Ebola - let's be rational

Ebola – let’s be rational

 

THE VIRAL disease known as Ebola has been very much in the headlines in recent weeks, with television and newspapers broadcasting horror stories of the new and most important outbreak to date. 

The disease, which was first identified in Zaire (now the Democratic Republic of the Congo) in 1976, reappeared last December and as of last week had infected some 1,800 people in Guinea, Sierra Leone, Nigeria, and Liberia. Fatalities are reported at 961, in line with the usual 50 to 60 per cent lethality rate seen during previous epidemics. 

The number of infections, superior to previous outbreaks that rarely exceeded 350 to 400 cases and Friday’s announcement by the World Health Organisation that “the Ebola outbreak in West Africa is a public health emergency of international concern” has sparked terrifying and irrational news reporting. 

So let’s review the disease and its epidemiology to assess the Ebola risk for ordinary individuals living or travelling in Southeast Asia. 

Ebola or Ebola virus disease (EVD), previously known as Ebola haemorrhagic fever, is caused by a virus from the filovirus family known to be among the most virulent for humans. Along with Marburg virus, Lassa fever virus, the Ebola virus is part of a group of deadly pathogens linked to severe haemorrhagic fever syndrome, which occasionally strike in sporadic outbreaks and essentially in Africa.

The Ebola virus is believed to live in several African animals, most likely fruit bats and some monkeys, which are considered the reservoir of the virus. The first cases of human infestations may have resulted from exposure to bat excrement or eating infected monkeys. Infected humans can transmit the disease but the contamination requires close contact with body fluids of the sick person, such as blood, saliva, vomit or faeces. The virus persists for several weeks on contaminated surfaces and dead bodies. The patterns of human-to-human contamination explain the high rates of infestation among health workers, carers and people involved in ritual burials. Ebola virus is not airborne and is not transmitted through droplets during sneezing or coughing and as such is not highly contagious like flu or common cold viruses. In other words, you're not going to catch Ebola from simply being across the room or in an aeroplane from someone who has it.

EVD begins after a 2 to 21-day silent period (incubation) during which the person is not contagious. It is again different from flu because infected adults shed flu from the day before symptoms begin and in children several days before. 

EVD presents with sudden onset of flu-like symptoms with high fever, headache, rash, sore throat, muscular pain and marked fatigue. In West African countries, these early manifestations can be mistaken for other, much more common infectious diseases, especially malaria, typhoid fever, dysentery or even dengue. After a few days, severe symptoms occur with vomiting, bloody diarrhoea and serious disorders of blood coagulation, causing bleeding both externally (bruises) and internally (especially intestinal haemorrhages) that lead to multiple organ failure, shock and possibly death. Among the 40 to 50 per cent who survive, recovery is rather slow, taking a few weeks or even months. 

There is no effective medication for Ebola virus and treatment relies on sophisticated supportive care in ICU with proper management of blood disorders and organ failure, which are rarely available in remote areas in the above-mentioned African states. No vaccine has ever been tested and prevention should focus on isolation of patients or suspected cases and on very strict implementation of individual precautions for healthcare staff or anyone in contact with the sick patients.

The ongoing rhetoric of panic and fear (“the country is not able to deal with Ebola”, “Ebola virus is out of control”) closely resembles that of the H1N1 flu epidemic in 2009 that prompted WHO to rashly raise its alert level to number 6 or pandemic status in only 3 months. This orchestrated urgency drama lead to an unprecedented stockpile and use of vaccines with unknown efficacy and safety (because for “emergency reasons” it was hastily developed without proper evaluation) and antiviral medications such as oseltamivir, which later was found grossly ineffective against the virus strain. Meanwhile, as early as July 2009 in the South hemisphere, the H1N1 flu epidemic began to subside leaving behind even a lower health impact than regular seasonal flu! 

From the features of Ebola, the disease is actually rare and obviously mildly contagious (about 2,000 cases in the last 8 months out of 185 millions people living in these 4 affected countries) and likely to remain in Africa because of the needed reservoir of native animals. 

Asian governments, which benefit from the bird flu containment experience (a much more serious health hazard than Ebola) should be able to effectively handle any threat with adequate measures directed at travellers from the infected areas. Despite the need to remain vigilant about the spread of any disease, Ebola appears today quite a minor, likely irrelevant health concern for the ordinary Thai population.

 

 

DR GERARD LALANDE is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].