Mashable is answering questions about the Ebola outbreak, which has sickened about 6,500 people in West Africa, and killed more than 3,300 to date. On Wednesday, the first case of this Ebola virus strain to be diagnosed in the U.S. took place in Dallas, Texas, after Thomas Eric Duncan contracted Ebola after traveling from Liberia, where he had helped transport a severely ill pregnant woman to a hospital.
Health officials are scrambling to identify and isolate any patients who may have come into direct contact with Duncan while he was suffering from Ebola symptoms, which is when he was contagious.
Q: What does "direct contact" even mean? What about touching a subway pole, bus seat or other surface that someone may have sneezed, coughed or sweated on? Could that spread the disease?
Ebola is only spread through direct contact with an infected person and their bodily fluids — it is not airborne. This means that even standing across the room from an Ebola patient will not likely cause you to become ill, unless you touch items the patient also touched while at a highly infectious stage of the disease.
“The safest thing anyone can do is avoid direct contact with bodily fluids of people who have Ebola, and with surfaces and materials (e.g. bedding, clothing) contaminated with fluids,” the World Health Organization (WHO) said on Thursday.
It is extremely unlikely that a random bus, subway pole or surface in an American or European city would have been touched by a patient showing symptoms of Ebola. In fact, the odds of contracting illnesses like the measles or the common cold are much higher, considering that only a single Ebola patient has been diagnosed in the U.S. so far.
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The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, has a much more in depth section on Ebola transmission on its website.
“Ebola is not spread through the air or by water, or in general, food,” the CDC says. However, direct contact may include exposure to coughing or sneezing from an Ebola patient, even if those symptoms are not typical Ebola symptoms.
Coughing or sneezing could, in a rare instance, spread the disease, though Ebola patients typically don't suffer from those symptoms. A different CDC website says, "Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone, and saliva or mucus come into contact with that person’s eyes, nose or mouth, these fluids may transmit the disease."
The people most at risk for contracting Ebola are healthcare workers, since they are most likely to come into close contact with infected blood or body fluids of sick patients. The virus has exacted a heavy toll among healthcare workers in Africa. “The high number of EVD infections in health-care workers (HCWs) continues to be a cause of great concern,” the WHO said in a statement on Wednesday. In all, 377 healthcare workers were infected, 216 of whom have died. The victims include some of the top hemorrhagic fever experts in West Africa.
Is it advisable to wear a surgical mask and/or gloves, especially when traveling? What else should you do to "protect" yourself?
It depends on where you're traveling. If you are traveling within, to or from one of the severely affected countries in West Africa, then avoiding touching people, even in friendly greetings, is advisable. A surgical mask and gloves would mainly be effective when working in a healthcare setting; it would do little, if any, good if you're traveling on a plane where the odds of infection are extraordinarily small.
What are the best- and worst-case scenarios that we're looking at?
In the U.S., the best-case scenario is that no new cases are diagnosed, and that Thomas Eric Duncan fully recovers. The worst-case scenario is that other cases pop up, and that several people die before the outbreak is contained.
In West Africa, things are still deteriorating, however, and the fight is a stark one: It's a future in which tens of thousands of cases occur, with thousands more still to die, or an outcome with more than a million cases, according to CDC and other projections. The outcome mainly depends on the timing and scale of international aid meant to fight the outbreak.
In fact, if the outbreak — which has been simmering since March — is not stopped soon, Ebola may become endemic to West Africa, which could cost billions to already struggling economies. This would also pose a greater threat to the U.S. and other countries, since it would provide more opportunities for isolated cases to reach beyond West Africa via air travel.
Q: Is it true that it keeps mutating? Although it's not airborne now, it could be in a future incarnation, right?
Yes, this strain of the Ebola virus, like other virus strains, mutates as it spreads. However, this is not nearly as scary as it sounds. The word "mutating" has a different meaning in biology than in pop culture, where it is often used in horror films or graphic novels.
The mutations that the virus is undergoing means there are features in its DNA that change as it goes from one person to the next. However, it does not mean there is a high chance that a mutation will lead to an airborne Ebola virus. In fact, the chances of that happening are extremely low, according to health officials, but they remain a remote possibility for as long as the outbreak continues.
One study published on Aug. 28 analyzed the genetic code of the virus strain that spread from Guinea into Sierra Leone. It found that the Ebola strains responsible for the current outbreak are distinct, with unique mutations, but that they likely have a common ancestor that can be traced to the first recorded outbreak in 1976.
