Ebola?

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.