Alan Blum, MD
Alan Blum, MD, is professor and Gerald Leon Wallace, MD, Endowed Chair in Family Medicine at University of Alabama School of Medicine. He also is director of The University of Alabama Center for the Study of Tobacco and Society.
From the public’s perspective, the outbreak of Ebola in West Africa is very frightening and tragic. However, the reality for people living in the US is far less dramatic than what has been portrayed in books and movies. Unfortunately, some fundamental misunderstandings about the current outbreak of this illness still persist.
To cut through the hype that’s now spreading about Ebola, Bottom Line/Health spoke with one of the world’s leading infectious disease experts, William Schaffner, MD.
Here are the main myths that are causing so much confusion…
MYTH #1: The Ebola virus has never before entered the US. Many Americans were frightened to learn that health-care workers who were infected with Ebola were being transported to the US for treatment. Weren’t we running the risk of spreading the virus here?
The fact is, Ebola has already existed in the US for decades—not in people, but in laboratory specimens used to research vaccines and cures. There has been no outbreak here.
To guard against any potential transmission of the virus, the two American health-care workers were transported on planes specially-equipped with advanced infection-control systems in place. The patients were transferred to Emory University Hospital in Atlanta for treatment in similarly equipped ambulances. They were then placed in isolation rooms, where all attending health-care providers used protective equipment (including face shields, masks, gowns and gloves) when caring for the patients.
MYTH #2: Ebola can’t be controlled. Even though the current Ebola outbreak in West Africa is indeed unprecedented, the virus typically comes and goes in rural African villages in small outbreaks that are quickly curtailed by diagnosing and treating the condition while also tracing the original source of transmission.
Many people don’t realize that the disease, which was first documented in Africa in 1976, usually disappears for three to five years before reemerging. This time, Ebola spread to African cities when doctors brought in sick patients from remote villages, hoping to provide better care.
Even in these cities, proper infection-control systems, such as the use of biohazard suits, are difficult to maintain because of the sweltering heat (it’s often very humid and temperatures can reach 100°F). Those bulky, cumbersome, spacesuit-looking forms of protection are like ovens and exhausting to work in. There’s also a shortage of necessary medical supplies, such as latex gloves and disinfectant, in underdeveloped parts of Africa.
No one really knows why each Ebola outbreak begins. But experts suspect that the virus is carried by bats or small mammals—monkeys, in particular.
A new round of the disease probably starts when a person is bitten by or exposed to the blood of an infected animal or eats or handles raw or undercooked meat of an infected animal. Authorities suspect that the most recent outbreak began when a two-year-old boy in Guinea became infected.
MYTH #3: Ebola cannot be treated. The initial symptoms, which develop two to 21 days after exposure to the virus, are not that different from those of the flu and are likely to include fever, aches, sore throat, weakness, nausea, vomiting and diarrhea.
Although there’s currently no medication or other specific treatment available for the disease, the supportive care that’s required is not that specialized. Any decent regional hospital in the US, not just those in major cities, is capable of providing this care safely.
What’s most important when treating Ebola is to stabilize the patient’s fluids and electrolytes while maintaining his/her blood pressure and oxygenation. As the virus takes hold, however, there may be uncontrollable bleeding from the nose, gums and bowels, and into the whites of the eyes. In severe cases of the illness, general organ failure leads to death.
It’s not fully understood why so many people die of Ebola and others survive—scientists suspect that it has to do with the immune system’s ability to withstand the initial viral attack. In the current outbreak, about 40% of people sickened with the virus have survived so far.
MYTH #4: Ebola is highly contagious. Ebola is not easy to catch—it spreads only by intimate contact with body fluids during the time when a person is actively sick.
It’s a particular problem in Africa because funeral rites require that families perform ablutions. This involves washing the entire body of the deceased loved one, including inside the mouth and anus.
Villages actually shun families that don’t perform ablutions. Even though village leaders can influence tribal practices in remote villages, it’s much harder to contain the disease in teeming urban areas, where the current outbreak is located.
Many Americans haven’t even heard of Chikungunya (CHIKV)—pronounced “chik-un-GUHN-ya”—but it’s worth knowing about. This mosquito-borne virus originated in Africa, spread to Southeast Asia and now also exists in the Caribbean and the Americas.
CHIKV is rampant in the Caribbean because of local living conditions—open windows without screens and no air-conditioning—which leave people vulnerable to mosquitoes. Because more than 12 million Americans travel to the Caribbean each year, it’s important that they understand how this virus is transmitted (via mosquitoes, not person to person) and take appropriate precautions.
At press time, 640 cases of travel-related CHIKV had been reported in 43 states and the District of Columbia this year. Mosquitoes infected with the CHIKV virus also were documented in Florida this July, and four cases had been reported there in people who had not traveled outside the US.
What are the symptoms? While CHIKV is rarely fatal, it is extremely painful and debilitating. In fact, its name roughly translates to “Bent Over in Pain,” due to the severe discomfort it causes in the small joints of the hands and feet. Other symptoms of CHIKV include fever and sometimes a reddish rash with slight bumps that may occur on the face, trunk, arms and legs. For most people, CHIKV lasts one to two weeks. But 10% of sufferers may have painful joints for up to a year.
What’s the best way to prevent infection? No matter where you live, it’s important to avoid mosquito bites. Mosquitoes can infect you with CHIKV, West Nile Virus and other diseases.
Prevention of CHIKV depends on avoiding mosquito bites, especially in the daytime when CHIKV-carrying mosquitoes are most likely to be out. However, these mosquitoes also bite at dawn and dusk.
The most basic precaution is to keep mosquitoes outdoors by closing windows and running the air-conditioning if possible…or putting mesh screens on your windows. Be sure to also open and close the door as quickly as possible when entering or leaving the house.
In addition…
For your skin, products containing DEET, IR3535 or picaridin offer long-lasting protection. Opt for products containing permethrin if you’re using repellent on your clothing. If you’re using both sunscreen and insect repellent, apply sunscreen first.