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Aug
3

Your Ebola reading list: Should you worry?

written by Tara Haelle

Update: I’ve posted a new piece discussing the arrival of the first U.S.-diagnosed case of Ebola. Check it out after reading these pieces here.

The news is abuzz with the Ebola outbreak in three African countries – Liberia, Guinea and Sierra Leone – and much of the media had a conniption when it was announced that Dr. Kent Brantly – the doctor who contracted the virus while doing humanitarian work treating Ebola patients – would be transferred to Emory Hospital in Atlanta, also home to the CDC. He has now arrived, of course, and in fact, he walked into the hospital himself (amid a completely shameful and unnecessary media circus).

Original image created by CDC microbiologist Frederick A. Murphy.

Original image created by CDC microbiologist Frederick A. Murphy.

In the past several days, I’ve seen very smart and educated friends of mine on Facebook sharing status messages of fear and concern about the virus, asking whether it’s such a good idea to “bring Ebola to the US” (when, in fact, it’s been here for many years) and whether it is appropriate to treat the infected doctor stateside. We fear that which we do not understand, so I’m writing this post to clear up some of that misunderstanding and hopefully alleviate some of those fears.

Ebola is not among my specialty areas of knowledge, but the advantage of being a science journalist is that I get to talk to a lot of epidemiologists and other infectious disease specialists, and one of my strongest skills is sniffing out the facts and separating the wheat from the chaff when it comes to picking out accurate, non-sensationalized articles that put news into perspective. Therefore, I’m providing a reading list of what you *should* be reading instead of the fearmongering at CNN and other outlets. (I pick on CNN because I keep thinking they should know better.)

First, however, the most important thing to know about Ebola virus is that your own likelihood of contracting the disease is *tiny* – it’s less likely than being attacked by a shark, which is less likely than being struck by lightning, which is less likely than SIDS, which is FAR less likely than fatal car accidents. (Or, as a friend and bioterrorism expert at the University of Pennsylvania put it on Facebook, “there are so, so many other things to worry about. Like antivaxxers. Food poisoning. Kangaroo attacks. Hippos. The morning commute. And so on.”)

But wait, you say, it’s a contagious disease! And it has a 90% mortality rate! However, both of those statements need heavy qualifiers. It is a contagious disease that is neither food-borne nor airborne and which requires contact with bodily fluids. The mortality rate ranges from 25% to 90%, but that rate has MUCH more to do with the health care quality and resources than it does the disease itself. A 60-90% mortality rate in Africa does not translate to a 60-90% mortality rate in the US.

Image creator wished to remain anonymous.

Image creator wished to remain anonymous.

And so, moving on, here is your (relatively short) curated reading list on the Ebola outbreak and the virus itself:

First up is a great FAQ at the Daily Kos. Yes, the Daily Kos is a partisan site, but this piece was pulled together by a contributing editor who is also a medical doctor, Greg Dworkin, and I contributed (on Twitter) some of the links he includes. It basically brings together the best gems from a wide range of linked sites.

Another nice overview and FAQ is at Nature: “Largest ever Ebola outbreak is not a global threat

Next, infectious disease specialist Tara C. Smith provides some perspective at her blog Aetiology: “Ebola is already in the United States” and “Are we *sure* Ebola isn’t airborne?

Next, epidemiologist Rene Najera at John Hopkins Bloomberg School of Public Health offers some great commentary on these two posts: “If Ebola does get to the United States, we’re doomed, but not for the reasons you think” and “Ebola is in the United States, now what?

UPDATE: Please be sure to check out Maryn McKenna’s commentary and curation at Wired: “Ebola in Africa and the U.S.: A Curation.” McKenna is pretty much *the* infectious disease reporter you want to follow for anything about “scary diseases.” She is based in Atlanta only a few miles from the CDC and has been covering infectious disease and food for well over a decade (or two).

UPDATE: A fun Q&A between Erin Gloria Ryan and two doctors, in classic Jezebel style, answers a lot of those pesky questions you keep thinking of at 3 am: “The Paranoid Hypochondriac’s Guide to the Ebola Outbreak.” h/t Andrea Luttrell

Over at Atlanta Magazine is this excellent short read by Rebecca Burns, “Yes, Ebola patients are coming to Atlanta for treatment. No, you do not need to panic.

Also, some good commentary on the arrival of Dr. Brantly is here at Forbes by David Kroll: “Should We Be Concerned About American Ebola Patients Coming To Emory Hospital?

UPDATE: If you’re wondering why treatment is so tricky for Ebola, check out Helen Branswell’s thorough piece at National Geographic: “Promising Ebola Drugs Stuck in Lab Limbo as Outbreak Rages in Africa.

Finally, though less about Ebola and more about risk perception, I highly recommend this brief thought piece on how we think and feel about risk: “How Ebola Can Help Us Vaccinate Against the Danger of Fear.

This list is not exhaustive, of course, but I wanted to highlight some of the better pieces I had come across, most of which are short, easy reads since we parents don’t have tons of time to be reading everything we come across. If you’ve found another good article, please leave it in the comments. I may update this post with other ones I come across.

Oh, and one last thing: No, for goodness sake, homeopathy cannot treat Ebola, and neither can cinnamon and oregano essential oils.

 

17 Responses to “Your Ebola reading list: Should you worry?”

  1. LIz Ditz

    Thanks for pulling this together. I have been thoroughly exasperated by the handwringing & pearl-clutching of people I thought had at least some common (science) sense.

  2. I couldn’t have said it better myself! This is great, as always! Thanks!

  3. Charlotte

    I admittedly have not done exhaustive reading on the matter and have made only a cursory review of the articles you link to above, but one question I haven’t seen answered is the matter of how aid workers were infected. If I’m not mistaken a prominent African physician died recently of Ebola even after taking appropriate precautions, and now these two workers have also become ill. Is it possible that the virus is mutating? Or do you think it’s more likely that the workers failed to adhere to protocol?

    • Tara Haelle

      I don’t know the answer to this question, but I’ll ping a couple colleagues (including those whose articles I linked here) who might know. It’s entirely possible that aid workers were not adequately protected due to lapses in protocol. From what I’ve read so far regarding mutations, it’s certainly always possible that the virus can mutate but generally it kills too quickly for that to be likely.

    • Ren

      With the number of people they’re working on being in the hundreds, the hours they’ve worked on them now being in the thousands, and the rudimentary (e.g. field hospitals made from tents) conditions they’re working under, it would not be out of the realm of possibilities that the workers and healthcare staff became infected through a lapse in procedure. We are talking hundreds of thousands of man-hours of patient care under very stressed conditions. It is far more likely that their infections were a result of personal protective equipment (like gloves and masks) that broke down, accidents like needlesticks or broken blood vials, than because the virus mutates. It is a very well-conserved virus from the point of view of mutations. That is, it doesn’t mutate easily. It does come in various strains, and that may explain why we see different attack rates (number infected out of number exposed) and different fatality rates (number dead out of number infected) depending on strain.

      Good question, though.

      • Darwy

        From what I’ve seen from pictures, etc. of the working conditions in Africa, the PPE they’re using is not the best protection against such a virus. It isn’t a one-piece suit with respirator (Class A or B self contained) – it’s a Class B without a respirator, and there are a number of ‘access points’ where fluids could enter the suit where pieces are overlapped.

        I’ve also seen images of the suits being washed/decontaminated so they can be re-used, which also poses a risk of transmission. Given the scarcity of resources to combat transmission, reusing the suits is definitely better than going without, but not as good as using new for each exposure.

    • Nope, not mutating. It’s also not even a “not adhering to protocol” situation. Ebola has always infected health care workers at an abnormally high rate, as well as other primary caretakers. It’s why you have situations where a family living together will have multiple adults (who care for sick family members) become sick, but not children who live/sleep in the same room as the sick adults. That’s just Ebola.

      For whatever reason-and my speculation is that it’s a combination of the 24/7 media cycle, social media, and uninformed people deciding they’re specialists-people are paying more attention this time. But that doesn’t mean the virus is behaving abnormally, or that the health and aid workers in Africa aren’t following protocols, etc. It merely means that the virus is continuing to do what it does: kill a certain set of the population at a higher rate, because of their higher risk.

      Think of it like this: traditionally, more soldiers than civilians die during a war. No one is surprised when that number is announced. Health care workers are the soldiers in the Ebola war.

  4. Hi Charlotte, I haven’t seen any good information on Dr. Khan’s death. He certainly knew that even with protective gear, nothing is 100% and especially in the hospital conditions he and other healthcare workers toil in in Sierra Leone and the other affected countries. I think it is more likely that there was an accidental exposure than a viral mutation that made it more transmissible. Early on during the epidemic there was some sequencing information that came out, and the genome was fairly stable compared with previous outbreaks of Ebola Zaire (even going almost 40 years back to the initial Zaire outbreak in 1976). It’s possible it may have mutated since then but that seems a less likely event than simple lapse of precautions, accidental needle stick, hole in gloves, etc.

