. We did not put the patients in coach and pick them up at Hartsfield-Jackson baggage claim. They were flown in under quarantine, transported to the hospital under quarantine, and set up in the hospital under quarantine. They will probably never even set eyes on someone who isn't under several layers of protective gear.
Dr. Lahey: What worries me more is travelers from outbreak countries who arrive in the U.S. before they develop symptoms, or who minimize symptoms that herald disease. The prospect of someone developing Ebola in downtown Manhattan, for instance, is scary. That said, it's also extremely unlikely. Only a very small minority of the several hundred known people with Ebola virus disease are likely to travel internationally, and there are travel restrictions from those areas as well as border surveillance for suspicious symptoms. This is not to say it's impossible, just very very unlikely.
This brings up a key point: there are way, WAY more frightening things to worry about than Ebola virus arriving in Manhattan. The rampant spread of antibiotic resistance due to widespread misuse in humans and animals, for instance, is truly nightmarish and actually killing lots of people every year, and yet because it's less exotic than Ebola it grips the popular imagination less well.
Freaking out about Ebola in the U.S. while antibiotic resistant superbugs rampage in our hospitals is like fearing Freddy Kruger will ring the doorbell while Jeffrey Dahmer sits at your dining room table.
Dr. S: It takes time for symptoms to develop, so there is really nothing stopping an asymptomatic person from traveling. If there is an outbreak in the U.S., that's where it will come from. Not from the patients we flew in for treatment (seriously, please stop freaking out about them), but by a random person who unknowingly (or intentionally, I suppose) brings Ebola to our shores. That was all it took to bring the virus to a Liberia, and that's how it will end up leaving Africa.
Dr. S: In the US? Probably not that many. If there was an outbreak, what we call the index of suspicion would be very high. That means every time someone goes into the hospital with non-specific symptoms, they would suspect Ebola. In the US, we have the facilities and the infrastructure to take the required precautions. Patients would immediately be quarantined. As we said, people aren't really contagious until they start showing symptoms. You start showing symptoms and you go to an ER. The ER is set up to handle your care. This is not the case in rural Africa – an outbreak in an industrialized nation would be vastly different.
In a third world country where both infection control and medical care are suboptimal due to inadequate supplies of equipment and trained personal, Ebola rarely afflicts more than a few dozen people and even in this worst epidemic under a thousand people have been infected to date. In Africa, death rates are between 40-100%. In the United States where our capacity to prevent, detect, and treat Ebola is far greater the mortality and spread of Ebola are likely to be far less severe.
Dr. Lahey: I'm going to go with "no."
Dr. M: Um no.
Dr. S: Great question. No. Actually, one of the primary ways people got infected with ebola was from contact with the corpses of infected apes and other animals. The same goes for human remains. Remember the virus is transmitted through body fluids. Corpses of the deceased must be handled by people wearing the same protective gear worn by those treating living patients. People should be buried immediately. Funerals have actually been outlawed in some areas to prevent spreading the infection – several clusters of infection in Africa were traced back to one body being moved from the place of his death to where he was buried.
If you are going to be eating meat that is possibly infected, cook it very well. I'm a firm believer in eating my steak medium rare, but in times of ebola outbreaks, everything is well done. I suppose this would go for human flesh as well.
Dr. Lahey: If you were in 12B en route to the US from the Guinea epicenter of an Ebola outbreak, and the passenger in 12A was sweating, bleeding and/or urinating on you from what was ultimately diagnosed as Ebola, then, yes.
Dr. S: It is unlikely that Ebola would spread on an airplane unless you get in contact with another patient's bodily fluids (are you sensing a theme here?). Most airlines are now screening travelers for symptoms of deadly infection before boarding, in addition to their usual hunt for guns, shoe bombs, and bottles of shampoo. People working in airports are being trained to recognize symptoms in infected patients and in the appropriate protocols to follow. That said, if someone on your plane is sweating excessively, constantly getting up to go to the bathroom, or generally looking like they might be infected with an incredibly vicious virus, I would notify the flight attendant and request to change seats.
Dr. M: Supportive treatment is currently the only option: managing fever, fluids, electrolytes, blood flow (including transfusions), preventing organ failure with dialysis, mechanical ventilation (when available)
Dr. Lahey: There is no specific therapy for Ebola virus disease. The best treatments are supportive: keeping the blood pressure up, and protecting organ function. Serum from someone who has survived Ebola can be used to boost immune protection from Ebola, but this is hard to do safely and not used in all cases.
Dr. M: If you only count from when you feel sick to when you actually die, about a week, two at the most.
Dr. Lahey: Death usually occurs within a couple of weeks of first symptoms.
Dr. S: You have a fighting chance, just a slim one. So no. Plus, think of the stories you get to tell about bleeding out of your eyeballs if you bounce back! On the other hand, if you are one of those terrible sick people who make the lives of everyone around them completely miserable, maybe do everyone a favor. Ebola is a nasty business. You're not going to enjoy it.
For help with this question, I consulted my friend, a PhD candidate in psychology. She responded: "Well, just see how bad it gets. Then kill yourself."
Dr. M: In the U.S. where medical infrastructure is strong, no…stay the course.
Dr. Lahey: Supportive care is WAY better in the U.S. than in western Africa.
Dr. S: The resources in the affected African areas right now are completely overtaxed. They have neither the facilities nor the manpower to deal with this epidemic. The American victims were flown to the States for treatment. A happy side plot of that is that the patients are bring treated by doctors and scientists from the CDC – people with the resources and background required to study the virus and work towards a solution to the epidemic.
