http://www.vox.com/2014/7/29/594841...se-virus-symptoms-africa-facts-guinea-nigeria
The deadliest Ebola outbreak in history
Updated at July 30, 2014, 3:50 p.m. ET
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about 4 hours ago
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Outbreak is the deadliest type of Ebola virus
Ebola_death_rates_2
These death rates were calculated by adding up the records of cases and deaths from all known outbreaks. Individual outbreaks can vary, and Zaire ebolavirus is often cited as having death rates up to 90 percent.
Not all Ebola viruses are the same. As happens often with viruses, close relatives can have very different effects.
The current Ebola outbreak is of the Zaire ebolavirus species. This one has historically had the highest death rate of the five different species of Ebola virus. The species was named after Zaire (now Democratic Republic of the Congo), where it was first found in 1976.
about 4 hours ago
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Should you be afraid of the Ebola threat?
The World Health Organization and the US Centers for Disease Control have both said the risk that Ebola will spread beyond West Africa is extremely low. "The virus is difficult to transmit," Gregory Härtl, a WHO spokesperson, told Vox. "Yes, there was this case of a person with Ebola going to Nigeria on a plane, but in all of history, only one or two people with Ebola got on planes."
Still, fear-mongering headlines about the worst outbreak in Ebola history abound in the press: "Here are the 35 countries one flight away from Ebola;" "Global authorities on alert over Ebola outbreak;" "Deadly foreign diseases are 'potential major threat'."
So we called Art Reingold, the head of epidemiology at UC Berkeley's School of Public Health to make sense of the news. As a disease epidemiologist who has spent the last 30 years studying the prevention and control of infectious diseases around the world, he knows how and why viruses spread. Here's a transcript of our conversation, lightly edited for clarity.
Julia Belluz: How is this outbreak different from others in the past?
Art Reingold: This outbreak is certainly really bad. It's different from the ones we have seen in the past, which generally have started in and often been confined to villages or reasonably limited areas where most of the population is rural and scattered. We now have an outbreak in multiple countries, including urban areas. For this outbreak to be in West Africa is unusual; most have been in Central and East Africa. This represents a new set of challenges people haven't faced before. It is definitely going to be a real challenge to bring this outbreak under control.
JB: Because this is the worst Ebola outbreak in history—with three Western African nations affected—and because Ebola is so deadly, people everywhere are afraid. What is the actual risk that this virus will spread beyond West Africa?
AR: People should not be concerned about Ebola spreading to the US or other wealthy countries. It's transmitted entirely through exposure to bodily fluids. In settings with Ebola, there's bleeding in a variety of places and the virus is present in those excretions, and people need to come into contact with that to get the virus. The people at risk are the family members who are taking care of sick people, those who are preparing bodies for burial, and health-care workers.
JB: Some airlines are enacting travel bans since the outbreak. Are they justified then?
AR: The virus is not transmitted through coughing and sneezing, or through sitting next to someone on a bus or the like. The idea that the virus can somehow mutate and become more readily transmissible from person to person through coughing or sneezing—those are Hollywood scenarios. The idea that Ebola can become more readily transmissible through casual contact is unrealistic and not something we are concerned about. It's people whose job it is to deal with this virus—those working at the ministries of health, health care providers, those struggling with how to get the outbreak in the affected countries under control—that need to be concerned.
JB: What about a worst-case scenario, if it did spread?
AR: In high-income countries like in Europe and the US, we know how to prevent the transmission of Ebola. It has to do with making sure suspected patients are treated and isolated, and appropriate measures are taken for the health-care workers taking care of them. That's what worked in Africa in the past and it should be possible to prevent further transmission of the virus. For people in the US, it's really not a plausible scenario that we are going to start to have to introduce these measures. I would have no fear or concern about getting on an airplane and going to affected countries if I had work to do there.
""More people die of diarrhea in a day than Ebola has killed in history.""
JB: Can you put the Ebola risk of death into the context of other diseases?
AR: A few thousand people in history have died of Ebola. Compared to AIDS or malaria or diarrhea, this affects far fewer people. More people die of diarrhea in a day than Ebola has killed in history.
JB: So if the risk is so remote, why do you think people are afraid?
AR: It's a highly lethal virus and sixty to seventy percent of the people who get it die. Being fearful is a reasonable response. But elevating that to a fear of getting Ebola by the average person is where it becomes irrational.
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about 8 hours ago
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Doctors share stories from the Ebola outbreak
"I knew it was going to be hard but I did not expect this extent of challenges, in terms of lack of equipment and gaps in infection prevention and control measures," says Mauricio. "However, after the initial shock, I started to see those difficulties as opportunities for improvement."
This is Mauricio Ferri, a doctor fighting Ebola in Sierra Leone as part of a World Health Organization deployment. He and another doctor shared their stories in an interesting piece that's up on the WHO's website here.
about 13 hours ago
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What would happen if Ebola came to the US?
The world is currently experiencing the worst Ebola outbreak in history — it's in West Africa and has killed about 672 people as of July 23.
But what would happen if the disease came to America?
