Media reports on the death of a
Liberian traveler in Lagos, Nigeria, and the transfer of two American medical
caregivers to the US for treatment due to the Ebola virus have definitely caught the world’s attention–and
for very good reason. We live in an
interconnected world, and now have to accept the fact that rapid long distance
air travel has the potential to spread nearly any infectious disease, viral or
bacterial, to any other country, and ultimately the entire world. Under this scenario, one person, unknowingly
infected with some really nasty disease, could embark on an international
flight and expose everyone aboard with the disease. As those people disperse, traveling to whatever destination, they
would of course be exposing all their fellow passengers to that same
disease. And consider what happens at
major air terminals worldwide, as those exposed travelers wander about, waiting
for their interconnecting flight! In
very short order, we have a quite serious worldwide pandemic exploding on the
scene!
In the case of the current Ebola
threat with it’s very high (50 to 90%) fatality rate, it’s no wonder that so
many people are quite concerned about these possibilities, and a potential
threat to the United States. However,
according to officials at the CDC, the actual chance of it developing into a serious public
health risk in the U.S. is quite small, in part due to the mechanism of it’s
spread. Ebola is not an aerosol, it’s
only spread directly, human-to-human, by direct contact with body secretions
such as saliva, sweat, blood, and feces. It can be spread through a break
in the skin or mucous membranes, or after touching your nose, mouth or eyes
after having contact with the virus. It is not transmitted by coughing
or sneezing (droplet spread), as would be the case for someone with influenza
or measles. (If it were, half the
population of West Africa would be dead by now.) Poor and crowded living conditions in the afflicted area, along
with improper sanitation, and rudimentary medical facilities seem to be a very
important element in the spread of the Ebola virus. These of course, are not
the conditions we generally find throughout most of the Western world, unlike
parts of Africa.
However, before we congratulate
ourselves on our good fortune, remember that Ebola remains a worldwide hazard
because it is one of the most deadly viruses known to man, due in part to its
ability to constantly undergo mutations.
Remember the seemingly endless stream of influenza strains we’re
threatened with each year? Influenza
constantly mutates (because of it’s quite simple make-up), into some new
threat, much as Ebola seems to be doing.
And much like so many other diseases, Ebola could readily be weaponized
by large terrorist organizations or an unfriendly power. Currently consisting of only 5 known
strains, Ebola was first identified in 1976 in the Western Democratic
Congo. (Along the Ebola river for which
it’s named.) Four of these strains can
be spread to humans, while the fifth resides only in primates. The fruit bat,
considered a culinary delicacy in West Africa, is presently believed to be a
natural reservoir and primary vector of the virus, pending further study.
Symptoms begin suddenly–often with
an intense headache and fatigue, sore throat and chills–followed by vomiting,
and diarrhea with onset of a hemorrhagic rash in the upper roof of the mouth
and skin that appears to be blister-like. While the virus incubates in
from 2-21 days, its important to know that only those who are
symptomatic–generally after 8-9 days–having fever along with diarrhea, vomiting
and potentially a hemorrhagic rash can transmit the virus to others. As a result, if someone on a plane with
active symptoms–including vomiting and diarrhea –soils a restroom, another
person, unaware of the threat, could theoretically touch a contaminated area,
and thus acquire the virus. That said,
it’s important to know that the majority of those who have become infected with
the Ebola virus have been healthcare workers in constant close contact with
patients, as well as family members caring for sick family members.
It’s also important to know that
persons with Ebola may have symptoms that are nonspecific (headache, chills,
and fever) making quick identification of the virus nearly impossible. It could
be easily be mistaken for other illnesses including malaria, cholera or even
typhoid fever. Only many days into the illness–after the onset of profuse
vomiting and diarrhea–will a patient exhibit the telltale signs of Ebola with
bleeding from the mouth and nose along with rectal bleeding concurrent with
shock, liver and renal failure, followed by continued bleeding and
cardiovascular collapse.
At this time, there is no vaccine
or antiviral medication available to treat the disease. Only supportive care,
with intravenous fluids, platelet and blood transfusions are available to
patients. While there have been some promising experimental treatments in
animals, (monoclonal antibodies), there are no specific treatments that are
currently available for humans. With
technical issues regarding the high mutability of the virus preventing
researchers from being able to produce a vaccine or viable antiviral
medication, other issues such as the danger of handling the live virus have
prevented more intense and speedy efforts to actively pursue such research.
The FDA is also warning consumers to
be aware of supplements and other products sold online that are fraudulently
marketed to treat or prevent Ebola infection. We currently have no agent, drug,
dietary supplement, or herbal supplement that are shown to prevent Ebola
infection or shorten the course of the infection. Nor has there been sufficient time to study the disease with an
eye toward producing any effective cure or preventive. Of course this hasn’t stopped some Internet
retailers from claiming that their products can be used against Ebola.
So,
unless you’ve recently been to West Africa, the only current Ebola threat to
American citizens is the very small number of snake oil peddlers capitalizing
on public fears. Consumers
beware: If it seems too good to be true, it probably is.
