|These are Doctors Without Borders in Sierra Leone (Photo: Reuters)|
Ebola Virus Disease or EVD manifests itself in human beings as Ebola Hemorrhagic Fever. First identified in 1976, the disease afflicted relatively few people in Sub Saharan Africa. However, at the time, almost all of those afflicted, died. Those of us in nursing or medical school in the late seventies and eighties told ourselves that with the care available in the US that a much higher survival rate would occur. We now know that Ebola Hemorrhagic Fever still has about a 90% mortality rate, even when US styled intensive care unit facilties and intravenous capability and laboratories are available in support of these patients.. The ten percent of individuals who survive may also spread the virus to others for two months after their own apparent recovery. The virus remains in the semen of infected men for sixty-one days after infection.
The disease is thought to have spread from monkeys or from fruit bats (who are asymptomatic) to human beings. Body fluids of infected humans may also spread the disease to others. There are other types of hemorrhagic fevers and from symptoms, it can be easily confused with malaria or Marburg disease or others. Therefore a very specific test must be performed to confirm Ebola. Traditionally, we have been taught that this is not as easy to catch as the flu and that close proximity is required in order to catch this illness.
The illness itself starts with an exposure to the above and then, two days to a couple of weeks later, just like flu, begins with a sore throat, muscular aches, and headaches. Then it progresses to nausea, vomiting and diarrhea. Then the disorder progresses to liver and kidney failure. The liver failure is the cause of the bleeding difficulties. Of course, a patient leaking multiple types of body fluids, diarrhea, serous fluid, blood, and vomit, is a great hazard to his own family and to his physicians and nurses. Staff who care for patients with Ebola Hemorrhagic Fever are carefully dressed in protective garb and then generally the outside of the protective garb is washed with a germicide before they exit the patient care area.
There are often skin manifestations, neurologic manifestations such as delerium, agitation, and seizures. Death does not usually occur as a result of fluid volume loss, but usually of multiple organ dysfunctions and failures. The onset to death is normally about thirteen days, but has been noted to have continued as long as twenty-five days. Care is focused on support through each phase, intravenous fluids and correction of fluid and electrolyte imbalance. Then, support through whichever organs begin a cascading failure. With a failing liver, the amount of medications given for comfort must be carefully controlled as the patient cannot detoxify such medications Ebola is handled using something called Level 4 Bio Containment.
Recently, several physicians and some health care workers in Sierra Leone have died despite the best we have in precautions. Experts say that "it is simply a matter of time before Ebola travels from the continent of Africa to the United Kingdom via airplane, and then on to the United States. Experts claim that the disease is "difficult to catch" without very close proximity contact.
Still, a virally transmitted illness spread through body fluids with a 90% mortality rate is on its way, to the UK, to Canada and likely to the US and anywhere else with air travel, as well.
About all we can do is maintain our health as best we can. Possibly avoid handshakes. Wash our hands frequently. Avoid travel to the African continent for the time being. No immunization against Ebola Virus presently exists. There have been twenty-five village outbreaks of Ebola in Africa since 1976
I wonder if any of the children traveling into the US illegally through our porous Southern border have Ebola yet ? Perhaps it's time for the US to tighten its borders and take their obligation toward public health more seriously before 90% of our own towns and villages succumb to Ebola.
The day after my initial posting here, the following post appeared elsewhere. It has value: