Ebola is an RNA virus transmitted through direct contact with infected bodily fluids, with viral load peaking within 48 hours after death, making cadaver management critical; the disease progresses through three phases (flu-like symptoms, gastrointestinal symptoms, and hemorrhagic phase) with a case fatality rate of 25-50% for the current strain, primarily due to limited healthcare access in rural outbreak settings; this outbreak is particularly concerning because it has spread to urban centers (Goma, Kinshasa, Kampala) unlike previous rural outbreaks, and faces challenges including lack of vaccines, ongoing conflict in the Democratic Republic of Congo, and poor infrastructure, with healthcare workers at highest risk.
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Ebola Outbreak Hits AfricaAdded:
An outbreak of Ebola in Central and East Africa raising alarms about the ability to contain the highly contagious virus.
New travel restrictions are in place to try to keep the virus from entering the United States. Travelers from Democratic Republic of the Congo, Uganda, and South Sudan must arrive in one of three US airports to be screened. Those airports are in Atlanta, Houston, and Washington D.C. In Africa, at least 1,000 Ebola cases and 220 deaths from the virus are suspected. The World Health Organization has issued warnings that the spread of the epidemic is outpacing any response efforts.
Dr. Tyler B. Evans is an infectious disease specialist and CEO of Wellness Equity Alliance. Dr. Evans joins us now to tell us more about the Ebola outbreak and its impact. And Dr. Evans, you have worked in global health across dozens of countries including in Sierra Leone in 2015 and in the Democratic Republic of the Congo in 2019 during the largest recorded Ebola outbreaks in history. Can you tell us what is Ebola and how it is transmitted?
>> Uh sure, happy to. So, just zooming out, what is Ebola? It is uh it's an RNA virus. Um it spread through uh through through contact. Now, that could be through uh that could be through droplets, that could be through a number of other sort of ways. Uh but it is uh you know, it it is very transmissible and uh and actually uh during the the 2014 to 2016 outbreak, uh a lot of folks were actually getting infected um as they were managing the cadavers. Um so, the viral load actually increases significantly. It's up it's at its highest uh within 48 hours after death.
So, uh so managing the cadavers is is uh is very important. Um and uh in terms of its symptoms, uh it starts it's it can be broken up down into basically three different uh phases. The first phase um are your sort of flu-like uh symptoms, very high fever, uh muscle aches, uh you could have a cough, some other upper respiratory infection-like uh symptoms, but the muscle aches and the uh and and the and the high-grade fever are key. Second phase are basically the gastrointestinal uh symptoms. Um and the third phase is basically the hemorrhagic. So, that's kind of like the classic sort of bleeding out um that uh that you will see with Ebola.
Um in from an epidemiological standpoint, this is uh this is as you mentioned, this is very serious. This is uh in from the WHO frame World Health Organization framing, this is the third time in history that Ebola has been identified as a public health emergency of international concern or PHEIC. Um so, it's not a pandemic, but it's it's sort of close to that in terms of uh in terms of concern.
>> Why is it so deadly? I do understand there is no vaccine as well. Why is it so deadly?
>> So, uh I mean the reason why it's So, the case fatality rate in general for Ebola can uh can fluctuate anywhere's from 10 to to to above 50%. Uh it with the with the uh with this current strain, the the Buji Bunda uh uh strain, it is uh somewhere between 25 to 50%. In general, the reason why is because um many of these folks do not get into care.
Um and in fact, almost all Ebola outbreaks in history have taken place The first Ebola outbreak took place in the 1970s that we know of.
Um and uh and almost all of them have taken place in rural settings.
And so a lot of these folks do not have access to health care.
So as a result of not sort of getting that access, they you know they they they often do pass away. If folks do get care, which is what we describe as supportive supportive treatments, they do tend to do you know quite a bit better. So that case fatality rate would sort of reduce. But that's that really what that's really what skews that number.
From a sort of from a pathological standpoint, what what exactly the the sort of the mechanism is, it's really the hemorrhagic component. With folks sort of bleeding out and not being able to have that supportive treatment with IV fluids etc. That's really what causes that that that sort of that lethality.
>> Now doctor, who is most at risk for this?
>> Well health care workers are going to be the number one sort of risk factor right now. Anybody who's going to be sort of in close contact with them. In in this particular outbreak, why it's so important and and why why we are so worried about it is because there's really five different reasons. Number one, we haven't had the proper tests to really start tracking this at an early stage.
And the reason the reason is is because this is again this is a this is an unusual strain. Number two, we don't have vaccinations or therapeutics that we know of. We are still testing to see whether or not the vaccinations have any effect. So right but right now the jury is out. Number three, the conflict in Congo is essentially it's one of the most conflicted nations in the world and if not the most if not the most conflicted. The reason that's most impact right now in Democratic Republic Congo is on the eastern border. It's in the Ituri province. That's right on the Uganda Rwanda border and and a lot of the sort of the the rebel groups and a lot of the conflict is taking place right there. So, the conflicts are a major issue. Infrastructure is very poor in this area, and that that has that has been exacerbated because of the pullout of USAID funding, as well as a lot of sort of additional funding that was helping Democratic Republic of Congo and Uganda basically track and respond to these to these issues in real time. So, real serious challenges there nationally. And then and then finally the the fifth major challenge here is the urban involvement. So, like I said before, almost all outbreaks in the play in the in the past have taken place in rural areas, but this is now in three major African cities. So, it's in Goma, Kinshasa, and Kampala. Um once Ebola once any infectious disease, but particularly Ebola, gets into urban centers, particularly really sort of concentrated centers like the the three that I just described, it becomes it becomes really a cluster. It becomes really challenging to to trace it and to and to basically sort of isolate it. So, for those for those five reasons, we're we're really concerned about about the impact here, both from a sort of both from a regional standpoint as well from a a global standpoint.
>> What precautions would you advise for any travelers that are heading out for summer trips that they should be aware of?
>> I think it's good question. Yes, summer travel, you know, I I don't I don't want to sort of you know, precipitate any sort of panic.
I think for folks that are that are traveling nationally right now, I would just keep an eye on you know, on the on the cases to see whether or not there are any American cases. If there are if there are any cases in the US, then folks are going to really really need to be vigilant. I mean, hand hygiene is important, knowing where the cases are.
Um, you know, really information is is really is is powerful right now. But that hand hygiene, you know, even whether it's Ebola, whether it's norovirus, whether it's hantavirus, whether it's flu, whether it's COVID, hand hygiene's key. You know, I've got two little ones and uh they're just, you know, they're they're a kaleidoscope of of microbes. So, you know, do your happy birthdays when you're washing your hands, you know, it's it's always a good idea.
>> Well, thank you so much for your expertise on the subject today, doctor.
>> Happy beer.
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