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Despite an Ebola death in the U.S., the likelihood of an epidemic here is low

Posted By Beverly Merz On October 9, 2014 @ 10:51 am In Infectious diseases | Comments Disabled

The New York Times has described Thomas Eric Duncan, the first person to die of Ebola virus infection in the United States, as “the Liberian man at the center of a widening health scare.” Use of the term “health scare” about Ebola in the U.S. just isn’t warranted, according to a consensus of several Harvard experts who have looked at Ebola through different lenses. They give four main reasons why an epidemic of Ebola virus disease isn’t likely to happen here.

The virus is relatively difficult to spread

Ebola isn’t transmitted through the air like a respiratory virus. That makes it much more difficult to catch. The Ebola virus is passed from person to person in bodily fluids, much like HIV, the virus that causes AIDS. But unlike HIV, Ebola is transmitted only by people who are visibly ill. To become infected with the Ebola virus, a person must somehow absorb blood, diarrhea, urine, saliva, sweat, or tears from a person with Ebola virus disease through the eyes, mouth, or broken skin.

As a result, even in the hardest-hit countries, on average fewer than two people are infected by each person with Ebola virus disease. In contrast, before the development of a measles vaccine, a person with measles infected 18 others. So far, none of the people with Ebola virus disease being treated in the U. S. have infected anyone else, although a deputy who entered the apartment where Duncan had been staying is being treated in isolation for flu-like symptoms.

Contrary to internet rumors, Ebola isn’t likely to become airborne, says Stephen Gire, a researcher who is studying the Ebola genome at the Harvard-affiliated Broad Institute. He notes that Ebola is a very small virus with relatively few genetic regions that can tolerate mutations without being detrimental to the virus. There are no known instances in which a virus has mutated to change its mode of transmission so drastically. “It’s much more likely for a virus to mutate to infect new species than to change its mode of transmission,” says Gire.

We have an effective emergency-response infrastructure

The United States isn’t hampered by the lack of infrastructure that set the stage for the Ebola epidemic in West Africa. “Sierra Leone’s and Liberia’s abilities to handle the epidemic are extremely limited due to the poor capacity of their healthcare and public health systems,” says Dr. Michael VanRooyen, vice chair of Emergency Medicine at Harvard-affiliated Brigham and Women’s Hospital.

Although he acknowledges the need for some improvement in communications among healthcare institutions, the international travel industry, and the general public, Dr. VanRooyen says the United States’ capacity to manage new cases of Ebola is excellent. “There is no reason to believe we will have an epidemic in the US, and we have the resources we need to manage infected people arriving from West Africa,” he says.

Dr. Paul Biddinger, chief of emergency preparedness at Harvard-affiliated Massachusetts General Hospital, says that the nation’s emergency-response systems are in a much better position to handle Ebola patients than they would have been a decade ago, citing widespread readiness training that minimized casualties following a devastating tornado in 2011 in Joplin, Missouri, and the 2013 Boston marathon bombings.

Ebola hasn’t taken the nation by surprise. “Responders have been preparing for outbreaks of emerging infectious diseases for many years. We’ve been emphasizing importance of travel history with emerging diseases like severe acute respiratory syndrome, Middle-East respiratory syndrome and influenza strains from East Asia.”

Most hospitals are equipped to treat Ebola safely

It doesn’t take a major metropolitan hospital or specialists in respirators and hazmat suits to treat someone with Ebola virus disease, argues Dr. Atul Gawande, professor of health management at Harvard School of Public Health in an October 3 New Yorker article. He says that only a few basic precautions are needed—a room with a door that can be shut to keep people from inadvertently entering; protective clothing for medical personnel and visitors, including gloves, gowns, eyewear, and leg and shoe covers; medical equipment that is used only on the patient; and a good system for disposing of contaminated bedding and clothing—all of which can be achieved by small community hospitals.

Dr. Gawande and colleagues advised the CDC on developing checklists to help medical institutions treat people infected with the Ebola virus. The nurse who first saw Duncan at Texas Health Presbyterian Hospital in Dallas followed the checklist, flagging him as a potential Ebola patient. But her note was overlooked by medical personnel who sent him home. Duncan returned two days later and was admitted to the hospital in serious condition.

Such tragic missteps can be easily avoided by “closing the loop”—confirming that important messages have been received and understood by the next person in the chain, Dr. Gawande says.

New treatments are in the works

Several potential treatments are being developed and may be available to Ebola patients experimentally. The antiviral drug ZMapp was given to two U.S. patients, both of whom have recovered. Another antiviral, brincidofovir, was administered to Duncan and another patient, who is still hospitalized. Several pharmaceutical companies have been enlisted to increase supplies of ZMapp, and two vaccines are being fast-tracked by the Food and Drug Administration.

Another experimental treatment is a blood transfusion from an Ebola survivor.

Taking precautions

If you have traveled to West Africa recently or have been in contact with anyone who has, the CDC website has some helpful tips and instructions for you.

If you haven’t, your chance of becoming infected is almost zero and the best advice is the same as it is for avoiding any infection—wash your hands frequently.

Additional information about Ebola is available from the Harvard School of Public Health and the Centers for Disease Control and Prevention.

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