Latest Ebola update from doctors on the ground in west Africa

I’ve been following some first-hand reports from doctors on-the-ground in Liberia, who are trying to help contain the Ebola outbreak in west Africa, and the reports are somewhat different from what we are hearing from the media.  The outbreak has hit Liberia, Guinea and Sierra Leone.

One doctor is a pediatrician and specialist in infectious diseases.  He has been sending back first-hand information, and things he’s gleaned from other health care professionals in the area.

There are also a few other doctors on the site who have been to Liberia recently, working in clinics there.  One just returned July 1st of this year.  So they’ve been adding their stories, as well.

They suspect that many of the Liberians may be avoiding getting medical treatment from doctors and hospitals.  One fear many locals have is that the foreign doctors have brought the virus with them, and that they will use it to kill Liberians and use their bodies as donors for transplantation of organs.  The fear is that possibly, up to 75% of people who may be having symptoms of a fever are staying home, possibly traveling to relatives or may be using local healers.  Of course, those with Ebola who do this can be spreading the disease to those that they come into close contact with.

Ebola virus, courtesy of the CDC.

Ebola virus, courtesy of the CDC.

One of the doctors points out that most Liberians have malaria, and an attack of malaria can present much like Ebola.  So when local health care workers, often nurses, see a patient with a fever, diarrhea and/or vomiting, they think of malaria and start malaria treatment.  They may also think of typhoid fever or gastroenteritis, also very common and try to treat those.  The point is, they are not thinking of Ebola.  And even if they do consider Ebola, there is only one lab, in each of the countries where the epidemic is occurring, that can test for Ebola.  And testing takes time.  A blood specimen has to be drawn in the clinic, transported to the central lab, the test set up and run, then the results have to be gotten back to the clinic.  If positive, the patient then has to be found and isolated.  It would be impossible to quarantine all of the patients who show up each day at clinics with symptoms that might be Ebola.  The clinics are usually fairly small, cramped, have very limited supplies and equipment.  Hospitals in the area are not much better equipped.  So even the patients who show up at a hospital with Ebola-type symptoms cannot all be effectively isolated.  This makes containment even more of a problem.

Other sources also show that the situation in this region continues to deteriorate.

Additionally, groups of local people have attacked and burned some of the clinics, because of their fear mentioned above, that the clinics and hospitals are spreading the disease.  At one point, police were called out to disperse a group by using tear gas on them.

Measures to prevent the spread of Ebola by screening travelers are not going as well as hoped. Some people are trying to get on flights (or find other ways out of the area via auto, boats, etc.) while avoiding screenings.  They may to slip past the screeners or bribe them.  Some airlines have stopped flights in to and out of the affected areas.  Med evac missions are also not allowed to leave the area.  So anyone who is ill with any problem, must be treated locally.

Local containment measures also include decontamination of reusable equipment (e.g., the boots that workers must wear). Bedding, clothes and other items that might be contaminated with Ebola need to be burned.  Body fluids and waste from victims has to be destroyed.  And the bodies themselves need to be handled appropriately to prevent spreading Ebola.  However, not all families are willing to forgo their own death and burial rituals that can lead to spread of the virus.

CDC, WHO and other groups say that the chance of Ebola spreading out of the region is low.  But they want health care professionals worldwide to be aware of Ebola symptoms, in case someone flies from Africa to another country and then falls ill. US doctors, for example, do not automatically think “Ebola” when a patient walks in with fever, diarrhea and vomiting.  Several US medical groups and societies have emailed their members with information concerning Ebola and its symptoms.  They want primary care doctors (family medicine doctors, internal medicine doctors, ER doctors and ICU doctors) to be aware of what is going on regarding the epidemic, the natural history of the disease, how to look for possible cases, testing options, etc.

One hospital emergency department in North Carolina responded appropriately when it thought that it might have gotten a patient who could have had Ebola.  They locked down the ER until they made sure that the patient was not at risk for having Ebola.

But vigilance is necessary.  The Liberian-American businessman who died of Ebola in Nigeria was planning to visit his family in Minnesota after he finished his business in Lagos.  It is possible for the outbreak to spread beyond Africa’s borders.

Public health officials think that should Ebola escape from Liberia-Guinea-Sierra Leone-Nigeria that it may show up in France first. There are many flights from Africa to France.  France, some French businesses and some French citizens have close ties to Africa.

One group of US healthcare workers that was planning to leave for the Ebola-infected area today, canceled its plans.  They are worried about the virus and the local conditions where health care workers may be assaulted. The Peace Corps is bringing all of its personnel out of the three countries where the epidemic is at its worst. There is some speculation that additional relief and medical works will not be allowed to enter these areas because of the danger from the virus and from some of the citizens.

