An overview of the new, and serious, Ebola outbreak in Africa

The Ebola outbreak in Guinea, Sierra Leone and Liberia has been growing since the first case was detected months ago.

Most recent reports indicate that a total of almost 1,100 people have been either confirmed to have Ebola, or are strongly suspected of having it.  There have been about 650 deaths.  The cases and deaths are totals combined from all three countries.  So far Guinea has been the hardest hit.

Ebola has been known to have a fatality rate as high as 90%.  The rate in this outbreak is lower, but still chillingly high.

The symptoms of Ebola start with fever and malaise (general feeling of being unwell) that start abruptly. Other symptoms often seen are: headache, joint and muscle aches, diarrhea, vomiting, anorexia. Some patients experience sore throat, cough, chest and/or abdominal pain.  In severe cases, the patient may bleed from multiple internal organs and also from external sites (Ebola is a hemorrhagic fever).  The bleeding can lead to shock, organ failure and death.  Symptoms can develop quickly (as soon as a few days after exposure to the virus) up to about three weeks post-exposure.

There is no treatment other than supportive measures.  No vaccine is available.

In the past, Ebola has emerged, killed and then, suddenly, the epidemic would end.  Until the next time.   Then, at some later time, Ebola would re-emerge and repeat the above cycle.

A sign warns visitors that area is a Ebola infected. Signage informing visitors that it is a ebola infected area. September 27, 2013, Congo, Africa. Sergey Uryadnikov / Shutterstock.com

A sign warns visitors that area is a Ebola infected. Signage informing visitors that it is a ebola infected area. September 27, 2013, Congo, Africa. Sergey Uryadnikov / Shutterstock.com

The best techniques to prevent Ebola are to avoid close contact with people who have the disease. Those who get Ebola need to be isolated and those caring for them need to use strict isolation techniques and high tech isolation gear, which are very difficult to get and use in Africa.  Ebola can be spread by contact with fluids from sick people (blood or other fluids) or through sticks and nicks from contaminated needles, scalpels or other sharps.

Medical workers and family members of the ill can contract the disease relatively easily.  To date, several nurses and ancillary workers have become ill with Ebola, some have died.  A few doctors  been treating patients have contracted Ebola.  At least two have died.  One doctor who has Ebola is from the US.  As of this writing, he is ill, but still alive.  Another US citizen who was working in the area assisting with decontaminating used supplies, has also gotten Ebola.

There are some unique problems in these countries that may be aiding the spread of the disease. Some patients and their families believe that the disease was brought to the area by doctors and personnel from the World Health Organization, Doctors Without Borders and others.

Therefore, they are hesitant to seek treatment when they are ill, fearing that the medic may give them the disease. One family went so far as to kidnap a relative from the hospital fearing that she was getting worse there.  Her abduction set off a search to try to find her, since she was infectious.  It was later learned that she died as the family members were transporting her to another location.

Death leads to another problem.  In this area, often the family members prepare a body for burial. Preparation and cleaning the body may expose the relatives to Ebola.  The governments in the areas have been trying to make sure that family members are careful when preparing to dispose of the bodies of their kin so that the infection doesn’t spread.

Another problem is that some people in the area prefer to see local healers rather than go to medical doctors.  There is a concern that the local healers, by coming into close contact with Ebola victims can contract, and later, spread Ebola to others.

There may be a confirmed case, and death, due to Ebola in Lagos, Nigeria.  The man was a Liberian national who flew into Lagos, Nigeria.  He collapsed and sought treatment.  He was placed in isolation and died.  The government there has isolated those with whom he was in contact.

The government of Liberia has restricted land travel out of the country. Only three roads leading to the borders have been left open. One road connects to each of the three neighboring countries. Travelers are screened as they attempt to leave the country. Any who appear ill are turned back.

