Will You Recognize the Ebola Threat Facing You?

Written by on December 1, 2014 in Features - No comments

Doctor-Holding-A-WorldWEBThere has been a great deal of interest or panic in the news lately regarding Ebola, including an episode that went unrecognized and undiagnosed until many people were exposed and the symptoms became fulminant.

While it’s true that the odds of an Ebola case coming to our practice or hospital in the U.S. are remote, it is conceivable. (As witnessed in Texas in the last month).  After all, the world is becoming a smaller place with mobility becoming easier and more affordable.

We are always warned against “chasing zebras” in diagnosis during training but as you and I know, zebras do exist.  Will we see them?

The thing is, people will be looking to us, as physicians to thwart a medical threat or disaster and protect them.

The question is: Can you?

Overview

Ebola hemorrhagic fever, or simply Ebola as it is known now, is nontreatable and has a very high mortality rate. It can infect all primates. There are five viral strains of Filoviridae Ebolavirus of which 4 attack humans.

First discovered near the Ebola River in the Democratic Republic of the Congo in 1976, outbreaks of this disease have sprung up in several countries of Africa. In 2014, Ebola reached epidemic status.

Signs and Symptoms

Symptoms manifest 2-21 days after exposure but typically in 8-10 days.  They include:

  • Abdominal pain
  • Diarrhea
  • Fatigue
  • Fever
  • Muscle pain
  • Hemorrhagic bleeding or unexplained bruising
  • Severe headache
  • Vomiting
  • Weakness and lethargy

Diagnosis

Because diagnosis is difficult in the early stages of Ebola infection, and can be confused with influenza, we rely on known contact with an exposed person (One who has travelled to a country where an outbreak has occurred).  Quarantine should be established and testing initiated.

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Transmission and Prevention

Spread

It is believed that infection comes from exposure to an infected primates leading to transmission between humans and can become rampant in healthcare sites when protective gear is not donned.

Method of spread involves direct contact through mucous membranes or broken skin and:

  • Contaminated body fluids- urine, saliva, vomit, ejaculate, breast milk, blood
  • Infected animals- apes, monkeys, gorillas, fruit bats
  • Contaminated fomites- needles, syringes

The virus isn’t air-born or contracted from water but can be spread from handling infected meat.

Though viral spread does not occur from a recovered individual, it can exist in semen for 3 months.  Condoms are advised but abstinence is a better avoidance plan.

Inhibition

Since there is no FDA-approved Ebola vaccine available yet, take the following precautions:

  • Avoid contact with body fluids from contaminated patients
  • Defer body handling in funerals
  • Avoid hospitals where Ebola patients are cared for
  • Take sterilization measures
  • Wear appropriate PPE gear
  • Isolate infected patients from others
  • Monitor your health for 21 days after possible exposure
  • Get immediate medical attention if Ebola symptoms appear
  • Notify health officials if direct contact with the virus occurred

Why worry about Ebola in the U.S.?

There are seven reasons why you need to be vigilant and “on your game”.

1) A new survey reported in the Association for Professionals in Infection Control and Epidemiology reveals that only 6% of American hospitals are prepared

Katrina Crist, the CEO, stated “the results of the poll paint a disturbing picture and point to an urgent need to bolster infection prevention resources in healthcare facilities”.

2) Ebola can conceivably mutate to an airborne variant- in 1989, the Ebola0Reston strain was seen to do this.

3) The spread is rapid among people in crowded living conditions or poor hygiene and can become a pandemic if not contained

4) Though not airborne technically, the Ebola virus can be spread through droplets transmitted in the air from a contaminated person nearby.

5) A Drexel University study shows that a quarantine of 21 days is insufficient for viral spread in 12% of the cases.

6) The Ebola virus can be viable for 50 days on a fomite.

7) Protective gear does not offer complete protection- even healthcare professionals using protective equipment (including 16 people in Doctors Without Borders) have become infected despite following established guidelines

We cannot be cavalier regarding the threat of Ebola being just “over there”.  We have already seen that with travel, it has also gone from there to here!

There is a big difference between wanting to avoid panic and not wanting to face reality.  While the chances of your exposure here are minimal or a “shot in the dark”, it behooves you to at least keep it in mind when examining new patients.

By Barbara Hales, M.D.
www.thewritetreatment.com

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