America Ebola SEDGE Spring 2015
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There are basically three broad categories of infectious agents known to man. While prion diseases are a strange class unto themselves, most human infections are caused by either bacteria or viruses. Bacteria are not unlike tiny microscopic plants, and these are the beasties against which antibiotic drugs are targeted. Viruses, however, are much smaller and more difficult to manage.

A few examples of viral illnesses include head colds, genital herpes, influenza, West Nile encephalitis and HIV. With a few exceptions, treatment for viral illnesses is supportive. There are some excellent HIV drugs in use, but typically most of the responsibility for fighting viral infections still falls to your own immune system. The sort of nastiness that stems from these viral infections ranges from the inconvenience of a head cold to the tragedy of AIDS. On the very worst end of the spectrum resides Ebola.

Know Your Enemy

Ebola is caused by a Filovirus that produces a type of hemorrhagic fever. The world’s first Ebola outbreak was retrospectively identified in Nzara, South Sudan, in the early summer of 1976. During this first reported outbreak, the disease infected 284 people, 151 of whom died. The first identified Ebola patient in human history was a storekeeper working in a cotton factory in this Sudanese community. When not active in human hosts, the disease is thought to reside asymptomatically within fruit bats. The cotton factory where the first patient worked was known to harbor such bats.

A variety of other animals, such as monkeys and chimpanzees, can contract the Ebola virus, likely from bats, and become sick. When a human host is bitten by or consumes improperly cooked meat from these animals, the virus transfers. The virus incubates quickly, but thankfully appears to be infectious to other humans only during the later, messier stages. As mortality rates range from 25 to 90 percent, this is likely the only reason the Ebola virus is not currently the dominant life form on the planet. The virus draws its name from the Ebola River, a prominent waterway located near the second reported outbreak site, in Zaire.

The burden of managing a disease possessing the innate malevolence of Ebola quickly overwhelmed the rudimentary health care systems in Guinea, Sierra Leone and Liberia. Hospitals and clinics were unable to cope with the volume of infected people. The management of other health crises like malaria, diabetes, complicated pregnancies and surgical emergencies deteriorated as well. By August of 2014, the disease had spread to Nigeria, the U.S. and Senegal. For the first time in human history, Ebola got a good head start in a fairly populated area, and it has subsequently proven extremely difficult to exterminate.

Signs Of Infection

Those infected with Ebola typically show the initial symptoms of a fever greater than 100.9, headache, body aches, fatigue and a sore throat two to 21 days after the initial exposure. In this manner Ebola closely mimics the flu or malaria in its initial stages, making it difficult to identify it early in large populations. This stage is typically followed by abdominal pain, vomiting, diarrhea, shortness of breath and chest pain. In about half the cases, patients develop skin manifestations as well. Patients also frequently experience some degree of liver and kidney failure. Five to seven days after initial symptoms present themselves, patients may begin to demonstrate both internal and external bleeding.

The virus induces a condition called Disseminated Intravascular Coagulation (DIC) in the human host. In DIC, the blood clots randomly and vigorously until its supply of fibrin, a critical protein required for blood clotting, is consumed. Once fibrin stores are exhausted, the blood can no longer clot. In its final stages, patients bleed from the ears, eyes, nasal and oral mucosal surfaces, and the gastrointestinal tract. It is at this point that patients are shedding the maximum amount of infectious virus. At room temperature, the Ebola virus can remain infectious for hours on dried, exposed surfaces, and for days in bodily fluids.

Death typically occurs six to 16 days after initial symptoms, and is usually attributed to catastrophically low blood pressure from precipitous fluid loss. Recovery for survivors usually begins seven to 14 days after initial symptoms. Survivors can recover completely or can experience lingering symptoms of joint and muscle pain, liver damage, hearing loss or blindness.
Ebola appears to transfer in a manner similar to a typical viral gastroenteritis, the classic 24-hour stomach virus or “stomach flu” that affects all human populations cyclically. Invisible infectious viral particles are liberally produced and coat exposed surfaces via affected vomit, blood or feces. These particles are then picked up, typically on another person’s hands. That person then scratches an eye, touches food, rubs across broken skin or absentmindedly strokes an itchy nose and is subsequently infected. Once survivors are declared virus-free, they can still pass infectious viral particles through semen or breast milk for an indeterminate period of time afterwards.

Prevent An Outbreak

Isolation of infected patients is the best way to prevent the spread. It was found that many of the worst initial outbreaks in Africa stemmed from long-held burial rituals wherein survivors remained in close contact with the corpses of loved ones who had succumbed to Ebola. The best method of control on a population level is to perform contact tracing and isolate anyone who might have come in contact with the virus until it starves for lack of hosts.

The greatest hope we have for future management of Ebola rests in an effective and safe vaccine. Clinical trials of experimental vaccines are currently ongoing in West African areas affected by Ebola, but this process is itself fraught with risk. If we are lucky, then we can develop a successful vaccine, produce it in quantity and subsequently beat this disease back into the Stone Age. If we are unlucky, we might inadvertently induce problems wholly unanticipated that might otherwise be exposed through a more protracted testing process.

ZMapp is an experimental anti-Ebola drug that uses chimeric monoclonal antibodies to incorporate genes from humans, mice and, of all things, tobacco plants in an effort at defeating Ebola. Similarly, antibody-rich blood products extracted from Ebola survivors have been transfused into those acutely suffering from the disease in a similar effort at boosting immunity. While these novel treatments should intuitively be effective, to date there have been no reliable clinical trials proving that hypothesis.

Fighting The Virus

Panic is never productive. The solution to pandemic disease is always to assess the weaknesses of the virus and exploit them. Wash your hands compulsively, do not touch your face and avoid contact with people who are sick. These same basic practices can protect you against more pedestrian pestilences such as flu that are, at the present at least, markedly more dangerous on a population basis than Ebola. These basic practices have also been shown to be effective in previous African outbreaks.

Defense against Ebola must be aggressive to be effective. For those who wish to be prepared for the modern Black Death that is Ebola, be proactive, be careful and be informed.

This article was originally published in the SURVIVOR’S EDGE ™ Spring 2015 issue. Subscription is available in print and digital editions here.

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