The scenario isn't as far-fetched as it might sound. With air travel as common as it is, borders don't mean all that much when it comes to disease. It's entirely possible — though by no means certain — that at some point, someone infected with Ebola could get on a plane and land in the United States. And then what?
As it turns out, experts say, we'd probably be able to contain an Ebola outbreak here pretty quickly. But it's worth exploring why that is. The outbreak in West Africa is so severe for a number of key reasons, including a lack of resources, inadequate infection control measures, and mistrust of health workers. The United States, by contrast, has far better public-health infrastructure. And that makes all the difference.
So here's a detailed look at how Ebola in America might go down:
1) The first 24 hours: identify the outbreak
The most likely way for Ebola to arrive in the United States would be an infected person flying from West Africa who has Ebola but doesn't even know it. Ebola can hide in a person's body from two days to three weeks before symptoms emerge. And people don't transmit Ebola during that incubation time — they're only contagious once they show symptoms.
"eARLY SYMPTOMS COULD BE CONFUSED WITH THE FLU or DIARRHEA"
Once an initial Ebola patient starts feeling sick, she'll probably seem at first like she has the flu or traveler's diarrhea. (Some of the more famous symptoms of Ebola, like bleeding from orifices, don't tend to come on until later. And bleeding doesn't even happen in about half of cases.)
Although the patient would now be contagious, that doesn't mean that it's exceptionally easy to catch. It's not. Ebola doesn't spread through the air. And it's harder to catch than things like the flu. You can't get it from a cough, sneeze, or just being on the same plane or in the same public space. The only way to get Ebola is to touch a patient's bodily fluids, like vomit, diarrhea, or blood.
Now would be when speed and public awareness plays a big role, no matter where in the world an Ebola patient is. The patient or someone around her will have to figure out: (1) This is something that looks like the flu or diarrhea and (2) This person was just in a country that has Ebola.
If people realize that this might be Ebola early on, they should be able to avoid getting infected by keeping away from the patient's bodily fluids. But if that doesn't cross their minds for a while, people will be more likely to get the virus by accident. In that first day of symptoms, every hour counts.
2) The next step: isolate the patient
In US hospitals, any suspected case of Ebola would be treated as a potential risk until tests come back negative. This means that standard procedures to protect other patients and health-care workers from the patient's bodily fluids would be put into place.
Because Ebola doesn't spread through the air, hospital workers wouldn't have to wear respirators or what you might think of as full Outbreak gear. However, they would protect their body and face from fluids that might splash on them, using things like gowns or full body suits, masks, gloves, and goggles.
Anything that touches the patient would be sterilized or disposed of in a safe manner. And if the patient dies, the body would be carefully handled so that it won't be a danger to anyone, either.
Better adherence to these safety guidelines is one reason why the virus wouldn't spread as quickly in the United States as it has in West Africa. For example, over there, some health-care workers have gotten infected, most likely because the rules weren't followed as closely. And there's actually a reason for that — people who are supposed to wear protective suits in 100°F weather will get extremely hot and might cut corners, says Michael Osterholm, of the Center for Infectious Disease Research and Policy at the University of Minnesota. But US hospitals are more climate controlled, he says, and even that small difference makes a breach less likely.
3) Track down other potential patients
Detective work is a major part of controlling a disease like Ebola. Experts would interview the patient, her relatives, and other potential close contacts to monitor them and make sure that they don't spread the disease to others.
Officials will then suggest various options for these people, depending on the level of risk, including watching and waiting, isolation at home, and testing for infection.
Tracking down contacts has been especially problematic in West Africa in ways that unlikely to happen in the US. An editorial in the major medical journal The Lancet says "The geographical spread of cases and movement of people in and between the three countries presents a huge challenge in tracing those who might be infected." And the World Health Organization says that "low coverage of contact tracing" is one key problem it uncovered in a recent assessment the Ebola response in Liberia.
4) Keep patients in hospital until they're not a threat
It's important to remember that about 40 percent of the patients in this Ebola outbreak have survived. There's no specific pill or shot that will make an Ebola infection go away, but doctors can try to make the patient comfortable, give IV fluids, and treat symptoms.
To prevent Ebola from spreading, health authorities wouldn't release a patient from the hospital until it's clear that she won't be a danger to others.
This might seem intuitive, but it hasn't always happened in West Africa. For example, the BBC reports that there are several missing patients in Sierra Leone — where some people don't trust that medical care will help them. That, obviously, increases the odds that the outbreak will spread.
The best case scenario and the worst case scenario
To sum up, the best case scenario is that someone coming back from, say, Guinea, realizes that she might possibly have Ebola as soon as she starts feeling sick. Everyone makes sure not to touch her vomit or diarrhea or other fluids. And the outbreak ends with just one patient.
The worst case scenario is that this person is ill for days and in contact with a whole lot of people before anyone realizes that something unusual is going on and brings her to a hospital. But it's still unlikely that Ebola will get farther than a local problem in one city or town. Even in the worst case scenario, "I don't think we’ll have a serious public health threat in any of the developed countries," Osterholm says.
For more on the basics of the Ebola outbreak, check out my previous story Ebola: what you need to know.
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