The President of Liberia, Ellen Johnson Sirleaf, has also authorized the military to confiscate private vehicles to aid them with their operations. And she has placed restrictions on public gatherings, and increased outreach efforts to educate the populace. However, the airports in Liberia remain open and flights continue to come and go, risking further spread of the 90%-deadly disease.

In Nigeria, Arik Air, a local and regional carrier has voluntarily suspended flights to countries where the Ebola outbreak is continuing: Liberia, Sierra Leone and Guinea. It is also calling for other airlines to do the same. Though the neither the Nigerian government nor the World Health Organization has called for airport closings or banning travel from affected countries, yet.

Outbound and inbound flights are still permitted from these countries.   The governments are screening passengers for signs and symptoms of Ebola in an attempt to try to halt the spread.  They are having them fill out questionnaires and checking their temperatures.  Those who have a temperature elevation will be screened for Ebola.

Vigilance to prevent the spread of Ebola outside of the confines of West Africa is important and necessary. Chances are that by taking appropriate precautions, the spread of Ebola can at least be kept limited. Patients are only contagious when they are actively having symptoms. The CDC is encouraging doctors in the US (and elsewhere) to be vigilant. The doctors should be aware of the symptoms of Ebola, to take a travel history from patients to see if they’ve visited an area where the epidemic is occurring, if they’ve had a known contact with someone who has had Ebola, if the patient is having any symptoms of Ebola himself, etc.

For the affected areas in Africa, travelers should be similarly screened for fever, other Ebola symptoms, close contact with someone who has had Ebola, etc. Anyone who has one or more of these factors, should be tested for Ebola and not allowed to travel. Essentially, the CDC and WHO are recommending watchful waiting along with using methods for diagnosis and isolation of people suspected of having Ebola.

(Here’s a brief reference to the CDC’s recommendations.)


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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  • Liam H

    I am in no way saying their behaviour is right, neither am i saying is wrong, i actually have no side in this argument, personally i am tolerant to all people.

    What i am saying is that the west 100 years ago was ten times worse, some of these countries have only just become a country like 3 decades ago or something.

    Like a 40 year old man expecting a 12 year old to be able to drive a car.

    I am in no way excusing their behaviour of course! All i am saying is that homophobia is not the main issue in most of these countries, first let them have stabilisation and democracy, and non-dictatorship, basic things, like good healthcare etc, they can join the first world and start worrying about homosexuality and women’s rights etc, and whether the wire or sopranos is the best TV show ever, you know things we worry about, things we take for granted. (little rant)

    There is no excuse for killing someone for their beliefs or sexuality. YES! Fully agree with you.

    Problem with generalisation, is that by sheer coincidence 70 percent of the people with ebola might actually all be gay, or atheists, or whatever, or might actually be tolerant people.

    That’s my point with generalisation.

    It’s like imagine if the world trade centre happened to have 70 percent muslims in it, when it was bombed, how ironic would that be?

    What if all those people with ebola you don’t care about, what if most happened to be gay, or pro-gay rights, generalisation!

    Like i said just because the law kills gays, doesn’t mean people in general in those countries hate gays!

    Just because we are in iraq, doesn’t mean citizens in the west actually agree with the iraq invasion.

    That’s my point.

  • dcinsider

    You can certainly apologize for their behavior if you choose, or rationalize their hatred. As condescending as that it is, I suppose you can excuse countries who criminalize homosexuals and punish them with death by adopting some tortured analysis of their governmental capabilities. That sort of contortion of understanding is beyond my pale. Unless and until they are capable of crawling into the 20th century and respect the individual rights of their citizens, the governments, and their MAJORITY of supporters within these countries who firmly believe that gays are worthless and unworthy of common decency as human beings, are equally unworthy of my compassion. As I said, I simply do not care if a few thousand homophobes in Africa get wiped out by a virus. I do care that this virus not spread, and thus I support efforts to contain and treat those infected, and to prevent the spread, but only to protect the rest of us.

