This post was originally posted on Aug 2, 2014 and has since been updated.
As this emerging disease continues, I plan to update this page as pertinent information becomes available, so please check back often.
Updated Aug 4, 2014, Aug 5, 2014, Aug 15, 2014 & Oct 4, 2014
So a few months ago I wrote a little piece on the MERS virus that showed up in the United States. (You can read about it here.) What caught my attention at the time was that this previously isolated outbreak of a new, little understood virus was now in my back yard. So, I started to do some research, educated myself and then shared it with you all. What I have learned is I have an uncanny enjoyment in learning about these new and evolving disease and probably should have been an epidemiologist…. that being said, as I was reading up on MERS, I also started coming across reports about the small Ebola outbreak in Africa. At the time, there was very little information about it in the media and it appeared to be contained. Well, we all know now how that turned out…. So, again, here I am reading anything I can get my hands on and learning all that I can. And again, my attention is heightened as the first case of an infected patient arrived in the US today. Ok, crazy diseases…. you have my attention again! So, here is what I have figured out, learned and can ascertain from all that I have read. Again, I am not an alarmist by any measure, but I do believe in being educated, so here is what I know this far.
Aug 4, 2014, the CDC did a Twitter chat with their leading Ebola expert. Updates have been incorporated for what was learned.
Current statistics according to the WHO – 1603 confirm, probable or suspected cases and 887 deaths = 55% mortality rate as of Aug 1, 2014. Countries involved are Guinea, Liberia, Sierra Leone and now Nigeria. A patient is being isolated and tested at Mt. Sinai Hospital in NYC as well as a patient in Saudi Arabia.
The second infected American, a nurse, arrived today at Emory Hospital in Atlanta for treatment.
Aug 15, 2015 Updates – As of Aug 11, the WHO reports 1975 cases with 1069 deaths = 54% mortality rate.
Oct 4, 2014 Updates – As of Sept 23, the WHO reports 6553 cases with 3083 deaths = 47% mortality. More alarming is the rate of mortality among health care workers – 375 cases with 211 deaths = 47% mortality.
What is Ebola?
Ebola virus disease also known as Ebola hemorrhagic fever because the patients were known to bleed at the end of their lives. This only occurs in approximately 50% of the patients. The virus is highly fatal with mortality rates up to 90%. The mortality rate of the current outbreak is 55% as of July 28. The disease was first noted in 1976 during an outbreak in Zaire (Democratic Republic of the Congo – DRC). Another simultaneous outbreak occurred in Sudan, however it remained relatively latent until 1994 when a small outbreak occurred in a gold-mining camp. It was originally thought to be yellow fever, but was later identified as Ebola. Since that time, the outbreaks continued to be more frequent. (You can see every recorded outbreak of the disease on the CDC website here.)
It is not clear where the Ebola virus “hides” in between outbreak. The current prevailing theory is that the virus lives in an animal and an outbreak occurs when the a person comes in contact with an infected animal. For it to be transmitted to another human, there must be direct contact with blood or secretions of the infected person or an exposure to objects (such as needles) that have been contaminated with infected secretions. Most of the affected people are family members who have cared for sick loved ones. The disease is also prevalent among health care workers due to their high risk of exposure in routine care. According to the World Health Organization (WHO), it can be transmitted through environments contaminated with infected fluids. The patient remains infectious, even after death. This has been a significant reason for the transmission in Africa due to the burial ceremonies in which mourners have direct contact with infected persons. The WHO also reports that men apparently can still transmit the virus through semen for up to 7 weeks after recovery from the illness. This was determined after an occupational exposure of Ebola by a laboratory worker who survived.
UPDATE from CDC Twitter Chat 8/4/14 –
- The virus has been detected in sweat.
- Can spread easily if you make contact with bodily fluids of symptomatic case.
- Although it varies a lot (temp, humidity, pH, etc), the virus CAN survive 1-2 days outside the body.
Signs and Symptoms
Unfortunately, the signs and symptoms of Ebola are very similar to many other disease – fever, headache, joint and muscle weakness, diarrhea, vomiting, loss of appetite. It is characterized by a sudden onset and also many reports of hiccups. Symptoms can occur anywhere from 2-21 days after an exposure, with an average of 8-10 days. Diagnosis is made when all other diseases are ruled out. Blood tests are used to clearly identify the disease. However, the patient should be isolated if there is any suspicion of infection and public health officials should be notified.
Unfortunately, there is no treatment for Ebola, other than supportive care. Dehydration is common, therefore maintaining adequate fluid and electrolytes are paramount. One article described the virus like a steel axe in the body – causing extreme destruction from a simple molecule string of proteins. This past week, the infected American’s were given an “experimental serum”. As far as I can ascertain, it appears they were given blood products or a derivative from a patient who had survived. In doing so, the patient receives the antibodies produced by the survivor and hopefully is able to combat the virus. It is unclear as of yet why one person survives versus another – sounds very similar to sepsis to me….
UPDATED Aug 4, 2014 – More reports are coming out this morning about the “experimental serum” that the infected American’s received. Basically they received antibodies produced from exposing mice blood to the virus…. yup, science is cool! Read more about it in this CNN article.
UPDATE from CDC Twitter Chat 8/4/14 –
- Once patient recovers, virus not retained.
- Surviving confers immunity.
UPDATE Aug 15, 2014 – an elderly, 75 year old Spanish priest was treated with the experimental ZMapp medication, however has subsequently succumbed to the disease. This continued to prompt ethical debates on if the medication should be offered and to whom. On Aug 12, 2014 the WHO convened an ethics panel and determined that in light of the current outbreak, the experimental medications should be offered despite no clear evidence that it works. The discussion will continue as to who will it be offered….
Isolation and the use of primary prevention measures is the key. When caring for infected patients, caregivers should be wearing protective clothing which should be completely sanitized after use. The patient ultimately should be isolated from contact with unprotected people. The WHO recommends the use of gloves when slaughtering animals, however, this is not always possible in undeveloped countries.
UPDATE from CDC Twitter Chat 8/4/14 –
- Any hospital is equipped to handle an Ebola patient using standard contact and droplet precautions.
- They also confirmed that the virus is retained in the semen for up to 7 weeks and the use of condoms is recommended. (This could be a serious issue as this is why HIV is so prevalent in Africa!)
UPDATE 8/15/4 – The countries of Sierra Leone & Liberia have taken extraordinary measures in an attempt to contain the spread of the disease. Cordons have been established not allowing any one our to restricted areas. These measures were common in the Medieval ages in an effort to stop the Black Death, and have not been used since 1918. There are concerns from the global community regarding humanitarian needs. Extraordinary measures for extraordinary times…
My humble thoughts…
Ideally, prevention is simple – don’t expose yourself to an infected person. As I sit in the comfort of my American home, this is simple. But in the less developed countries of Africa, this becomes more problematic. The trouble with containment is due to a variety of social-economic issues. First is the lack of infrastructure and resources. Followed by huge mistrust of the health care system as a whole. Some villagers have not been allowing health care workers to enter their villages as they feel the “curse” will be brought there also. Another issue is the mobility of the people. With loose borders, people are more transient and continue to infect populations without knowledge that they are even infected. This makes tracking exposures impossible in an already taxed system.
Many humanitarian programs have been helping since the outbreak started back in March. Doctors Without Borders has been the primary group leading most of the efforts. They had reported in late June that containment seemed to be happening and some of the isolation hospitals had been closed due to no patients or turned over to other groups, such as Samaritan’s Purse. However, almost suddenly, there was a surge of reports and the number of infected persons climbed significantly. It has been a difficult fight every since considering the limited resources have already been maximized.
Recently, we sadly learned of the death of one of the leading doctors in Sierra Leone, Dr. Sheik Humarr Khan. This news was followed by the news of two American humanitarian workers who were infected with the virus – a doctor and a nurse. Today, the doctor was transported to Emory University Hospital in Atlanta, Georgia for increased care and treatment. This will be the first time a person infected with Ebola will be treated in the US. I personally am not a fan of this plan. In my humble opinion, it pretty much defies every infection principle and places undue risk on a multitude of people. They keep “assuring” us that all will be fine and the risk of exposure is minimal. Did you notice they said minimal…. What I recognize as a nurse, not everyone follows the rules or practices as they should – its just human nature. In fact in the recent CDC recommendation, they state you should place a person outside their door to insure consistent use of protective equipment. Also, what you don’t hear a lot of in the news reports… the doctor and nurse were most likely infected during the decontamination process, which logically places anyone caring for them at risk.
UPDATE from CDC Twitter Chat 8/4/14 – I asked multiple times throughout the chat why so many health care workers were getting infected if using appropriate precuations, especially the Americans, the response was that infection likely occurs prior to then knowing the patient is infected. I am not so sure about this…. apparently the virus is spread like any other blood borne pathogen (think HIV, Hep B), however, why is is spreading so uncontrollably? I suspect this is more contagious than authorities want to let on. However, in watching the panic of some of the questions yesterday, I am not surprised – it appears the public can’t handle the truth.
According to current reports, he will be cared for by two nurses at all times. Sadly, my first question was, “Who volunteered for that assignment? I have to meet them!!” Don’t get me wrong, as nurses and health care providers, we expose ourselves to lots of fun and interesting diseases, but not usually by choice. I have to give it to them, I don’t know that I could do it.
UPDATE 8/15/14 – In a recent Washington Post Op-ed article, Emory Chief Nursing Officer expressed in pride in her staff and the reasons for bringing the patients to their hospital. Apparently, the staff, who have trained for years for this very situation, all volunteered to care for the infected Americans – some even canceling vacations. Although very heroic of them, the article also hints at the fact that this is one big learning experiments….not so sure how I feel about that one…. You can read the article HERE. I would be interested to hear your thoughts – please leave your comments below and lets talk some more about it!!
UPDATE 10/4/14 – On Sept 30, 2104 the first case of Ebola was diagnosed in the United States. Although the case is ongoing, the patient is noted to be in serious condition and had an estimated 100 contacts prior to his hospitalization after his symptoms became severe. Many questions have surrounded why he was not identified earlier as he presented to the hospital 2 days prior, however, he was not flagged as a possible Ebola patient and was discharged into the community. It has not been learned that he did disclose recent travel however denied being around sick people recently. Initially the nurse was blamed for not communication this information, however the hospital now recognizes there was a break in the electronic medical record work flow. I could go about this forever… but for now, lets stick to the facts. As health care providers, we have to vigulant and aware to identify these patients – it is EVERYONE’s responsibility to do due diligence in screening patients. Be educated!!
I hope you have found this helpful. Thanks for taking the time to read it, educate yourself and listen to my humble opinions on the matter. Come back often as I do plan to continue to update any important information of facts I may come across as we watch this unfold.
In the meantime, here’s some info you might find interesting and / or be familiar with depending on your occupation:
CDC Current Recommendations for Known or Suspected Hospitalized Patient – these were just published Aug 1 – hot off the press!
NBC News – they have a storyline that covers all the major events – good quick info.
Doctors Without Borders – they are an amazing humanitarian company that tries to meet urgent health care needs around the world
I’d love to hear your thoughts – please leave my your comments below & lets get the conversation started!
Take care, be safe & wash your hands.