Sunday, 30 March 2014

Ebola's Back: What You Need to Know

"The rampant deaths in Guinea have Westerners on high alert about Ebola, but Dr. Kent Sepkowtiz says contracting it in the U.S. is unlikely as the uncontrollable outbreak stems from the absent health care systems in resource-strapped foreign countries.

Ebola virus is back. In the last few weeks, reports from Guinea, a small country in West Africa (formerly French Guinea and not to be confused with either nearby Guinea-Bissau or New Guinea, the large island north of Australia) have identified at least 80 cases of Ebola resulting in 59 deaths. This is the first large outbreak since 2012 when the virus killed several persons in Uganda and the first natural outbreak of the disease in West Africa.
Public health experts are scrambling to contain the disease, which has no known treatment or preventative vaccine. The disease is caused by one of several closely related viruses and typically kills the majority of people infected, the same rate seen in Guinea now. Early symptoms include aches and pains and fever, with rapid progression to confusion, respiratory problems, and finally hemorrhage. For unclear reasons, the millions of tiny blood vessels throughout the body begin to leak, leading to blood under the skin, in the lungs, everywhere thus its designation as a hemorrhagic fever.
The blood itself, as it leaks out from blood vessels, is highly contagious and typically affects those caring for the initial patient. Symptoms generally begin 8-10 days after exposure. Though spread of established infection person-to-person is well-understood, the exact epidemiology of the infection in nature remains uncertain. Most experts blame bats as hosts (“reservoirs”) who can spread the virus without themselves becoming ill. Somehow the virus appears to spread from bats to primates such as gorillas and chimpanzees, perhaps from partially chewed fruit that distracted bats drop onto the ground as they whoosh to their next landing. The gorillas and chimps perhaps then chomp the half eaten fruit and become ill with a devastating human-like disease. (Entire gorilla communities have been devastated by the virus.)
Ebola would just be another weird disease that caused the occasional death were it not for the nearly absent health care system in the resource-strapped countries it affects.
The question of how humans then contract it from gorillas seems to stem from the collection and consumption of “bushmeat”—chopped up wild animals considered a delicacy for many. Most Ebola outbreaks have been traced to those who handle the newly killed animal or else butcher a dead animal found in the field. The ferocity of the infection—people can go from feeling fine to an overwhelming infection in days—makes ascertainment of a clear history sometimes quite difficult as affected patients are usually too sick to tell their story.
Ebola would just be another weird disease that caused the occasional death were it not for the nearly absent health care system in the resource-strapped countries it affects. In these areas, family members are the ones to clean the bleeding loved one, discard urine and stool, wash, and when necessary, eventually bury him. And with each contact, the risk of spread increases. 
As a result, Ebola outbreaks typically decimate large families as each cares for the next becomes ill, spreads to the next relative and so on, until the diagnosis is secured and public health authorities can establish the remedy—disposable gloves and goggles and gowns and needles and syringes that keep the dying patient’s secretions away from the next person. For this reason, most outbreaks end soon after global recognition—the identified cases either die or pull through but transmission is stopped cold. The intervention is simple, effective, and widely availably in any country with a rudimentary system of isolation and enough money to assure rapid and adequate isolation. For Ebola, the quarantine (named centuries ago after the Italian word quarantaor forty—this being the duration sailors from visiting ships would be isolated for the native population, a period long enough for them to get sick and die from the Bubonic Plague) is all it takes to end an outbreak.
While this sort of thing makes for frightening headlines and occasional dud movies (here and here for starters), Ebola and its related group of devastating infections will never become a threat to the US. The disease simply sickens and kills too quickly, plus anyone in the US with an odd febrile illness and rapid progression to prostration is placed into gown and glove isolation at just about every hospital in the country.
The real story of Ebola is not about some grave global danger, but the fact that such an easily preventable disease outbreak continues to occur because healthcare systems are so poorly structured and wildly underfunded in countries without minimal wealth and governance. Though much talk is focused on the need to generate a vaccine and rid the world of the threat, the next virus will simply come along. Little will actually be solved other than a generation exhaling with self-satisfied relief. Because a new vaccine does nothing to address the root cause for Ebola, Malaria and many other diseases over there, but never over here—the discrepant quality of health care in the world today. Now that is the true healthcare crisis. "

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