August 1, 2014
News Review From Harvard Medical School -- Ebola Outbreak Grows; Americans Urged to Avoid Area
As the major Ebola outbreak in West Africa grew worse, officials advised Americans July 31 to avoid any non-essential travel to the region. The warning came from the Centers for Disease Control and Prevention (CDC). The outbreak covers the countries of Guinea, Liberia and Sierra Leone. The World Health Organization said the number of deaths has reached 729. More than 1,300 suspected cases have occurred. Ebola causes failure of multiple organs. It has no cure. It is caused by a virus. People are contagious only if they are having symptoms that spread body fluids, such as blood or vomit. Because it is not spread easily, CDC officials said the disease is unlikely to reach the United States. Two American health-care workers infected with Ebola were expected to be flown home for treatment under strict infection-containment procedures. In all, about 100 health care workers have been infected. The CDC is sending 50 more experts to the region to help cope with the outbreak. Other U.S. experts will help African officials prevent infected people from boarding planes. There are no plans to routinely test U.S. passengers returning from West Africa for Ebola. HealthDay News wrote about these developments.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Two days, ago, the Peace Corps announced that it was pulling out its 340 volunteers in Liberia, Sierra Leone and Guinea. These West African nations have been stricken with an epidemic of Ebola virus.
People leaving these countries have been questioned about symptoms as they exited through the airports. Liberia closed its borders this week in an effort to contain spread of infection. Liberia also has closed its schools and asked residents to stay away from public parks. All offices in Liberia have been asked to close today to allow community workers to sanitize all public areas.
The current epidemic is the deadliest Ebola outbreak in history. There is no cure for Ebola. In this outbreak of 1,300 suspected cases (about 900 of which have been confirmed cases), there have been 729 deaths. Ebola causes an illness known as hemorrhagic fever. Symptoms include aches, fever, abdominal pain and internal bleeding. A person who has Ebola symptoms is contagious for up to 21 days. Spread of the infection occurs by direct contact with body fluids.
As an American and a doctor, I am bracing myself for the possibility that Ebola may spread to other regions. We live in an interconnected world. Air travel can spread contagious infection in a day.
What Changes Can I Make Now?
For those of us outside of West Africa, there is no immediate action we need to take. But you may choose to follow the news.
This epidemic has grown worse in the last couple of weeks. Experts from the World Health Organization and Centers for Disease Control and Prevention continue to reassure us that spread can be contained with appropriate care. This is true. But appropriate care is difficult. It requires a long stretch of quarantine for anyone who has come into contact with an Ebola patient.
Appropriate work is being done to control spread. There is a "Level 3" travel advisory for countries involved in the outbreak. This means that U.S. health officials have asked people to avoid non-essential travel to the region. Surveillance procedures are being introduced at airports to screen people leaving the affected countries. Officials want to make sure that nobody travels while having symptoms that might turn out to be Ebola virus. People without symptoms are not contagious, even if they have been exposed to the virus.
These strategies are very important to containment of the disease:
- Identify new cases early. This means that health systems in the area of the epidemic need financial support so that they can do appropriate lab testing. They also need the trust of their communities. Trust requires collaboration with local traditional healers.
- Isolate (quarantine) patients during the 21 days they are known to be potentially contagious.
- Identify people who have been in contact with cases of the disease. Then begin a careful watch for symptoms.
- Use safe burial practices and protective clothing. (Medical professionals use hoods, goggles, boots and multiple layers of gowns when caring for an Ebola patient.)
- Continue research about what might be a non-human source ("reservoir") of the virus. Currently, we don't know how epidemics of Ebola begin. Spread from a mammal, possibly a fruit bat, is suspected but not proven.
- Conduct research to develop a vaccine or treatment.
What Can I Expect Looking to the Future?
The U.S. government says it will work with other countries to try to end the Ebola epidemic. Our president’s budget proposal for fiscal year 2015 asks for $45 million to fund a "Global Health Security Agenda." Work on Ebola would fall within this request.
I hope that Ebola can be contained before it spreads to other countries. Could one of those countries even be our own? Yes, I think it is realistic. But if it does spread, containing the epidemic will take a level of cooperation by the American public that we have not required in the past.