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 /

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 /

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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