  5. […] And finally, two excellent multi-link round-ups: Daily Kos[14], and Tara Haelle[15]. […]

  6. […] And finally, two excellent multi-link round-ups: Daily Kos, and Tara Haelle. […]

  7. TJ Harvey

    It is true that some of the HCWs may not have taken the appropriate precautions. But we’re talking about more than a handful of HCWs. Some of the top ebola doctors have become infected and died, and we can only presume they were aware of the dangers and were taking every possible precaution. Moreover, if you read journal entries of some of the HCWs you will notice that extreme precautions were being taken (rubber boots, gloves, biohazrd suits, masks, etc.) and yet in those entries HCWs were still reported as contracting the disease.

    If you graph the progression of ebola cases (and deaths), you will see that the disease has been spreading at an exponential rate, with a noticeable upturn in the “hockey stick” in early June. The non-linear nature of the incidence rate suggests we are dealing with a virus that is more akin to an airborne flu than a “fluids exchange” virus.

    Looking at the numbers you will also see that the fatality rate is presently around 50%, which is historically a low rate for ebola. However, you will also see that despite a lower fatality rate, the virus is infecting and killing far more people than any other ebola outbreak in history. In my opinion, this seems to suggest that this variant has mutated and is achieving increased transmission combined with reduced host fatality, which is a hallmark of evolving pathogens.

    So in short, I’m very concerned at this point, and think it very unwise to assume that airborne transmission is off the table. Incidentally, if we’re wrong, and this ebola variant is in the process of going global, we’re probably facing several hundred million deaths, if not more. Very little is to be gained at this point in assuming that we are operating in a best case scenario. We should be assuming the worst and taking every possible countermeasure. If we don’t, and our assumptions turn out to be wrong, we will likely witness one of the most catastrophic events in the last 10,000 years of human history.

    • Ren

      Epidemic curves are to be read in an epidemiological context. They only show how many people the virus infects with each generation. That’s all. We cannot make any determinations about how it is spread based on that alone. Now, plenty of investigation into the virus has been done in outbreak and laboratory settings, and nothing shows that it can be transmitted by air from one person to another. Like I wrote before, it’s about viral load, and the virus is not like measles; it cannot survive alone up in the air without droplets, and those droplets are too big to travel great distances.

    • As I already noted, many, if not most, health care workers become infected before they know the patient they are treating has Ebola – yes, even now. People can shed the virus without “clearly” being sick. Ebola presents as malaria, as a bacterial infection, as a random tropical fever. That, coupled with the huge increase in numbers of patients, and the mechanisms of transmission, explain why the infected are almost always either health care workers or those who otherwise care for the infected (adult family members).

      Ren has already neatly explained epidemic curves, so I’ll just add that no, it’s not “going airborne,” and even making such a statement is incredibly irresponsible, especially given the current climate of fear.

      Ebola is a horrible pandemic, both in the sense that it’s horrible for those on the ground, and it’s horrible as any sort of sustained disease. It requires the sorts of conditions that exist in impoverished, underdeveloped nations, and is easily stopped by even the very basic hospital and health systems of the developed world. Pretending otherwise is merely fearmongering for the adrenal rush.

  8. chuck

    A simple question: I read that we should not be concerned because Ebola can be spread only thru contact with bodily fluids “such as saliva.” Doesn’t this mean it can spread by means of a cough or sneeze that contains saliva? That doesn’t sound reassuring to me. We live in a diverse community and many people travel between here and Africa.

    • Ren

      It’s all about viral load. You need A LOT of the virus for it to be transmitted to you. Incidental contact, e.g. kissing, is not going to be enough.

  9. Oh, regarding infection, health care workers, etc, it’s also worth noting that Ebola doesn’t present like, well, the popular conception of it says it presents. You don’t just start gushing blood from all orifices (in fact, many, if not most, cases don’t bleed out). What are the symptoms of Ebola? Diarrhea, fever, malaise, maybe a touch of nausea. …doesn’t sound very OMG DEATH VIRUS does it? In fact, it sort of sounds exactly like the much more common and problematic (and deadly) malaria. Which is what the general diagnosis tends to be at first, which then allows an infection to rapidly spread. (In fact, there are other, less deadly, hemorrhagic fevers endemic in West Africa, like Lassa, that might have actually been Ebola in disguise. There are some researchers who are hoping to make their way through the last 18 years of Lassa blood samples to see if there are Ebola antibodies there.)

    Anyhow, when you live in a place with multiple tropical diseases, you think the common before the uncommon, and unless a victim has something distinctive, like bloodshot eyes or leaky blood upon admission, you think malaria, fevers, bacterial infections, helminths, etc, before you think of the rare. It’s a real-life example of the “if you hear hoofbeats, think horses, not zebras” situation.

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