How contagious is Ebola really?

The Centers for Disease Control (CDC) has confirmed that a patient in the US has Ebola. It seemed timely to have a discussion of just how contagious Ebola really is.

As you probably already know, other American Ebola patients have already been flown back to the US for treatment, but they were brought in under conditions of quarantine. This patient traveled back from Africa (Liberia) on a commercial flight, arriving on September, 20th. He was asymptomatic while traveling.

Ebola can only be transmitted when the patient is displaying symptoms. The patient developed Ebola symptoms on September 24th, four days after returning to the US.

Upon developing symptoms, the patient sought treatment on September 26th. He was treated and sent home. When his symptoms continued, he went to a local hospital in Dallas on Sunday, September 28. He was admitted and placed in “strict quarantine” per the hospital.

Specimens were taken to test for Ebola, and sent to he CDC and a Texas State Health Department laboratory. Both sites showed that he has Ebola based on highly specific tests.

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 /

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 /

Since the patient had symptoms for four days before being admitted, the possibility exists that some family members could have become infected if they came into contact with body fluids from the patient.

The CDC estimates that there may be “a handful” of people who could be exposed and potentially develop Ebola. Additionally, health care workers at the first treating facility will be tracked and monitored. The epidemiologists have interviewed family members and are working on locating and interviewing others with whom the patient may have had contact. At this time, none of the contacts are symptomatic. All contacts will be monitored for 21 days.

Remember that Ebola is not transmitted via the airborne route as something like influenza virus is. Patrick Sawyer, for example, flew into Lagos, Nigeria, symptomatic with Ebola. He was feverish and vomiting on the flight. Yet, only one other person on the flight developed Ebola – that was Sawyer’s personal assistant who had been traveling with him for days. His assistant might have even gotten Ebola from the same source as Sawyer.

If Ebola could be spread via airborne transmission, I’d expect dozens of people on that flight, and members of the crew and cleaning crew, to have gotten Ebola. That didn’t happen. And in any case, the Dallas patient wasn’t symptomatic with Ebola when he flew.

Epidemiologists from the CDC are en route to Dallas. They will coordinate with the hospital and public health agencies in Texas. Dr. Thomas Frieden, Director of the CDC, and Texas public health officials did a press briefing on this case of Ebola. Dr. Freiden says that he is quite confident that Ebola can be contained in the area. He stressed that, as long as the outbreak continues in Africa, we need to be vigilant and have a high index of suspicion that Ebola could be present in people who have returned from West Africa within the last 21 days, or health care workers who could have had contacts with Ebola patients.

Dr. Freiden stated that the patient can be treated adequately in Texas. He emphasized that any hospital that can isolate a patient in a private room with its own bathroom, and use basic isolation precautions (hand washing, mask, goggles, gown, gloves, limiting visitors, keeping a log of visitors, etc.) can care for Ebola patients.
Patients would also need to be treated symptomatically for dehydration, shock and other problems that Ebola may cause.

Ebola is much more difficult to treat in developing countries than is it in more developed areas. For example, the clinics and hospitals in Africa where Ebola patients are treated are basically large rooms filled with many patients. There are few doctors and nurses, hundreds to treat million of people. Isolation equipment and supplies are limited. There is often no running water, electricity or adequate sanitation. IV fluids, necessary to treat severe dehydration, are at a premium. Many workers have only limited training and experience using isolation techniques. Transportation may be primitive or lacking. Advanced medical techniques (dialysis, ventilators, etc.) are not available. There are difficulties communicating with and educating the local people. Medical infrastructure is poor. Tracking contacts of Ebola patients is often hit-or-miss. These, and other factors, can easily contribute to high mortality and continued spread of the disease in Africa.

In the US and other developed nations, almost all of these problems don’t exist. Most hospitals would have no problems with handling isolation and intensive medical treatment. The local health departments could handle tracking, reporting, monitoring and education. There are many more physicians, nurses and allied health personnel available. Laboratories are ready to test patient samples.

The upshot is that containing and treating Ebola in a developed nation will be easier that it would be in areas like Africa. That doesn’t mean that Ebola isn’t dangerous – it is. But it can be controlled.

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

Share This Post

© 2019 AMERICAblog Media, LLC. All rights reserved. · Entries RSS