The Ebola virus is pillaging its worst recorded outbreak in West Africa, and could reach 10,000 new cases per week by December, according to an October 15th article on USA Today. Now with two new cases reported among Dallas healthcare workers who treated Thomas Duncan, the first patient diagnosed in the U.S. who passed away on October 8th, the threat has crossed the ocean to U.S. shores.
One of the first Ebola victims diagnosed in Africa and transported to the U.S. for treatment is Patrick Sawyer, an American citizen working for the Liberian government who developed symptoms of the disease after having boarded a plane bound for his home in Minnesota. Fortunately, no reports of others on that flight showing Ebola symptoms, and we seem to be past the window of opportunity for that group of people. Let’s hope.
The Ebolavirus is named after a river in Congo near the region of the first identified case, discovered in 1976 by Belgium research scientists. Just the story of how it was discovered and named is worth reading – you can check it out here. Ebola is simply put, ‘the ultimate killing machine’ probably only paralleled by Marburg virus that follows a very similar pattern. The illness is marked by severe bleeding as well as multiple organ damage and, according to some estimates, nine out of ten people who get the disease die.
There have been sporadic outbreaks of this disease in Africa for several decades, but this year Guinea and Liberia seem to be bearing the brunt so far. One reason Ebola is so deadly is that it interferes with the immune system’s ability to fight, but no one can explain why some people are able to recover and others do not.
Finding Patient Zero
Personally, I’m fascinated by any ‘patient zero’ story behind an outbreak. If you’ve seen the feature film World War Z, then you know ‘patient zero’ is the first identified case of an outbreak, which scientists hunt down in order to find the source, and hopefully at some point, a cure.
In this most recent Ebola outbreak, researchers believe patient zero may have emerged about eight months ago when a 2 year old toddler in a village in Guinea, West Africa suffered fever, black stool and vomiting. Just four days after showing the painful symptoms, the child died on December 6, 2013, according to a report published in The New England Journal of Medicine. Scientists don’t know exactly how the toddler contracted the virus.
Researchers who published the paper this year found a chain of illnesses in the toddler’s family. After the child’s death, the mother suffered bleeding symptoms and died on December 13, according to the report. Then, the toddler’s 3-year-old sister died on December 29, with symptoms including fever, vomiting and black diarrhea. The illness subsequently affected the toddler’s grandmother, who died on January 1, in the family’s village of Meliandou in Guéckédou.
The area in southern Guinea is close to the Sierra Leone and Liberia borders. The illness spread outside their village after several people attended the grandmother’s funeral.
Funerals tend to bring people in close contact with the body. Ebola spreads from person to person through contact with organs and bodily fluids such as blood, saliva, urine and other secretions of infected people. It has no known cure. What we’re seeing in U.S. cases, however, is that early detection is absolutely a key factor in the survivability rate.
“In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines,” WHO says, though researchers think fruit bats are what they call the virus’s “natural host.”
The Ebolavirus lives in animal hosts and bats, and humans can contract the virus from infected animals after which there can be person to person transmission through contact with body fluids and contaminated needles. Although experts say Ebola is not airborne, clearly its devastating effects on a human’s organs, which cause projectile vomiting and diarrhea, mean it can be transmitted through micro-droplets of human bodily fluids—thus rendering it essentially… airborne!
In laboratory settings, non-human primates exposed to aerosolized Ebolavirus from pigs have become infected. In the case of the now two Dallas healthcare workers, it seems protocols were breached and the virus was more than likely transmitted via some bodily fluids gone airborne – either directly from the patient, or, from the personal protection equipment as it was removed. Nurses at the facility have issued a statement that training was minimal and many were ‘learning as they went,’ in trying to effectively treat Duncan and prevent further contamination.
What’s just as concerning about Ebola and these protocols, is that when the virus was dried in tissue culture media onto glass and stored at 4 °C in a lab study, it (the Zaire Ebolavirus – or ZEBOV strain) survived for more than 50 days*. That’s nearly two months! It is known that a person can start showing symptoms/signs about 2 to 21 days after contact with an infected person. Infected people typically don’t become contagious unless they develop symptoms. There is currently no effective treatment and neither is there a vaccine to prevent it.
So what do we really need to know, given its making its way to the United States one passenger at a time, and what might everyone be missing!?
First, Know the Facts About Ebola Virus
There are 8 important facts to know:
- EBOLA CAN MASQUERADE AS OTHER DISEASES. Early symptoms of Ebola infection include fever, headache, muscle aches and sore throat. It often resembles other diseases such as malaria, typhoid fever or cholera at the onset. It’s only in latter stages that people with Ebola begin bleeding both internally and externally, often through the nose and ears.
- EBOLA VIRUS CAUSES A VIRAL HEMORRHAGIC FEVER DISEASE. Symptoms include: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, and abnormal bleeding. Symptoms may appear anywhere from 2 to 21 days after exposure to ebola virus though 8-10 days is most common.
- EBOLA IS ONLY SPREAD THROUGH CLOSE CONTACT. The Ebola virus is not airborne, so you would have to come into direct contact with the bodily fluids of an infected person, including blood, sweat, vomit, feces, urine, saliva or semen – making transmission through casual contact in a public setting unlikely. However, given the violent symptoms once the virus has taken hold – such as projectile vomit and diarrhea, it’s not unlikely that micro-particles of such fluids can easily become airborne and transmitted further through the air than most experts even realize.
- EBOLA IS NOT IN FOOD OR WATER. Ebola is not a food-borne illness. It is not a water-borne illness. You can’t get it from something you eat or drink.
- EBOLA INCUBATES FROM 2 – 21 DAYS, however, it’s 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.
