Ebola--Separating Fact from Fiction
By Fred Fletcher
Does Ebola deserve the attention it’s been getting lately? Is it as dangerous as some so-called “alarmists” (e.g., Mike Adams, Donald Trump, etc.) are suggesting? Or is it the easily-manageable threat others (like the CDC) are proclaiming? Actually, the truth may lie somewhere in the middle.
Yes, infectious disease experts may know the most about the viruses that cause Ebola virus disease (EVD) and the other hemorrhagic fever diseases; scientific facts are always preferable to unfounded theories and worst-case prognostication; and some people do attempt to profit/benefit from the hysteria that comes from potential threats.
Notwithstanding these truths, some skepticism and cynicism can also play a useful role, especially if the so-called “experts” turn out to be wrong, circumstances change, or new facts come into light.
After all, none of the experts alive back then expected the flu epidemic of 1918 to get out of control as quickly and voraciously as it did. In fact, some people have argued that part of the reason the epidemic became so deadly is because the plague (at least at the beginning) was grossly underestimated, public health measures meant to keep the disease in check were not implemented as efficiently and aggressively as they needed to be, and government officials (probably worrying too much about political correctness) did not forcibly detain and isolate infected people quickly enough.
After all, who (either in 1918 or today) wants to send in the army (if that is what is called for) to put people in concentration camps (for lack of another term)?
What about AIDS? Some experts have argued that the disease was allowed to spread because the government was so worried about political correctness that it failed to, just as in 1918, forcibly isolate people with the disease—instead opting to let people voluntarily report their disease status, as well as insisting that reported cases be made/kept anonymously. This may be fine when you get prompt and consistent cooperation but history has shown (as in the case of tuberculosis) that this is often not the case. For obvious reasons, people object to and actively fight against public health measures—even if it’s for the common good.
Clearly, public health measures were not followed appropriately with the HIV virus and, now, the disease has spread beyond epidemic proportions.
This is all to say that, since Ebola is mostly an unknown variable (i.e., there is more about these viruses that we don’t know than we know), maybe downplaying their capacity for destructiveness may be as irresponsible as sensationalizing it. Some experts, for example, in making fun of Mark Adams and Donald Trump, make these viruses sound as if they are stable, predictable pathogens. They are not. A virus can mutate repeatedly. During each mutation, its properties (including virulence) can be altered drastically.
In other words, the Ebola viruses can become airborne without any fanfare or warning at any time. This is especially true if the strains that have sprung up recently (which are not necessarily and, in fact, probably are not) are not the same as those that sprang up in the 70s and 80s in Africa; this is of even more concern if said strains have been tampered with genetically.
Since bioterrorism is an ever-present threat these days, who is to say with 100% certainty that this is not what we are seeing today?
What, Then, Do We Know for Sure—if We Should Rely on Facts?
These are the facts in a nutshell:
1) We are dealing with 3 genera and 5 species of viruses belonging to the Filoviridae family. In other words, we are not talking about one single type of organism but several.
2) These are RNA viruses, which have proven to be more pathogenic and dangerous than DNA viruses, probably because these viruses replicate more quickly and easily, their shape is uniquely tied to their pathogenicity, and they are often enveloped (meaning that they are more difficult to detect and attack by the immune system).
3) These are zoonotic pathogens—i.e., the original hosts were animals. The influenza virus, Variola (smallpox) and HIV (three of the most lethal viruses known to man) are also zoonotic. In other words, this puts Ebola under a very dangerous category.
4) Although the transmission pathways identified thus far appear to require direct contact with infected bodily fluids (as is the case with AIDS), there is nothing to prevent these viruses from mutating into airborne pathogens—in fact, it’s reasonable to assert that, with time, they might mutate in that direction.
5) These viruses are, so far, restricted to only certain countries in Africa; they are not yet a palpable threat to the US or any other developed country.
6) There are several methods for diagnosing the diseases these viruses can inflict. These include ELISA, RT-PCR, antigen-capture detection, serum neutralization, and cell culture virus isolation.
7) These pathogens are too small for the strongest microscopes; in fact, they require electron microscopes. The high cost and difficulties in using this most effective way to identify Ebola is one of the impediments faced by third world countries.
8) It is not true that there is nothing that can be done for Ebola patients. The use of certain measures (e.g., anticoagulants and rehydration fluids/electrolytes) can reduce mortality rates. Also, several experimental drugs (Zmapp, TKM-Ebola, etc.) and a vaccine are expected to be available in the future.
