The Ebola outbreak that wasn’t

Back in the mid-1990s, a physician from Gabon who had treated an Ebola patient became ill while visiting South Africa. He went to a local clinic for treatment. He didn’t disclose to those treating him that he had been exposed to Ebola. At the time he was treated, he didn’t have the more typical symptoms of Ebola. He was in contact with several healthcare workers at the clinic. He left the clinic and went to a private home in South Africa.

A few days later, one of the nurses who treated him became ill. She was feverish and developed diarrhea, among other symptoms. She was admitted and tested for Ebola among other possible diseases. Initial testing for Ebola antibodies came back negative. She became more ill and a culture taken from her at the same time as the antibody test showed Ebola virus.

South Africa braced for an Ebola outbreak. An Ebola outbreak had recently occurred in another area of South Africa and had killed hundreds.

The Ebola virus, courtesy of Shutterstock

The Ebola virus, courtesy of Shutterstock

The outbreak never materialized. It was estimated that between the nurse and doctor, over 300 people were exposed to Ebola. None became ill. No one in the nurse’s family sickened. No other workers at the clinic got it. None of the nursing staff who initially took care of the patient before her diagnosis with Ebola (and who weren’t using barrier precautions) became ill. The people with whom the doctor stayed as he convalesced never got it. The lab workers who handled the patients’ specimens (without taking any special precautions) remained Ebola-free.

This example shows that Ebola, while definitely contagious, is not wildly contagious or unstoppable. Remember, in the areas of Africa where it is spreading now, the medical facilities are poorly equipped, healthcare personnel may not be very well-trained, they don’t have adequate isolation facilities to name a few problems that they face. And they don’t have contact with just one Ebola patient, there are dozens around them. Wards (wards – large rooms with many patients in close proximity. Not single-room, negative-pressure isolation rooms) full of Ebola patients vomiting and having diarrhea, needing blood drawn and IVs started. South Africa has a capable medical infrastructure and a sound economy. They are technologically advanced. They are currently using automated infrared overhead temperature scanning devices at their international airport.

The three countries most heavily involved in this outbreak are devastatingly poor, with an undereducated population. They have a healthcare delivery system that is virtually nonexistent except for medical missionaries. A population that eats bushmeat (a possible source of infection) and fears healthcare workers. Many live in remote villages difficult to reach and communicate with. The differences between the two sets of countries are shocking. It’s not a surprise that Ebola is spreading and very difficult to contain under those circumstances.

If Ebola HAD broken out in South Africa, it would have probably been much easier to contain. An outbreak there would have likely consisted of a few cases, not thousands. Additionally, those diagnosed could have gotten isolated and treated sooner. Research has shown that the sooner a patient begins supportive treatment, the better his chances are for survival.

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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