Wednesday, October 8, 2014

Ebola: The Fine Line between Reasonable Concern and Needless Panic

A colorized electron micrograph of the virion that causes Ebola viral disease. 
As many of you are already aware, the United States recently had its first ever case of Ebola viral disease (formerly known as Ebola hemorrhagic fever) to be diagnosed within its borders. Last month a Liberian native, Thomas Eric Duncan, tested positive for the virus in Dallas. Unfortunately, today it was announced that, despite aggressive treatment, he has passed away.

These events have raised serious questions about what is the most widespread outbreak of the virus to date. According to the World Health Organization, it has caused more deaths and cases than all previous outbreaks combined. The CDC lists the last known numbers at 8033 cases (4461 confirmed) and 3865 deaths. This is is a death rate of between 48.11% and 86.64%, depending on what number of cases are used: the total based on symptoms or only the lab-confirmed cases. Generally, the death rate for this outbreak has been given as "around 70%." Statements such as that are rather terrifying, and it's no wonder people are getting scared. However, there is a great deal of difference between being concerned in the right way and just panicking at the statistics.

Where Ebola viral disease has occurred
Except for a comparatively tiny number of cases, the current Ebola outbreak has been clustered in west Africa. Liberia has been the hardest hit, but Guinea and Sierra Leone have also had very large case numbers. Nigeria has had significantly lower numbers, though there have still been death, and all other places have minuscule amounts of cases compared to the three major countries of concerns. The disease originates in western or central Africa, and the main origin appears to be the bushmeat trade, with fruit bats believed to be normal carriers of the Ebola virus. In the past, Ebola has essentially been self-regulating. Since it is so deadly, the virus would "burn itself out" before spreading very far. Before this year, the largest number of cases in a single outbreak was 425 in the 2000 Ugandan epidemic, and the greatest death count was 280 in the first recorded Ebola outbreak: the 1976 event in what is now the Democratic Republic of the Condo.

This is why the current outbreak is so concerning. It has spread wide and killed many, with no real sign that it's stopping. Borders have been closed to try and prevent spread to more countries. People in west Africa are scared, and they have reason to be. HOWEVER, there are major traits about the disease that, under certain circumstances, make it quite difficult to transmit. These points are very important to emphasize. People can only become infected if they come in direct contact with bodily fluids of someone who is symptomatic. Note: Someone is ONLY infectious if they are CURRENTLY SHOWING SYMPTOMS. So, for instance, since the man who was diagnosed in the United States started showing symptoms after he was already in the country, he posed no risk to the people who traveled near him on his way over.

Researchers working with the 2014 Ebola variant
Perhaps the biggest issue with the regions that have been worst hit is that they do not have very good infrastructure. Health care workers that have traveled oversees to help in west Africa frequently report a lack of all sorts of supplies, including facilities and staff. Some areas do not have consistent running water, making sanitation more difficult. It can be harder to set up quarantines if the government does not have protocols on how to do so effectively. There have been cases of villagers refusing to cooperate with medical personnel, believing those who were trying to help them were the reason behind the deaths. Some victims have been afraid to look for help for similar reasons, putting those around them at greater risk of infection.

In west Africa, people have good reasons to be afraid. In the United States and other developed countries, the reason for concern is vastly lower. Sadly, I've already run across irrational panics and insane conspiracy theories (this one really takes the cake). Despite the death in the United States and the Spanish nurse who is now the first person to contract Ebola outside of Africa, the risks are not very big. We have the infrastructure that is lacking in so much of west Africa, which is why there have been infected people evacuated to their home countries for treatment. We can more easily prevent spread with quarantine laws, good facilities, and well-trained medical staff. This is the sort of thing that is needed oversees so that in the future widespread outbreaks can be prevented. It also wouldn't hurt if we could stop people from eating bushmeat, nipping the problem in the bud before it even starts.

The United States is now screening people who have flown in from countries where Ebola is active. This is not an unreasonable action, and is a step toward protecting US citizens. Unfortunately, it also means a big hassle if someone winds up sick with something less serious, but still has to deal with quarantine. The people at greatest risk of infection from Mr. Duncan have been quarantined, so with luck the number of future cases in this country will be few to none. I can only hope that Liberia, Sierra Leona, and Guinea will see a speedy end to the epidemic.

Sources are the WHO, CDC, and BBC (one, two, three, four, five, six). Images are from Wikimedia Commons under Creative Commons licenses or are copyright free: one, two, three