Ebola- What we Need to Know

The Ebola Virus- Some Helpful Information

The Ebola virus has been a frightening danger for some time, and for good reason.  It is a serious infection and cause real harm.  So let's start with the bottom line: although there is a case of Ebola infection in the United States, it is one case, it is easily contained, there should be no spread.  No one in Ohio is at risk.

As we all know there is a case that appears to have developed in the United States, although it was not likely caught in the United States.  This raises the concern about Ebola coming to the US, but we are very far from a situation where catching this illness in this country becomes a risk of significance.

Here are some basics that should help understand what Ebola is all about.

The Germ

With any infection, the disease is caused by a micro-organism, either a parasite, a bacteria, or virus.  And all such micro-organisms that cause infections are called germs.

What's a virus?

The germ that causes Ebola is, as the name indicates, a virus.  Viruses are the smallest of germs.  They actually are bits of genetic material wrapped in a protein coat.  The genetic material has one purpose: to instruct a living cell to make more viruses.  The protein coat has one purpose:  to allow the virus to gain access to the living cell so that the genetic material it contains can do its job- force the cell to make more virus.

All viruses work this way.  They are simply copying machines.  But in the process of forcing a cell to make more virus, the cell is usually damaged or destroyed.

Although every virus works the same way, each infects its own special set of cells.  It is the pattern of cells infected that defines the nature of the illness.

Cold viruses only attack the cells lining our airways, so they cause colds which are infections of the airways.

Stomach flu viruses only attack the cells lining our gut, so they cause stomach flus which are infections of the gut.

The Ebola virus.

The Ebola virus is named for a river that flows into the Congo River, the Ebola River, where it was first discovered in 1976.  Our current approach to categorizing viruses places five different species of virus in the category of Ebolavirus.  Four of these all cause an illness that is called Ebola virus disease.  One of these four species was named the Zaire ebolavirus, and recently had its name changed to the Ebola virus.

As with many emerging infectious diseases, infections that have only recently begun to infect people, the Ebola virus mainly infects another animal rather than humans, and for the Ebola virus, the original source of the virus was fruit bats.  In some way that is not yet known, the virus happened to contact humans, somewhere on the banks of the Ebola River, and infections in humans began.

The Disease

The Ebola virus infects mainly the cells that create blood vessels, liver cells, and several cells of the immune system.  This means when the infection occurs, these systems are the ones that suffer. 

When the blood vessels get infected, they get leaky, and this causes one of the key symptoms of Ebola virus disease: bleeding.   The bleeding occurs anywhere in the body, including reddened eyes, bleeding into the skin, vomiting blood, coughing blood, severe nosebleeds, and many other sites.

The infection of the immune system cells leads to symptoms such as fever, severe muscle pains and stomach pain, headaches, severe tiredness.

The infection of the liver,, makes it harder for the blood to clot, making bleeding even worse.

As you will note, the general symptoms of fever, severe pains, and tiredness are seen in many, many viruses, including harmless flus.  And, in perhaps as many as half of cases of Ebola virus disease, these may be the only symptoms, with no bleeding occurring. 

This means that one cannot rely on symptoms to know who has Ebola instead of some other viral illness, Ebola is best found if the contacts that cause it can be shown to have occurred.

How Ebola virus disease is caught, and how it is not caught

The Ebola virus does not enter breath.  And so it cannot be caught by air or breathing near an infected person, or in the same building or room as someone through the air.

The Ebola virus is spread by direct contact with an  infected person's body fluids.   The virus can live for sometime on objects so it can be spread via contact with objects that have touched an infected person's body's fluids- for example, needles.

This is perhaps the best news about Ebola virus, if one can avoid direct contact with an infected person's body fluids, you can be protected from infection.  It does not spread easily.  Infections can be contained.  One can avoid infection.

The incubation period

The incubation period for any infection is the time that usually occurs between the virus entering one's body and the first symptoms appearing.   During the incubation period, one is infected, but since there are no symptoms during this period, it is very hard to know your are infected.

The incubation period for Ebola virus disease is usually about 8-10 days, but some people have developed symptoms as soon as 2 days after catching the virus, and as long as 22 days later.

Note that the person who showed up with Ebola virus infection in the United States on the last day of September of 2014, was infected in Liberia, but had no symptoms, he was still incubating the infection.  This is why he was able to fly to the US. He did not know he was sick and no one at the airport would know to be concerned.  So he caught the virus in Liberia, came to the US while having no symptoms, and ended the incubation period in the US revealing he had an infection.

The Risk of an Ebola Epidemic in the United States, and our Risk here in Ohio
As stated at the start of this discussion, it is very, very unlikely Ebola would ever take hold in the US, or ever develop into an epidemic here.

Why is that?  Fortunately, for several reasons:

1. There have never been more than one or so cases of Ebola virus disease in the United States.  To get an epidemic going, you need more than one case at a time.  This also means that at any point in time, the United States is Ebola-free but for that one place the one person with the infection is present.
2. Since the infection can only be spread by direct contact with an infected person's body fluids, then a medical system that can limit that contact can very well end any further spread.  This is not just a theoretical advantage, it has taken place in prior outbreaks, and is happening now in Nigeria.  The American medical system can stop the spread of this virus from any known infected person.
3. The CDC is very alert to the dangers Ebola can present, and how those dangers can be contained.  The current outbreak is limited to a small number of countries in Western Africa.  As horrific as this outbreak has been, any large epidemics have only occurred in these three countries.  And so the CDC is in an excellent position to monitor the emergence of any symptoms in anyone visiting or returning to the US from these active countries.
4. There are no natural reservoirs of Ebola virus infection in the United States.  The virus mainly lives in fruit bats in Africa, human infections are far less frequent.  And so outbreaks erupt in areas of the world 

As far as Ohio occurs, the outlook is very good.  There are no cases of Ebola virus disease in Ohio, there have never been any cases in Ohio.  Given that the entire US is alert to this danger, any case that occurs in the US is very tightly contained.  Even though several people with Ebola virus disease have been in the US, not once has the disease spread to someone in the US.  This makes it essentially impossible that a spreading outbreak would take place in Ohio.

Current Limits and Future Prospects for Treatment
As a new infection there are no vaccines to protect anyone from getting Ebola virus disease.

Like other viruses, with very few exceptions, there are no medications that can cure or even slow down the course of the illness.

This means that there is no way other than avoiding contact to prevent infection with Ebola virus.

And, no treatments for Ebola virus disease now exist, beyond basic supportive therapies.

But a worldwide initiative is underway to create a vaccine and to create actual therapies that kill the virus and cure the infected person.

Bottom Line

Ebola virus is a virus that lives very peacefully in bats, but when that virus crossed paths with humans, it caused a very dangerous illness in people.  Such crossing of paths is most likely to occur where the bats live, so far in Africa.

It does not spread from person to person without direct contact of body fluids, and so it can be contained.

There have been isolated, individual cases of Ebola virus disease in the US, but every single case has been one where the infection began in Africa, and in every instance the medical center they have been treated at has been able to keep even one case from spreading.

Ebola virus disease is a very dangerous illness, but there is every reason to expect it will not become a threat to people living in the US.

Dr. Arthur Lavin

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