- SOME PEOPLE HAVE SURVIVED EBOLA. While the fatality rate for Ebola can be as high as 90 percent, health officials in the three countries say people have recovered from the virus and the current death rate is about 60 percent. Those who fared best sought immediate medical attention and got supportive care to prevent dehydration even though there is no specific treatment for Ebola itself.
- FEAR AND MISINFORMATION. In the three countries, health workers and clinics have come under attack from panicked residents who mistakenly blame foreign doctors and nurses for bringing the virus to remote communities. Family members also have removed sick Ebola patients from hospitals. Government officials have stepped up efforts to isolate patients, educate the public, check travelers and tighten borders to prevent the disease’s spread.
- WEST AFRICA OUTBREAK NOW LARGEST IN HISTORY. The current outbreak in the neighboring countries of Liberia, Guinea and Sierra Leone has sickened more than 1,300 people and killed hundreds since March. The outbreak is unusual for West Africa as the disease is typically found in the center and east of the continent.
What Could We Be Missing? Consider Revamping Disinfecting Methods & Protocols Completely
- Clearly understanding everything we need to know about Ebola is an evolving process. Although the CDC has put out critical training videos and detailed guidance on treating Ebola patients and preventing further transmission to hospitals across the country, there must be areas that are being overlooked or missed altogether. As of this post, the CDC just released a statement confirming that are looking current protocol guidance to determine where adjustments need to be made. The two Dallas healthcare worker cases confirm that it’s more likely most hospitals are not adequately trained or prepared. The other breaking news is that the second Dallas healthcare worker boarded a Frontier Airlines plane with a low grade fever. The airlines confirms the plane was ‘decontaminated twice.’ But that leads me to my second point…
- Are we trying to combat a killer superbug with inadequate and severely outdated disinfecting techniques? Whether it’s Ebola or the Enterovirus (which as of this post, the first death in Arizona of a first grader was just reported), or MRSA, or antibiotic resistant Tuberculosis – current CDC guidance calls for the use of bleach or other harsh chemicals to be mixed with water and applied to the surface – either using rags or in some cases sprayers or foggers. But what about water sensitive, corrosive areas such as electronics and medical equipment where bleach and water cannot be used, and where disease transmission may often occur? What about the overspray from sprayers that essentially create a super-carrier mechanism to blast the bleach, water and virus mixtures beyond the current surface to large areas unseen? What about the airplanes and other public facilities where patients travel? What about the fact that bleach is also harmful to people in higher concentrations, which are needed to kill the virus in the first place? What about the environmental impacts and the fact that bleach breaks down materials, in some cases, relatively quickly?
- Are the airlines prepared, let alone other public service areas such as airports, trains, schools, etc.? Given the answer to number two above, likely not. Current methods for disinfecting are based on 50 – 75-year old techniques that are frighteningly outdated and inadequate, and simply cannot be used across too many surfaces that are likely transmission points. They are prone to human error and are time and labor intensive – making them completely impossible to use across large-scale, high volume areas that need to be operational almost around the clock.
To effectively address what’s being missed in the current Ebola battle, guidelines and protocols should be completely reinvented to better address disinfecting the environment. Ebola is proven susceptible to alcohol-based products, and alcohol is a well-known disinfectant which pathogens cannot build a resistance to. That means using a formula of concentrated alcohols with a four-chain quaternary ammonium compound could be applied to any surface – including large-scale areas and facilities — yet without damage or corrosion, including medical equipment, fine electronics, personal protection equipment, metals, fabrics, and other fomites– in order to break the chain of transmission.
The four-chain quaternary ammonium compound helps form an antimicrobial layer of the alcohol for residual virus-killing power (typically up to 24 hours). Power spraying such a formula using technology that renders the alcohol completely non-flammable, including next to spark or open flame, can dramatically speed disinfecting time, while doing a much more thorough job of killing pathogens throughout the environment.
A Few Final Personal Prevention Tips
The battle lines are drawn; with no vaccine to prevent and no medication to treat except for supportive care such as blood transfusion, fluids, pain relief, your best bet is to avoid this disease by eliminating unnecessary travel, and taking the following personal precautions:
- Avoid areas with Ebola outbreak
- Wash hands FREQUENTLY
- Soap and water is preferred but in its absence you may use
- Hand rubs (sanitizers) containing at least 60% alcohol
- Avoid handling bats and other bush meat
- Avoid contact with infected (suspicious) people dead or alive.
- Beware of body fluids such as blood, tears, sweat, stools (toilet) and vomitus. It is better to err on the side of caution.
- Follow infection control procedures especially if you are a health worker or caregiver
- Proper disposal of syringes and needles and NEVER re-use these
- Wear appropriate protective wear while handling patients
- Don’t handle dead bodies; leave that for people who are specially trained to perform that task. Why do people kiss dead bodies anyway? If you have to, do that when the person is alive and healthy.
- Keep your immune system as healthy as possible with regular exercise and a healthy diet filled with fruits and vegetables, avoid smoking and reduce alcohol consumption.
- Wash your hands frequently with soap and water and REMEMBER this is no HUGGING season.
- Keep your body fluids to yourself. If you suspect you may have contracted Ebola, be sensitive. Keep away from others and contact a healthcare facility.
As of this post, the U.S. government has no travel restrictions to West Africa in place, though the Centers for Disease Control issued a mid-level advisory to health workers traveling to the region. Several African nations have restricted or banned air travel from Ebola-stricken countries, and airlines including Kenya Airways, British Airways, Air Cote D’Ivoire and Nigeria’s Arik Air have suspended flights from the countries. Other airlines have greatly reduced travel to the region. Although airport screenings are underway, they are not likely to catch every infected passenger since the virus can lay dormant for up to 21 days before symptoms appear.*Source: Public Health Agency of Canada Pathogen Safety Data Sheet.