I’ll update this information if I become aware of other developments.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • arleeda

    I think I may have to cancel my cruise up the coast of West Africa in April. Haven’t heard from tour company as yet. I’m hoping they cancel first so I can get my deposit back.

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  • HeartlandLiberal

    For those of you traveling by plane:

    Gerba, whose travel souvenirs often include test swabs from airplane
    lavatories, has identified the three germiest spots on airplanes —
    toilets, tray tables and the latches on overhead bins.

    He’s found
    the norovirus, the influenza virus, diarrhea and MRSA on airplane tray
    tables, which he says are rarely disinfected. The latches on overhead
    bins also get “lots of touching, but no cleaning.”

    Gerba says an
    average of 50 people (up to 75 on budget airlines) use the lavatory each
    flight and warns that even if everyone bothered to wash their hands
    before exiting, this is the ickiest spot on a plane. “The tap water
    shuts off on you when you try to wash your hands and the sink is too
    small for people with large hands,” he said. Gerba has found that the
    lavatory exit door on airplanes usually has E. coli on it after a long
    flight.

    http://www.usatoday.com/story/travel/flights/2012/11/14/germiest-surfaces-planes-airports/1702683/

    My wife and I are planning a 50th anniversary trip next summer to northern Europe and northern Germany, maybe London, too. We are planning to travel by duplicate bridge cruise ship in one direction, and possible hop a freighter from Hamburg to get back to east coast. Turns out many freighter lines carry a small number of passengers as a regular practice, for reasonable practices. And frankly it sounds like a great adventure.

    We are not enamored of flying anymore. To say the least.

  • docsterx

    Sadly, Michael Crichton died a few years ago. He’s lecturing on another plane right now.

  • docsterx

    Cold viruses are easily transmitted through airborne spread (coughing, sneezing) and touching secretions from the mouth and respiratory tract. So colds spread much more easily. Best defense still seems to be frequent handwashing.

  • Dave of the Jungle

    Re-entry has a good sterilizing effect on external surfaces. Plus, the astronauts are in enclosed air spaces which pretty much locks everything out. Should be no problem.

    But, what about other planets? If we tried to colonize a planet with a similar atmosphere to earth there might be a Zillion pathogens there to which we would have no immunity. Scary.

  • Indigo

    The idea that viruses can travel on international flights bothers me at another level. The common cold travels that way and almost every flu season some horror from out-there in not-us Land manages to find its way here, why not Ebola? Scary. But then, living within an hour’s drive of the NASA launch pads, I also like to worry that astronauts might have brought unknown (alien?) infections back from space with them.

  • http://www.rebeccamorn.com/mind BeccaM

    Off somewhere giving yet another speech denying there’s any such thing as global warming…

  • http://wicca.com/celtic/wicca/wicca.htm Colin

    My first understanding of the Ebola virus wad in reading ‘The Hot Zone.’ scared the hell out of me then and does the same now.

  • just_AC

    wheres Michael Crichton when you need him?

  • just_AC

    but I thought i read an article that one of the people hit was a business man intending to fly to minnesota. Yeah http://www.thedailybeast.com/articles/2014/07/30/minnesota-widow-on-her-husband-he-could-have-brought-ebola-here.html s
    o how many others are out there?. And, forget suicide bombers, how about a suicide cougher?

  • just_AC

    time for me to start masturbating

  • http://heimaey.us/ heimaey

    I hope they’re right.

  • docsterx

    Probably not. The WHO and CDC say that, while spread outside of the current area is possible, the chances of that happening are low.

    From the CDC:
    “I want to underscore that Ebola poses little risk to
    the U.S. general population. Transmission is through direct contact of
    bodily fluids of an infected person or exposure objects like needles
    that have been contaminated with infected secretions. Individuals who
    are not symptomatic are not contagious.

    [ . . . ]
    No Ebola cases have been reported in the United
    States and the likelihood of this outbreak spreading outside of West
    Africa is very low. It’s more likely that the countries surrounding
    Guinea, Liberia, and Sierra Leone may see cases because of the wide
    geographic spread of this outbreak.

    [ . . . ]

    While it’s possible that someone could become
    infected with the Ebola virus in Africa and then get on a plane to the
    United States, it’s very unlikely that they would be able to spread the
    disease to fellow passengers. The Ebola virus spreads through direct
    contact with the blood, secretions, or other body fluids of ill people,
    and indirect contact – for example with needles and other things that
    may be contaminated with these fluids. Most people who become infected
    with Ebola are those who live with and care for people who have already
    caught the disease and are showing symptoms.”

    More information: http://www.cdc.gov/media/releases/2014/t0728-ebola.html

  • http://heimaey.us/ heimaey

    So it’ll be in the USA by Christmas time?

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