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Daniel J. Park, the study's co-author and computational biologist at the Broad Institute, toldMashable in August that the virus could mutate in ways that make diagnostic tests less accurate, or make the virus more virulent.
"What we know is that the virus continues to change during an outbreak. As a result, it might stumble upon evolutionary opportunities that it hasn’t experienced before," Park said. "The longer the outbreak continues, the more opportunities the virus has. Whether this will lead to changes that affect disease transmission or progression, we are unable to say."
The CDC, the WHO and individual Ebola researchers have all said it is highly unlikely that the virus will mutate in a way that will make it not only airborne, but also highly contagious.
The WHO released a statement on Friday emphasizing that Ebola cannot be spread via air.
“Following recent media reports, the UN Mission for Ebola Emergency Response (UNMEER) seeks to clarify that Ebola is not an airborne disease. At this point in time, we have no evidence and do not anticipate that the Ebola virus is mutating to become airborne,” it said. The organization continued:
However, there are real risks and concerns with this outbreak: every day, more people are becoming infected and more are dying because they cannot get the care they need. Energy needs to be focused on swiftly addressing the real needs and gaps in communities affected by this disease.
The Ebola virus only spreads through contact with bodily fluids. The World Health Organization (WHO) monitors the virus closely. Viruses do mutate but it is a complex process that takes time.
Q: What exactly is it about the treatment options available that accounts for the huge differences in Ebola death rates between the U.S. and West Africa?
The main reason why the death rate is lower in the U.S. compared to West Africa is due to the chasm between the countries' health infrastructure. In addition to experimental drugs, such asZMapp, the best known treatment for Ebola is for doctors to manage patients' symptoms, such as through IV fluids to keep them hydrated. Doctors can treat some of the symptoms of Ebola, but they cannot cure the virus itself.
Because the virus causes severe nausea, vomiting and diarrhea, it can quickly make a patient severely dehydrated, leading to blood clotting problems and more serious complications.
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Doctors in the U.S. have more more experience, as well as supplies on hand, to manage these symptoms while keeping patients isolated; whereas doctors in countries such as Sierra Leone and Liberia have been struggling to keep up with the influx of patients without getting infected themselves. As The New York Times and other media outlets have reported, many patients have been left to die on the floor of crudely constructed treatment centers in Liberia because there is no available bed for them.
The health care facilities in Liberia and Sierra Leone, in particular, were decimated by years of civil war, which is why countries including the U.S., Cuba and China are working to set up more advanced treatment facilities there.
Q: What are the chances that there will be a large-scale Ebola outbreak in North America?
The chances of a large-scale Ebola outbreak in North America is extremely low, but not zero. The CDC, White House and others have all said that the American health system is prepared to identify and contain Ebola cases before the virus spreads out of control.
“We can’t make the risk zero until the outbreak is controlled in west Africa,” CDC director Tom Frieden said.
One positive aspect of the Dallas case is that epidemiologists know who “patient zero” is, and they have him in isolation. In most disease outbreaks, specialists must laboriously track the network of patients and exposed people without knowing who that initial patient was.
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Using genetic analysis, for example, scientists discovered months later that Ebola likely entered Sierra Leone after people were exposed at a funeral ceremony for a traditional healer — which involved touching the deceased — just over the border in Guinea. That healer had treated Ebola patients.
Q: Why did the Dallas Hospital send a patient with Ebola virus disease symptoms and a suspicious travel history home with antibiotics?
Media accounts differ on what Duncan, the Texas patient, told physicians during his initial visit to the emergency room, and what doctors could see in his electronic-records file. The hospital has said there was an error in the electronic records that prevented doctors from making the link between Duncan's symptoms and his travel history.
Q: Is the CDC prepared for a serious outbreak? What is in place to address this situation if it escalates?
The CDC says it is part of a “whole government approach” to protect the American public from Ebola. It is working with other government agencies, such as the National Institutes of Health and U.S. Army Medical Research Institute of Infectious Diseases, as well as the WHO, to coordinate its work, and has activated its emergency operations center. The CDC has deployed more than 100 personnel to West Africa and a team of at least 10 experts to Dallas.
The experts in Dallas amount to an Ebola rapid-reaction force, and is comprised of five “disease detectives,” a public health advisor and three senior scientists.
