Ramblings of an old Doc
Published on October 2, 2014 By DrJBHL In Everything Else

 

There’s a lot of justifiable fear out there. This is to hopefully increase your knowledge and decrease your fear.

Yes, I know that isn’t easy. The first time I encountered the saying “Knowledge Prevents Fear” was at the entrance to the wonderful Disneyland known as Jump School. My first reaction (and others’) was “R-i-i-i-i-ght!” (Cosby inflection here).

 

We’ve known about it since 1976 when it first emerged in 284 people in Sudan and Zaire. It was named after the Ebola River in Zaire, where it exhibited a 53% mortality rate. A few months later, a variant was found (EBOZ) which had an 88% mortality rate. While dogs can harbor the virus, you can’t get it from them, and it can live for a few days on surfaces, but catching it that way has a very, very low probability. EBO-R (Reston) was found in 1989 in monkeys from Mindanao (Philippines) which were imported into the US. The latest strain is EBO-CI (Ivory Coast) accidentally contracted by a person doing an autopsy on a dead chimpanzee. Other animal vectors? Bats. Don’t eat bats, or animals which can harbor the virus.

OK, then. Let’s start. Ebola (and its first cousin the Marburg virus) are classed as hemorrhagic fever viruses. There are other classifications, but this one will do. It is only transmitted through contact with the body fluids of those exhibiting symptoms of the disease.

These symptoms become apparent 2-21 days after exposure to the body fluids if those with the disease, or those who died of it:

  • Fever (greater than 38.6°C or 101.5°F)
  • Severe headache
  • Muscle pain
  • Weakness
  • Diarrhea
  • Vomiting
  • Abdominal (stomach) pain
  • Unexplained hemorrhage (bleeding or bruising)

Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days. – CDC

Transmission:

  • blood or body fluids (including but not limited to urine, saliva, feces, vomit, and semen) of a person who is sick with Ebola
  • objects (like needles and syringes) that have been contaminated with the virus
  • infected animals
  • Ebola is not spread through the air or by water, or in general, food. However, in Africa, Ebola may be spread as a result of handling bush meat (wild animals hunted for food) and contact with infected bats.

Diagnosing Ebola in an person who has been infected for only a few days is difficult, because the early symptoms, such as fever, are nonspecific to Ebola infection and are seen often in patients with more commonly occurring diseases, such as malaria and typhoid fever.

However, if a person has the early symptoms of Ebola and has had contact with the blood or body fluids of a person sick with Ebola, contact with objects that have been contaminated with the blood or body fluids of a person sick with Ebola, or contact with infected animals and a travel history to places where the disease is active, they should be isolated and public health professionals notified. Samples from the patient can then be collected and tested to confirm infection.

Also, an epidemiologic team from the CDC will appear and will get the list of contacts and who should be observed for symptom appearance.

Diagnosis:

The clinical presentation, travel/contact history and specific blood testing after symptoms start.

Treatment:

The treatment is mainly supportive.

  • Providing intravenous fluids (IV)and balancing electrolytes (body salts)
  • Maintaining oxygen status and blood pressure
  • Treating other infections if they occur

Some experimental treatments developed for Ebola have been tested and proven effective in animals but have not yet been tested in randomized trials in humans. Also, two Americans have been treated with serum from recovered patients and an experimental drug and have recovered well, to normal function without damage.

However, recovery from Ebola (and any acute infection, for that matter) depends on the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer.

Prevention:

Clearly, hygiene and Universal precautions are of greatest importance:

  • Practice careful hygiene. Avoid contact with blood and body fluids.
  • Do not handle items that may have come in contact with an infected person’s blood or body fluids.
  • Avoid funeral or burial rituals that require handling the body of someone who has died from Ebola.
  • Avoid contact with bats and nonhuman primates or blood, fluids, and raw meat prepared from these animals.
  • Avoid hospitals where Ebola patients are being treated. The U.S. embassy or consulate is often able to provide advice on facilities.
  • After you return, monitor your health for 21 days and seek medical care immediately if you develop the symptoms of Ebola.
  • Notify health officials if you have had contact with a person diagnosed as having contracted Ebola, or with any body fluids of such a patient.

The source for this was the CDC…plus my memory.


Comments (Page 2)
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on Oct 04, 2014

The CDC states clearly that 

"The C.D.C. says that health care workers treating Ebola patients need only wear gloves, a fluid-resistant gown, eye protection and a face mask to prevent becoming infected with the virus. That is a far cry from the head-to-toe “moon suits” doctors, nurses and aides have been seeing on television reports about the outbreak."

There were a plethora of interviews and statements by various people. Not always are the complete questions and answers available. I can't find the 'original attribution' of the 4 hospital thing you're attributing to the CDC. The misunderstanding of the Levels (1-4) probably gave rise to this in the media reporting: Level 4 is defined as a lethal infective agent for which no proven treatment is known and requires isolation of a rigorous type. 

In fact, in 2008, a patient with Marburg (1st cousin, similar lethality) was treated without further infection in a regular hospital in Denver employing no more than:

 "Officials from the hospital told Rocky Mountain News that they followed the protocols for dealing with an unknown infection. This included: 

"Contact isolation (gown and glove) and testing for a number of infectious [agents], with some of the tests being performed at the CDC." - http://www.medicalnewstoday.com/articles/138304.php

 

So, while Ebola is highly infectious (small amount of pathogen required to infect), it is poorly contagious. It is because of the local customs, distrust of medical personnel, very poor medical infrastructure don't follow basic body fluid and physical barrier isolation techniques (washing without physical barriers like gloves and splash protection) that the disease spread so far.

As for the 'aerosolized' spread? A person (infected and symptomatic) would have to cough into your nose or open mouth from a very close distance for spread to occur (closer than 3 feet) without falling to the ground first. Aerosolized means that it would (after being discharged in a cough or sneeze) remain suspended in the air for a very long period.

 

on Oct 04, 2014

Begs the question of how Dr. Brantley got infected, someone using max precautions.  I'd also be curious about the survivability of the virus outside the body on surfaces and in liquid pools.


EDIT - Here's what the Canucks say about it - good reference:  link

on Oct 04, 2014


Begs the question of how Dr. Brantley got infected, someone using max precautions.

Obviously, that "max" lapsed. No one's perfect. All it takes is one slip when working with an ill person, or an object he/she touched recently. Tt depends on what you define as "max", also. He was working in a medical clinic. Maybe a patient wasn't screened properly, or he touched contaminated gloves accidentally...the possibilities are endless.

 

on Oct 04, 2014

DrJBHL

...the possibilities are endless

Sort of the rub.

on Oct 04, 2014

Not with anyone symptomatic, I hope.

 

on Oct 04, 2014

 

on Oct 04, 2014

^^ 

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