by Kyle Patton
While there is only currently one known case of Ebola virus transmission outside of West Africa, the Harvard School of Public Health recently released a poll showing that four out of ten adults in this country are concerned that there will be a large scale outbreak at some point in the future within the United States. This kind of public fascination and fear of an apocalyptic virus is not something new within our society. In fact, if there’s anything that can be observed from the AIDS epidemic it’s that as a populace we fear what we don’t understand. In contrast to our understanding of HIV in the 1980s there is much about Ebola that we do understand and sharing a little bit of scientific fact with our patients can go a long way in helping lessen those fears surrounding the recent outbreaks.
It has been hypothesized that outbreaks of Ebola first occur as a result of human contact with an infected animal. The exact animal reservoir is unknown at this time, although fruit bats in Ghana have been found to have specific antibodies against the virus making them suspicious host candidates. Ebola is spread from infected persons through direct contact with contaminated blood and other bodily fluids. Once the virus enters the body it spreads throughout the lymphatic system most notably to the liver resulting in liver cell destruction and resultant blood clotting issues. It can be difficult to diagnose patients during the early stage of the infection as the initial presentation is nonspecific and includes symptoms of fever, headache, muscle aches, sore throat, and rash. The estimated mortality rate for the current outbreak is 55%, 75% in certain areas, and it is unknown why a small percentage of cases resolve, albeit with a somewhat prolonged period of recovery. That being said, progression to the later stages of the infection is in almost all cases fatal as it can lead to overwhelming septic shock, internal bleeding, decreased clotting factors, and multi-organ failure.
Because of its mode of transmission, the virus has been spreading relatively quickly through healthcare settings where patients aren’t properly isolated, and the staff are not wearing the appropriate protective equipment, such as masks, gowns, and gloves. Because direct person to person contact is required for infection, an outbreak within the United States would be highly unlikely given that we have systems in place for safe management within our hospitals and communities. In fact, much of the concern by public health officials about the continued spread of the virus is that those countries affected simply do not have the capacity to manage the outbreak on their own.
A vaccine is currently undergoing early human testing in clinical trials and is at best many months away from being mass produced. In spite of this, there is still much being done by the international community in educating healthcare workers on the nature of the disease and techniques for contact prevention. The World Health Organization has set up field laboratories where medical and logistical experts find and treat those with the disease, and then tracing the contacts of those patients back to ensure that they also have not been infected. Because patients are contagious even after death, management teams are also working to implement proper safety protocols for burying the deceased. This has been somewhat challenging as the team must allow families to perform cultural mourning rituals while keeping the family safe from becoming infected themselves. The United States recently committed significant resources that will build upon the already present response. Specifically, this includes the construction of Ebola Treatment Units in affected areas, and the deployment of healthcare workers and supplies through a newly built military staging base.
We should be encouraged by the recent shifting of resources to affected countries, and while there is little risk for outbreaks within industrialized nations, this does little to comfort those affected in Nigeria, Guinea, Liberia, and Sierra Leone. As clinicians we should educate our patients not only to minimize their fears but also to maximize their empathy for those living in these critical areas.
Up to date information about ebola can be found here: http://www.cdc.gov/vhf/ebola/
Kyle Patton is a fourth year medical student at the University of Utah School of Medicine.
Family Medicine Vital Signs 