“The CDC experts will help ensure that proper infection control procedures are followed, and monitor healthcare workers treating or attending to the patient. Long experience shows that these tried-and-true core public health interventions stop the spread of Ebola,” the CDC says on its website.
"We are stopping Ebola in its tracks in this country," Frieden said. "We can do that because of two things: strong infection control that stops the spread of Ebola in health care; and strong core public health functions to trace contacts, track contacts, isolate them if they have any symptoms and stop the chain of transmission. I am certain we will control this."
In cooperation with other agencies, the CDC held practice exercises to prepare for an outbreak of a highly communicable disease in the U.S., such as a flu pandemic. Outbreaks of other diseases in recent years has helped the public health system shore up its weak spots, including SARS and MERS.
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So, there are protocols in place for dealing with Ebola if it escalates, although they have never been fully tested in the real world. As the mistakes made at the Dallas hospital illustrate, the health care system in the U.S. is not perfect.
One factor that affects the government's readiness to face Ebola is recent budget cuts. The CDC, like other government agencies, has seen budget cuts that have affected its operations in recent years. The across-the-board cuts enacted in fiscal year 2013, known as budget sequestration, forced the agency to reduce funding for "Emerging and Zoonotic Infectious Diseases" — the heading that Ebola falls under — by $13 million, to $344 million. Also hit was "Public Health Preparedness and Response," which was cut by $98 million.
The CDC has received additional funds through subsequent spending bills to fight the outbreak.
U.S. President Barack Obama's budget proposal for fiscal year 2015 would boost the agency's budget by $45 million for strengthening lab networks that can diagnose Ebola and other emerging disease threats, according to Senate testimony in September by Beth Bell, director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases.
Q: How are hospitals and clinics getting the best and most up-to-date care instructions for treating infected or exposed patients?
The CDC has sent a team to Dallas to help treat Duncan, and assist in contact-tracing efforts, which is the process of tracking down people who he may have had contact with. This incident will also raise awareness throughout the U.S. medical system, simply by being a major news story. But beyond that, the CDC is taking additional steps to reach out to healthcare providers by providing advisory guidelines and information resources online.
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Specifically, the CDC, along with state, city and local health agencies, are alerting staff at hospitals to be on the lookout for patients with Ebola symptoms who have traveled to affected areas in West Africa. The CDC is advising doctors "to consider Ebola if symptoms present within three weeks of a traveler returning from an affected area."
Q: How does the education aspect for Ebola (i.e. practices, procedures, manuals) differ from other infectious diseases, such as malaria, swine flu/avian flu, meningitis and so on?
The education aspect does not differ much from these other diseases, except to clarify that Ebola is only spread through direct contact to patients and their bodily fluids. Also, the disease has different symptoms than meningitis or malaria, for example, although it may first seem flu-like.
Q: If you survive an Ebola infection, are you immune to it?
A: Likely yes, you are, but no one knows for how long. What's more, recovered patients may only have immunity to this particular strain of Ebola, making them susceptible to other strains in the future. Because so few Ebola cases have been witnessed (this is by far the largest outbreak on record), the intricacies of acquired immunity have not been thoroughly studied.
Q: What guidance is the CDC providing to airlines to prepare them for dealing with Ebola patients?
The CDC issued guidance for airlines, stating that federal law authorizes them to deny boarding to a passenger they suspect of having Ebola symptoms.
“A U.S. Department of Transportation rule permits airlines to deny boarding to air travelers with serious contagious diseases that could spread during flight, including travelers with possible Ebola symptoms,” the CDC says. “This rule applies to all flights of U.S. airlines, and to direct flights (no change of planes) to or from the United States by foreign airlines.”
The CDC also tells airlines how to treat someone if they become sick during the flight.
“The risk of spreading Ebola to passengers or crew on an aircraft is low because Ebola spreads by direct contact with infected body fluids. Ebola does NOT spread through the air like flu,” the CDC says on its website.
“Even if the person has been in a country with Ebola, cabin crew won’t know for certain what type of illness a sick traveler has. Therefore, cabin crew should follow routine infection control precautions for all travelers who become sick during flight, including managing travelers with respiratory illness to reduce the number of droplets released into the air. If in-flight cleaning is needed, cabin crew should follow routine airline procedures using personal protective equipment available in the Universal Precautions Kit.”
Additional reporting by Kari Paul
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