The latest breaking news about Ebola is that Dr. Brantly, a family physician from Texas who was volunteering in Liberia, has been transported to Emory University Hospital to be treated in a special isolation unit developed with the CDC. On social media, some people are expressing concern about bringing this infection to the U.S., but patients were evacuated in similar ways during the SARS outbreak in 2003 and in cases involving drug resistant tuberculosis in 2007. The isolation unit in Atlanta where Dr. Brantly is being treated is physically separate from other patient areas. The hospital staff trains regularly throughout the year in protocols to avoid transmission of contagious diseases to others.
In a totally selfless move last week, when there was only one dose of an experimental serum available to treat Ebola, Dr. Brantly insisted that a co-worker in Liberia, Nancy Writebol, receive it in hopes that it would help her. Both Dr. Brantly and Ms. Writebol are seriously ill, but evidently stable at this time. Dr. Brantly reportedly was able to walk from the ambulance into the Emory University Hospital yesterday, rather than being wheeled in on a stretcher. Plans are to transport Ms. Writebol to the U.S. soon as well.
This is the largest and deadliest outbreak for Ebola, with more than 700 deaths and 1300 infections so far, according to the World Health Organization. It is not clear how the first person in each outbreak becomes ill. The best information at this time is that the reservoir for the virus might be in bats which then infect humans and other primates. All human cases have occurred in Africa, except for three lab contamination cases, one in England and two in Russia.
The CDC has announced that there is little fear right now for spread of Ebola from Africa to the U.S. Person-to-person spread occurs only from physical contact during active illness with the patients, their bodily fluids (blood, sweat, urine, vomitus, etc), or needles contaminated with these fluids. The highest risk is for health care workers in settings where they are not wearing appropriate masks, gowns and gloves or are using equipment that is not properly sterilized. It is not like SARS or the flu that can easily be transmitted in a crowded room by airborne particles. So, for instance, being on the same airplane with someone who is well during the incubation period, would not put the other passengers in danger.
In assuring Americans that spread is unlikely, the CDC said that since multiple flights are required between West Africa and the U.S., it would be very difficult for a person who is ill there to complete the trip to the U.S. However, there is great concern for spread to countries in Africa adjacent to the countries currently affected. Prior Ebola epidemics were easier to control because they were in less densely populated areas and ‘burned out’ on their own; in West Africa, spread of the virus is ongoing. Several prior outbreaks were believed to be a result of needles being re-used to vaccinate groups of people against malaria; unfortunately, the needles were contaminated with Ebola from one of the people being vaccinated.
CDC workers are in Africa helping at airports to help screen passengers and hope to avoid further dissemination of the virus. Currently, the CDC has a level 3 advisory, the highest travel warning which is rarely used, for U.S. residents to avoid non-essential travel to Sierra Leone, Guinea and Liberia, the three countries most affected. This warning does not apply to people traveling for humanitarian purposes. In fact, fifty additional disease control specialists will be sent from the CDC to help control the outbreak.
Treatment in Africa is sometimes hindered by fear of health care workers in gowns and gloves, belief that the workers actually brought Ebola to their country, and by rumors that the workers will remove limbs before burying those who died. Consequently, families sometimes prefer to be treated by faith healers, which causes further spread of the virus. If a patient dies in a medical facility, the family may try to remove the body to bury their relative themselves, continuing to risk spread, since the virus is transmissible even after death.
Symptoms are similar to other viruses – fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, and abdominal pain. Less commonly, there can be red eyes, skin rash, cough, sore throat, chest pain, shortness of breath or bleeding. Symptoms occur from 2 to 21 days after exposure, but most often between 8 and 10 days. Following these symptoms, there can be liver, kidney and brain involvement, leading to shock and death. The name of the illness is hemorrhagic fever because it causes extensive clotting in the body, then a decline in the clotting factors. As it progresses it can lead to bleeding, internally and externally. Ironically, much of the damage is done not by the virus itself, but by the body’s response to the virus, in which it produces an excess of chemicals that lead to shock.
We health care workers here in the U.S. are receiving frequent updates about the virus. We are asked to review recent travel history with patients who present with flu-like symptoms. If there is concern that a patient has Ebola, they would be isolated and have blood tests and viral cultures done. When patients develop antibodies in their blood to the virus, they are more likely to survive the illness.
There is no vaccine available at this time, but there are several possibilities in the pipeline that require further testing. Although vaccines usually take years to develop and be approved, they can be fast-tracked when they are needed for a deadly disease such as Ebola.
No specific treatment exists for Ebola, but a few of the potential vaccines might turn out to be useful for protection after a person is exposed to the virus; they have been shown to work in non-human primates in this way. For now, physicians can only isolate patients, support them with appropriate fluids, give them medications to maintain a normal blood pressure, provide extra oxygen and treat superimposed infections. So far in this outbreak, the death rate is 60%, compared with previous 90% death rates in some outbreaks. This suggests that these protocols may have been effective.
For updates, check the CDC website.