  • Liam H

    Fair enough you might hate a culture, but don’t forget that it’s the government who criminalised homosexuality, how may laws have our governments made that we don’t agree with. Secondly when you say culture, don’t forget a culture is made out of people. I mean part of the people who have the ebola virus may even be homosexual, who knows?

    That’s the problem with generalisation, you’re always going to hurt someone, and sometimes it’s actually the majority you hurt, rather than minority, homosexuality wouldn’t be a big issue in west africa if there weren’t a lot of homosexuals there, and if there are a decent amount of homosexuals in west africa, then that means, they can’t all be homophobic, unless they’re self hating.

    Another thing is some of them who are homophobic, are not malicious, lets not forget where the word homophobic comes from

    “fear”, note everyone who’s ‘scared ‘of homosexuality, is necessarily offensive, i.e. they may be wary of gay people, doesn’t mean they would verbally or physically hurt them, it’s just ignorance some people are just old fashioned, west africans aren’t as liberal as us, not necessarily a good thing or bad thing, depends on how you see it, either way, they are progressing.

    It’s not just homosexuality, i mean there’s other stuff, like trusting basic modern medicine like, paracetamol rather than a guy in the forest giving them “herbal medicine”. Theism/Atheism tolerance, equal female rights and responsibilities, etc.

    First they have to do basic things, like women rights, and other stuff, before they can climb over the barrier of homosexuality, most of their countries are pretty young as independent countries, they haven’t even got true stabilisation yet, not to talk about equal rights, and all those things we take for granted.

    it’s okay to hate the rules, but don’t hate all the people, hate the specific homophobic ones, if you’re going to hate anyone.

    America is 200 years old, britain is like a thousand years old, you’re comparing them to 50 year old countries.

  • dcinsider

    I certainly understand that. I believe we need to address this, but not because of the humanitarian requirement of coming to the aid of so many people who, if healthy, would condemn us, but for the purpose of preventing the spread of this virus. My comments are intended to be a condemnation of an entire culture that has acted in an abysmal fashion and, as a result, a culture for which I hold absolutely no compassion.

  • Liam H

    One, it’s not all africans who murder gay people, im sure they could say the same that westerners go to other countries and kill people, i.e. afghanistan and iraq etc, why should anyone care about some emprical westerners, however a lot of british and americans actually were against the invasion, so it would be a wrong statement.

    Secondly, a us person has died, and an outbreak is never an individual issue, if a 1000 africans can die from a disease, it only takes one person, or doctor, immigrant, legal or illegal, doctor, professor, teacher etc, to travel from Africa to Europe or america, and then YOU will give a crap.

    Look at how globalised we are, all it takes is some guy to kiss, or be in close contact with an unaware victim, grab a private or commercial plane, before symptoms show on him, (takes 21 days).

    Takes a taxi, and sneezes next to you, etc.

  • andrewjwilliam

    my roomate’s half-sister makes $63 /hr on the internet
    . She has been without work for ten months but last month her pay was $17500
    just working on the internet for a few hours. check this J­a­m­2­0­.­C­O­M­

  • dcinsider

    Let’s just say that I hate to see any person suffer, but some get more sympathy than others.

  • emjayay

    Not to defend Big Pharma or anything, but the one and only goal of any business is to maximize profit. Finding or synthesizing and developing and testing any drug costs many millions of dollars.

    You can’t really expect a profit making business to spend multi millions on something with no chance of getting any money back for doing it. It is up to the people though their governments to fund ebola drug or vaccine research maybe with the help of nonprofits. Anything alturistic a profit making company does is necessarily just for its profit maximizing potential in terms of currying government favor or polishing their image or something.

  • emjayay

    Not a very charitable attitude. On the other hand….

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

    Ouch… That’s a huge loss. How horrible.

