What you should know about Ebola: Infectious disease specialist answers 10 common questions

By Kristy Bleizeffer Aug 25, 2014

The Ebola outbreak in West Africa has killed more than 1,500 people and infected more than 2,500. The news reports can be scary and sometimes contradictory, while the “facts” shared on social media are often misleading.
The outbreak is alarming, but there is little chance it will spread to the United States, says Dr. Mark Dowell, medical director of infection control at Wyoming Medical Center. If it did, our advanced medical system would be able to contain it.

Dowell is an infectious disease specialist at Rocky Mountain Infectious Diseases and the Natrona County Health Officer. Here, he answers 10 common Ebola questions.

A slide of  Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #10816. Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers. English | Slovenščina | +/−CDC/Cynthia Goldsmith - Public Health Image Library, #10816

Electron micrograph of an Ebola Virus (Centers for Disease Control and Prevention's Public Health Image Library.

1. What is Ebola?
Ebola is a virus that lives primarily in non-human primates. It can also live in bats, rodents and in humans. It was discovered in 1976, but until this year, there have been very few cases save for a couple of smaller outbreaks in the 1990s. This outbreak probably began from a human exposure to an infected animal. They think maybe it was a little boy, but they aren’t sure.

2. How is it spread?
It is spread by body fluids, and it is pretty contagious. Unlike HIV, Ebola can be spread by saliva, sweat, feces or urine and from exposure to an infected animal. You can kiss someone with HIV and not acquire HIV. That is not the case with Ebola.

Countries with active transmissions, as of 9 August 2014. Countries with active transmissions of the Ebola virus in the, as of August 2014: Guinea Sierra Leone Liberia Nigeria

Countries with active transmissions, as of Aug. 9, 2014: Guinea Sierra Leone Liberia Nigeria (CDC). (Click to enlarge)

3. Why is this outbreak so much larger than those in the 1990s?
There are now about 2,500 cases of which the death rate is about 6 in 10 people. It’s happening in a pretty localized area of West Africa where the health care is pretty mediocre to say the least. In a lot of very rural areas, people are not aware of what this is, and it’s spreading because they just don’t have the infection control policies that we have and access to the kind of care that we have.

It tends to be spread through this misunderstanding. There was a hospital fairly dedicated to Ebola, and a group of people broke in and released all the patients – which is horrible because they then went to find their families and exposed them to the virus. It’s that kind of education that has to occur.

4. What are the symptoms?
After infection, the virus incubates in your body for up to 21 days, peaking at 8 to 10 days. Then you start to develop muscle aches, joint aches, fever, red eyes, sore throat, maybe a rash. The rash can look like a lot of other rashes. A certain percentage of people become extremely ill, going into shock, bleeding. And the death rate is 60 percent. It’s a very aggressive virus.

The problem is some of its presentation mimics other illnesses seen in that part of Africa, such as malaria and typhoid fever. It may be something that is missed in the initial diagnosis. If eight people have been caring for an infected patient, and you’re not thinking about Ebola, than several of those people may become infected. So it is a really tricky situation.

But it doesn’t spread if you’ve got someone in isolation and you are following infection control protocols. It’s when those protocols are broken that it spreads.

5. Is there a vaccine for Ebola?
There is no vaccine and any treatment for Ebola is very experimental.

6. How is Ebola treated?
The care that is available is what we call supportive which means we concentrate on relieving the symptoms of the illness. So, if the patient needs a ventilator, we put them on a ventilator. If he needs blood products or fluids, we give those.

You can imagine if you are in rural West Africa where you don’t have access to all those supplies, your death rate is going to be higher.

7. So, if you have access to supportive care, the only way to fight the Ebola virus is with your own immune system?
That’s the only way patients survive. At the moment, the party line is 40 percent of people survive it and get well. But it might be better odds if you were to have it in a developed country where you had better health care. For example, look at the two infected American health workers who contracted Ebola during a medical mission to Liberia. They were transported to Emory University Hospital in Atlanta where they received the supportive care. Both of them survived. Now maybe they were healthy and they were going to survive anyway, but I do believe the death rate would be a lot lower if the facilities were better in West Africa.

United States Army Medical Research Institute of Infectious Diseases - http://www.sciencenewsline.com/medicine/2010052012000036.html A researcher working with the Ebola virus while wearing a BSL-4 positive pressure suit to avoid infection Biosafety level 4 hazmat suit: researcher is working with the Ebola virus

A researcher wears a BSL-4 positive pressure suit while working with the Ebola virus. (United States Army Medical Research Institute of Infectious Diseases)

8. Does this outbreak pose a threat to Casper and Wyoming?
The chances of it posing any kind of threat here are so remote that I don’t even give it a thought. As a healthcare provider, I have to be taking patient histories to make sure that I’m not seeing someone coming out of Sierra Leone or Liberia or maybe parts of Nigeria now. With our worldwide travel, it is conceivable that someone could get on an airplane and travel somewhere else and potentially develop the illness. But if a patient hasn’t traveled to those countries, there is no risk because it’s not been seen anywhere else.

All of us in health care and infectious disease are on our A-game right now. We are all watching for it, but it is not a panic situation. There have been no cases in the United States, and I’m glad they brought those two American health workers, who were giving their heart and soul to try to help people during an outbreak, to the United States and took care of them. There wasn’t any risk to the public, and I think it says a lot about us as a country that we did that.

9. Has Wyoming Medical Center been put on high alert to watch for Ebola, or has it adopted any new protocols?
The Centers for Disease Control and Prevention has been updating everyone, particularly infectious disease specialists like me, about the outbreak’s progress – the number of new cases, anything we’ve learned about how to isolate infected patients and how Ebola is spread. There’s nothing special about the treatment of Ebola – as opposed to how we already treat patients with highly infectious diseases – other than providers wear a gown, gloves, goggles, shoe covers, and they’re 100 percent strict with their protocols. Ebola patients are treated in special isolation rooms, and you never break that protocol. We have that capability here at Wyoming Medical Center. And, as you can see from Atlanta, nobody else got ill. Nothing got transmitted.

10. How concerned are you about the Ebola outbreak spreading to the United States?
I’m not concerned. We can handle the virus here. What’s going on in West Africa is horrible. When you have 2,500 infected people, who are just trying to live their lives, and there is nothing you can do about it, it’s terrible.

There has to be a lot of international intervention – not only to help these people, but to help control the outbreak. With a concerted effort by the World Health Organization and CDC, I think we can control it in Africa.

Mark Dowell M.D.

Dr. Dowell is board certified in infectious disease and is the medical director of Infectious Disease at Wyoming Medical Center. He is also the Natrona County health officer. He moved to Casper in 1992 and was the first infectious disease specialist in the state of Wyoming. He raised two kids here. He founded and practices at Rocky Mountain Infectious Diseases.

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