MD, chief medical officer for The University of Kansas
Hospital has offered ten things one need to know about Ebola Virus Disease
Cases Are Out-Migrating From
This is happening due to the fact that infected or ill people are
traveling out of those countries in Africa with
Ebola outbreaks. Cases found outside of Africa
may likely go up as the number of people leaving outbreak areas increases when
aid-workers and others return to their home countries.
No Cases of Human-to-Human Transmission Outside of Africa:
There has been no human-to-human or other
transmission to humans outside of Africa.
Ebola Is Not Transmitted By Air, Only Via Bodily Secretions:
not respiratory, so it is not transmitted through coughing or breathing. These
infections are occurring because of people who are exposed to bodily fluids of
Ebola Is Not The Most Infectious Disease:
As infectious diseases go,
Ebola virus isn't inherently the most infectious nor is it the least infective
from person-to-person. Measles and chickenpox, for example, are easier to
spread. So are influenza and MERS.
High Mortality Rates Due to Geography
: The mortality rate is quite
high in Africa Ebola cases, partly because of the chaos, instability, and
unrest of the governments there, and very directly related to the fact that
their access to standard treatment supplies (IV solution, tubing, syringes, and
protective equipment) is not universally available. Ebola cases identified and
treated in westernized nations, and those with modern infection control
practices, will have a much lower rate than those seen in most African regions.
Likelihood of Breakouts In Areas Outside of Africa:
Meticulous infection control practices in modern hospitals will make it more
unlikely that human-to-human transmission will occur in these settings.
While expensive and advanced bio-containment units provide the highest level of
infection control, it is unlikely that these units will be widespread
throughout the world.
No Approved Immunizations and Treatments:
There are no approved
immunizations to prevent Ebola virus infection. There are no approved
treatments for Ebola virus infection. There are experimental antibody
treatments, as well as an antiviral medication not approved for Ebola.
But whether either or both are safe or effective for widespread use is not
known. "Compassionate use" or "experimental use" of the
above treatments is tempting, because no targeted, specific "conventional
treatment" exists. But widely adopting experimental, unproven
medications as "the new conventional therapy" has its own
difficulties: Is it safe? Is it effective? Is it costly? Are
there unanticipated "down-sides" to using them? A WHO ethics panel
has given the go-ahead for this, something it has never done before.
How Animals Play a Role:
The non-human vectors that can harbor Ebola
virus (fruit bats, non-human primates) are widespread in areas far removed from
Africa. As such, it bears watching whether those vectors begin to harbor
the virus. The WHO has an excellent map showing the parts of the world
with these vectors.
The WHO and CDC both recently increased their respective
alert levels. State and local health departments throughout the U.S. and world
will certainly seek guidance as to the adoption of best "local
practices" to guide hospital and care providers. The guidance by the CDC
as to how to manage exposed individuals and those who might be incubating the
infection are quite specific and helpful. They will certainly change as
time goes on.
What We Don't Know About Ebola:
There are things unknown about
Ebola. For example:
- Can a
person have had a low-level infection and not know they ever had it?
Probably, based on serum testing.
- Does a
person who has had it and survived develop lifelong immunity? That
is unknown at this point. The various strains of Ebola are enough
different antigenically that there may not be cross-immunity.
- Is there
such a thing as a "chronic carrier state" in humans where a
person can shed the virus and be infectious for a long period of time,
even when they themselves have no illness or symptoms? That is also
unknown at this point.