  • docsterx

    Ebola has claimed another victim. Dr. Sheik Umar Khan was Sierra Leone’s lonly expert on hemorrhagic fevers. He recently contracted Ebola himself after being involved in the care of over a hundred Ebola patients in Sierra Leone. The Health Ministry had hailed him as a “National Hero” for his work with the current viral outbreak. He was diagnosed with the disease about a week ago, isolated for treatment in a local hospital, and died a few hours ago. He was only 39 years old. He is one of a number of health care workers who have died during the epidemic.

  • http://musephotos.wordpress.com/ GarySFBCN

    There is a reason, regardless of intervention, that statisticians and epidemiologists group data over a period of time. Citing the percent for one year and promoting percent is wrong for many reasons.

    And I’m done discussing this. Be happy.

  • trinu

    The fatality rate for HIV decreased because of the invention of antiretroviral drugs. There has been no such breakthrough with Ebola.

  • http://musephotos.wordpress.com/ GarySFBCN

    Could it be that in the last 10 years more is known about the transmission and treatment of Ebola? Starting with 2004 for my analysis wasn’t an arbitrary choice. Using multiple years in analysis is common and is often the only accepted method used. I chose 2004 for a 10 year review of the data.

    Nobody with any credibility would cite the case fatality from the early years of the HIV/AIDS epidemic for anything other stating a historical fact. Can you imagine reading a document about HIV/AIDS that stated that HIV/AIDS can have a case fatality of up to 87.2% ?

    Why isn’t that same standard used by WHO for Ebola?

  • docsterx

    In your initial post, you want to exclude outbreak data from pre-2004. That’s problematic. By doing so, you are:
    1. Eliminating a large number of Ebola cases from the data base. ABout 700+ cases of Zaire ebolavirus.

    2. Some of the outbreaks from 2004 on have been of Sudan ebolavirus and Bundibugyo ebolavirus which are different from Zaire ebolavirus.
    3. The WHO just says that the case fatality ratio has been as high as 90%. It isn’t saying that the ratio is always 90%. There was 1 reported case of Zaire ebolavirus in Zaire in 1977 who died. That was a case fatality ratio of 100%. If WHO wanted to use scare tactics, they could say that it has been 100% fatal.

    Also, I think that we need to look at the circumstances. Most of the outbreaks have been in Africa where medical care is, at best, spotty and limited. Many of the cases were first treated in local missionary hospitals that were poorly staffed and had almost no supplies. Some had no IV fluids or blood products to transfuse. How do you treat shock when you have a patient bleeding from multiple sites, internally and externally, without IV fluids and blood products? Or not having the ability to use IV pressor drugs? When you can’t maintain the patient’s airway and have no ventilator? Or, in some areas, even a reliable supply of electricity, limited running water, latrines, etc.? The mortality might be significantly lower if doctors and patients had access to those therapies and facilities.

  • nicho

    Most recent reports indicate that a total of almost 1,100 people have been either confirmed to have Ebola

    Jut about the same number of people in Gaza who have been murdered by the terrorist Netenyahu with Americans’ dollars.

  • dcinsider

    Given that it’s occurring in Africa, I’m a little shocked these dimwitted fobs have not tried to blame it on the gays. Get back to me when these countries crawl into the 21st century on human rights, and then I’ll try to give a crap about the latest plague they have to deal with.

    Sorry, but the truth is I just don’t give a crap about Africans who mutilate and murder gay people.

  • nicho

    Of course, but if there isn’t a big enough potential market — a lot of people with enough money to pay for the drug — Big Pharma won’t even look.

  • http://musephotos.wordpress.com/ GarySFBCN

    That’s just ridiculous. Having worked in public health for 24 years, I have first-hand knowledge that these types of ‘statistics’ do more harm than good. They incite hysteria and it does not aptly characterise the disease.

    If you look at the link that I posted and scroll to the data, you will see what I am discussing. And then there is the issue of what is statistically reliable. The overall case fatality is 67%, which is horrible. There’s no reason to go the the higher number. I could easily counter and say that the case survival rate has been as high as 75% (Uganda 2007) and that would be equally irresponsible.