Dr. S: Sure. Tylenol helps with headaches. Although if you have a real Ebola headache you should probably just go to the doctor – the drugs they give you will be a lot more fun than Tylenol.
Dr. M: Probably.
In the event of an Ebola outbreak, what things should normal people be paranoid about? Public restrooms? ATMs? Gyms? Public transportation? What places should we avoid?
Dr. S: You should be wary of any place where people congregate or there are body fluids being thrown about. This isn't an airborne disease though, you need to be up close and person with infected individuals to catch it (within 1 m is the oft repeated distance). The truth is, the people most at risk are caregivers and medical professionals in contact with infected individuals. My rational brain knows that. The rest of my brain is planning on barricading the front door with 2x4s.
Dr. M: Assuming a stateside outbreak occurs, and is small-scale, as noted earlier, you should still be fine to go about your normal routine, but be extra diligent with your hygiene methods, just in case.
Dr. M: Yes, but masks are really only necessary if you are caring for an Ebola patient or in close quarters with them.
Dr. Lahey: Healthcare workers to take care of people with Ebola need to wear equipment that prevents splashes of body fluids. This includes face shields, masks, gowns and gloves.
Dr. S: Yes, absolutely. This will protect you on places like the subway, where some jerk will undoubtedly cough directly in your face, dousing you in flakes of Ebola laden spittle. You should get one of the masks with an eye shield though because it's not something you want in your eyeball either.
Dr. Lahey: Animals can get Ebola. Horses for instance can be infected and their serum can confer some protection to humans. Pigs can be infected, although they don't get sick from it. Fruit bats are the most likely guilty party.
Dr. S: I don't know that there are any cases of disease in dogs and cats, but if you've got a pig, an antelope, or an ape, yes there have been documented cases and your beloved pet may be at risk.
How can I tell if other people have Ebola? What should you do if you suspect your roommate or boyfriend has Ebola?
Dr. Lahey: The first symptoms of Ebola virus disease are non-specific: fever for instance. I'm going to go out on an epidemiological limb here and say you should not conclude your roommate has Ebola on the basis of fever. However, fever in someone who has been to Guinea, Sierra Leone or any other involved country needs to be worked up by healthcare workers wearing personal protective equipment.
Dr. M: A persistent lack of facilities, equipment, and personnel coupled with this overload of severely ill patients that need respirators, dialysis, etc. And the local populations are blaming the clinics/hospitals for the disease, refusing treatment, not abiding by the guidelines to change customary practices that help to spread disease (which is understandable, I'm sure the messaging is not appropriately tailored to the audience). It's kind of a perfect storm.
Dr. S: It's not clear but the likely sequence was that a fruit bat infected an animal. A 2 year old girl became infected, probably through consuming bush meat. People who came into contact with her became infected. They did not suspect it was Ebola until months later, long after the virus had begun spreading through communities.
A better question is: How is this going to stop? The answer to that is when we give people the resources and education required to contain the virus. Or find a vaccine. That would be nice, too.
Dr. S: We can't treat the virus itself so the real key is to provide the resources and training needed to support and contain infected individuals. This means setting up quarantine wards, providing appropriate protective gear to staff, and educating locals on how to protect themselves and their families. New cases need to be reported immediately to stop the spread of disease. Dead bodies are a significant hazard and the deceased should be treated with the same caution as the living. Funerals have been outlawed for this reason. Some governments have prohibited consumption of bush meat, a likely source of the virus.
To stop the large scale outbreak, our best bet is containment and education. That takes money and time. You can't do anything about the latter but you can help with the former. You can donate money to MSF (Doctors without Borders) and the Red Cross. They're on the front lines of this epidemic and need everything you can give.
Here's Dr. S, with a note about how quickly the virus can spread under the right (wrong) circumstances:
A few weeks ago, an American citizen left Liberia and traveled Nigeria for a conference, switching planes in Ghana and Togo. He exhibited developed a fever and vomiting while on the plane and when he arrived in Lagos, collapsed in the airport. He was immediately hospitalized, and died five days later. When he arrived, he told the hospital staff that he had had no contact with the Ebola virus. They later discovered that he had been caring for his ill sister in Liberia – a woman who was subsequently identified as infected with Ebola. He was the first known patient in Nigeria. Officials are now working to track down everyone he was in contact with - people on the flights, those who tried to help him when he collapsed, and airline staff. If one of them was infected they may be a source of a new outbreak in the country. [...]
Because the American traveler was transferred directly to a hospital from the airport and died rapidly, we hope the spread of Ebola in Liberia will be contained. If he had been asymptomatic when he landed and left the airport, the ramifications could have been enormous. Think of the ripple effect. A seemingly healthy man arrives in a populous city. Eventually he would have begun to show symptoms (remember, it's from 2 – 21 days after infection). At that point, people who came into close contact with him would be at risk. A person sitting next to him at the conference who he accidentally coughs on, people who help him when he falls ill in public, the doctors who cared for him before they identified the source of his illness, his friends and family. If the virus spreads in the United States, that's where it's going to come from – a seemingly healthy person flying in. As discussed elsewhere though, we have the facilities and resources here to contain an outbreak. It would be deadly, but not spread through the population like it has in West Africa. Additionally, anyone traveling from that area will be carefully evaluated before entering any new country. We are now armed with knowledge of the outbreak. That will be critical to containing it.
The good news amid all this almost cinematic potential for disaster is this little nugget of information: Ebola can be killed by hand washing. Think about that the next time you're considering just waltzing out of a movie theater restroom without stopping at the sinks.