9) Infected persons, furthermore, can benefit from oxygen/blood pressure monitoring and treatment of concomitant infections.
10) The main symptoms for Ebola-related disease include: severe headaches; fatigue; diarrhea; vomiting; muscle pain; fever; peculiar hemorrhaging; etc.
11) The most efficient ways to prevent/avoid the disease is by avoiding places (including healthcare facilities) where infected people have been; not touching objects or clothes or body parts of infected persons; immediately isolating infected persons; approaching infected persons while wearing disposable gloves, face masks, etc.; immediately taking infected persons to a healthcare facility; practicing good hygiene (including washing hands frequently) etc.
12) Persons infected with Ebola are most dangerous after they exhibit symptoms/signs.
13) The incubation period is between 2 and 21 days (i.e., the time required to show symptoms after becoming infected); the average time required for this event is about 8 to 10 days.
14) People having their temperature tested at check points and airports is, at best, an imperfect way to check for infection. A person may not show a temperature for up to 21 days or they may have a temperature for reasons other than Ebola.
15) Some of the reasons the infection and mortality rates are so high in Africa are because of inadequate medical facilities and medicines; cultural practices which prompt people to have contact with diseased persons; superstitious believes (e.g., that Ebola is the result of bad magic); re-use of medical tools (i.e., syringes); etc. Since these conditions may not apply to more developed countries, the threat posed here may not be as great or produce the same results. Also, there is less eating of raw meats or the consumption of hunted game in the west.
16) Although the prevalence/incidence and mortality rates seem high at this time, they are still manageably low (under 10,000). Also, as long as the Ebola viruses do not undergo mutation into an airborne pathogen, they can reasonably be controlled at this time.
17) Western countries around the world are mobilizing resources in order to help the affected countries better deal with the epidemic. This should reduce the risk that Ebola will spread out of control.
18) Infected patients can be transported out of Africa into western hospitals with very limited chance for an outbreak as long as disease-containment protocols are followed and the patients remain isolated while recovering.
19) Some of the people who contract Ebola do survive (e.g., Dr. Kent Brantly). As more people develop immunity, the disease as whole becomes less of a threat. It should be noted, however, that immunity may be of limited-time scope and may be irrelevant once the original virus one was infected with mutates.
20) Our understanding of viruses is improving with each day. More importantly, we have won significant battles (although the “war” is yet raging) against viruses. For example, smallpox was eradicated from the face of the earth through vaccination. There is no reason for thinking that a similar vaccine (or some other type of medicine) cannot be developed for Ebola.
Conclusion
While everyone needs to take the Ebola problem seriously, there is yet no reason to panic—much less to fan the flames of sensationalistic fear-mongering. Having said that, it is just as irresponsible to downplay people’s fears out of arrogant optimism or the unswerving assumption that Ebola couldn’t possibly turn into a “Flu Epidemic of 1918” type disaster.
At this moment, whatever threat Ebola poses is under the capable hands (for the most part) of the CDC. A concerned citizen, though, who was participating in a discussion about Ebola recently asked, “How much can we trust in the CDC?”
The response he was given was “as much as you can trust the IRS, the FDA, FEMA, or any other government agency . . .”
Considering what happened during Katrina and other mismanaged disasters in the US’s history, maybe Donald Trump is not being completely out of line for telling people to worry—even if, at this time, the facts don’t support the need to over-react or panic.
Then again, skepticism and cynicism may actually be a good thing, if it prompts all of us to remain vigilant (rather than blindly trust in any government agency), keep a close eye on new developments, and take steps to be prepared for whatever disaster comes our way—whether it be biologic, political, economic, or some other type.
References
1. http://www.who.int/mediacentre/factsheets/fs103/en...
2. http://www.who.int/csr/resources/publications/ebol...
3. http://www.cnn.com/2014/04/11/health/ebola-fast-fa...
4. http://www.politico.com/story/2014/09/facts-about-...
5. http://www.cdc.gov/vhf/ebola/symptoms/index.html
6. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-a...
7. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-a...
8. http://www.cdc.gov/vhf/ebola/exposure/index.html
9. http://fas.org/programs/ssp/bio/factsheets/ebolafa...
You need only to look at Aids which is much harder than Ebola to transmit and still more than 1.1 million people in the United States are HIV+ with almost 1 in 6 (15.8%) unaware of their infection. Source: CDC
So, if the truth indeed lies somewhere in the middle then I'm taking the side of great caution as I would expect our government officials to act prudently and hope for the best but definitely prepare for the worst.
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