    When discussing flu vaccines and prevention strategies, nobody cites fatality rates from the 1918 flu pandemic, because that too would be irresponsible.

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

    In reading up on Ebola and the pathology of potentially fatal diseases, what I’ve noticed is there seems to be this correlation between virulence, onset time, and mortality.

    If there’s a disease that hits hard and kills fast, it seems to tend flare up and then to die out, especially if it was in an isolated location. Most diseases that are easily spread and which have a long-ish onset time typically don’t kill — in a way, an evolutionary adaptation to allow for maximum spread.

    I’m not going to use the ‘perfect storm’ trope…but Ebola has for a long time (especially the most fatal strains) been one of the worst possible viral threats out there. Apparently it is very easily spread. Infected victims may not know they’re sick for days or even weeks — which means they have time to travel, and nowadays it could be to the other side of the planet. And not only does it have an appallingly high mortality rate, Ebola can be caught easily from the bodies of the dead.

    It seems like the only thing working for now is containment…and that is all too easily breached in today’s world.

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

    It’s not scare tactics. As Mark notes, this particular strain is apparently one of the worst.

    It’s like saying “the flu isn’t so bad” — unless you’re a young person and you’ve just caught the 1913 version.

  • FLL

    Your witty reply went over Bill’s head completely. He believes that your reply is a serious proposal rather than parody.

  • http://musephotos.wordpress.com/ GarySFBCN

    I’m not confused.

  • Bill_Perdue

    You seem confused. The diseases and their progenitors have been around for a long time. There were no ‘existing socialist healthcare systems’ in the colonial period.

    Obama’s main preoccupation in Africa is arming right wing homophobic states in Africa. “U.S. Bolsters Right-Wing Regimes in Uganda and Nigeria That Persecute Gays and Abuse Human Rights – The Obama administration’s outraged rhetoric over anti-gay legislation masks strong U.S. military support in those nations.”
    http://www.alternet.org/world/us-bolsters-right-wing-regimes-uganda-and-nigeria-persecute-gays-and-abuse-human-rights

  • http://musephotos.wordpress.com/ GarySFBCN

    Exactly. Before colonial conquest and genocide, there were few diseases in Africa and the few that did exist were fully managed within the existing socialist healthcare systems.

    And Obama.

  • docsterx

    Finding the drug often takes time. When a disease causes a pandemic, there usually isn’t a lot of time.

  • docsterx

    There are different strains of Ebola. The strain in this area is Zaire ebolavirus, the most deadly. Depending on outbreak, mortality has approached 90% in data shown by both WHO and the CDC. In 2002-2003 in the Republic of the Congo, the disease infected 143 people and killed 128 for a case fatality ratio of 89%. In the first outbreak in Zaire, 318 people were infected and 290 died for a case fatality ratio of 88%. In other outbreaks the case fatality ratio has ranged from about 53%-83%.

  • Bill_Perdue

    Because of their colonial past and neo-colonial present many African countries simply don’t have the means to defend themselves from these outbreaks. The lack of a global socialist government to provide good nutrition and health care could not be more dangerous.

  • Indigo

    Worrisome, particularly in tourist destination areas. Folks fly in from all over the place, bringing their germs with them.

  • Indigo

    That very though crossed my mind too.

  • http://musephotos.wordpress.com/ GarySFBCN

    The case fatality for all cases since 2004 is 54%, and for all time is 67%. The 90% figure is based upon WHO scare tactics, which are completely unnecessary as even a 54% case fatality is horrendous.

    http://www.who.int/mediacentre/factsheets/fs103/en/

  • nicho

    No. As soon as people with enough money (i.e. white people) start coming down with this, Big Pharma will find a drug to fight it.

  • nicho

    In the end, the bugs are going to win.

  • http://heimaey.us/ heimaey

    Could this be the one?

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