Ebola: What are the real risks?

by Lt. Col. Juan M. Ramirez Public Health Flight Commander

Given the shear amount of information being broadcast via television, print, radio and the Internet, it’s easy to understand why many people have concerns over what is now being called “the largest epidemic of Ebola in history.” While true, we need to look at the current outbreak with a more critical view than what the news agencies provide.
First, we need to understand the basics of the disease. According to the World Health Organization, the Ebola virus is a severe and usually fatal illness with a death rate of around 90 percent. However, with the current outbreak, early and aggressive medical treatment has lowered the case fatality rate closer to 60 percent. The illness affects only humans and nonhuman primates such as monkeys, gorillas and chimpanzees. While unaffected by the illness, African fruit bats are thought to be the likely carriers of the disease.

How does it spread?
Ebola is transmitted only from close contact with blood, body secretions and organs of effected persons and animals. It is not spread through the air like tuberculosis or by droplet spray like the influenza, or also known as the flu. It is thought that the current outbreak began from close contact with infected animals and / or consumption of “bush meat,” bat or primate.

What are the typical signs and symptoms?
Unfortunately, many of the initial signs and symptoms mirror many non-life threatening viruses. Generally patients exhibit sudden onset of fever, sore throat, headache, muscle pain and weakness. Signs that the illness is more than just the common flu include: vomiting, diarrhea, rash and, in some case, internal and external bleeding.
The incubation period, or the time it takes someone from getting the disease to having symptoms, is between two to 21 days. A person is only contagious when they show symptoms.

Am I at risk?
In my opinion the risk here in Europe is very low. First, given the way the disease is transmitted, the persons at risk are usually loved ones caring for the sick and health care workers treating the ill. If you critically analyze the information coming from the media, you’ll notice that much of the disease spread is due to the local populations failing to understand the disease process as well as from mistrust of local government’s health initiatives meant to break the chain of infection. In developing countries where literacy is an issue, mistrust of preventive medicine protocols such as isolation and quarantine, while medically warranted, is usually poorly received and often ignored.
Secondly, given the heightened awareness of the disease at international airports, the probability of Ebola spreading out of West Africa is again pretty low. A person who’s very sick and contagious would likely be identified prior to travel.
Also, those who are not yet ill are also not contagious. If they happened to make it on a plane and land in a major city, one would anticipate that health care professionals at the new location act quickly and appropriately.

Are we doing anything locally to monitor the potential spread of Ebola?
A core mission of units such as Ramstein Public Health and our Preventive Medicine counterparts at Landstuhl Regional Medical Center and the German Health Departments are tasked to monitor and protect the health of our populations. We work together to assess global health events and ensure our base leadership and beneficiaries have the most accurate information available.
For additional information refer to the Centers For Disease Control and Prevention website at http://www.cdc.gov/vhf/ebola/ or the World health Organizations at http://who.int/csr/disease/