Friday, October 17, 2014

Don't Freak Out: What You Need To Know About Ebola

Ebola is scary, and people are frightened. And that's okay. Sheesh, Ebola scares even the most seasoned MSF worker out of their pants. (Freaks me out, too.)

However, we need to be scared of Ebola because of what we know about it, not because we fear what we don't understand. A lot of people have been asking questions, and a lot of Americans are freaking out – because they don't understand the situation. I'm hoping to lay out the situation and let you know what I know. There's a lot of misinformation about Ebola, and a lot of this “Fearbola” is unfounded.

My dad, working in the Ebola unit, helps Dr. Brantly suit up
in his protective gear. (Photo courtesy of Samaritan's Purse.)
(Before I go on, let me tell you why I can talk about this with some authority. I lived in Liberia during one of the worst parts of the outbreak. Dr. Kent Brantly and Nancy Writebol were both friends of mine – Dr. Brantly was our neighbor and Mrs. Writebol was our organization's Personnel Coordinator. My dad was a unit manager of the non-medical staff, and did the same job as Mrs. Writebol, working closely with both her and Dr. Brantly. I lived on the ELWA campus where there are two Ebola units, one of which is the largest Ebola treatment center in the world.

I'm not trying to brag or put myself above people. But please understand, I know what I'm talking about. I'm not just a teenager giving opinions. What I'm about to share with you is a collection of facts, not my own spin on the subject.)

Okay, let's go.

The Basics

Ebola is a hemorrhagic fever. That means that Ebola always comes with a fever, and that as it advances, it can, but doesn't always cause hemorrhaging (uncontrolled bleeding). My dad describes it as a disease where every liquid in your body is trying to get out—causing internal and external bleeding (in cases far along), uncontrollable diarrhea, vomit, and severe loss of hydration, among other things.

The Ebola virus is ONLY found in liquids. This makes a very simple rule: you can only get Ebola through direct contact with someone's bodily fluids – blood, urine, feces, vomit, and so on. Furthermore, if you come in contact with those fluids, it has to enter your body through a semi-permeable membrane– eyes, nose, mouth, open sore or cut, and so on. Furthermore, it's not a tough virus—bleach, soap and direct sunlight kill it easily.

If someone contracts Ebola, the incubation period is 2-21 days, with 8-10 days being the most common period from exposure to the onset of initial symptoms. That means you're safe after three weeks.

Basically, if you don't touch an Ebola patient or their fluids, you won't catch it. My dad has sat across the threshold from an Ebola patient, less than three feet away. He never got sick. He had contact with Mrs. Writebol while she was sick—but because he didn't have contact with fluids, he did not contract Ebola.

It's also worth saying that the sicker you are, the more contagious you are. (That is one of the reasons why my dad did not contract Ebola from Mrs. Writebol; she was in the early stages of the disease.) So if you're well enough to walk about, and you have Ebola, the chances of getting someone else sick are much lower.

This is why I'm confident that the American nurse who flew on a commercial airline before contracting Ebola did not give Ebola to anyone else. Assuming that she had symptoms when she flew (a dubious assumption), she would have nevertheless been in the very beginning stages of the virus – and thus she would not be very contagious. Why am I confident? Patrick Sawyer, a Liberian who flew to Nigeria and caused a small Ebola outbreak there, flew on a commercial airline while he was VERY sick – and no one on the plane or affiliated with the airline contracted the virus.

Also, don't listen to the fear-mongers. Ebola is NOT airborne.

One more crucial point: if a person has Ebola in their system but shows no symptoms, they are not contagious. A lot of people get this wrong, so pay attention: you're only contagious after you show symptoms; and you are not highly contagious until the disease is farther along. Example? My dad ate pizza with Dr. Brantly less than twelve hours before Dr. Brantly developed symptoms. Dad's fine.

What About An American Outbreak?

There won't be one, unless nobody in America has running water and the hospitals make a lot of really bad decisions. (Since neither are true, I'm saying this with confidence.) Let me explain why.

1) American hygiene is miles better than West African hygiene.

Much of West Africa has very few working toilets, very little running water, hospitals that didn't implement universal precautions, and a population that has very bad individual hygiene – with almost no hand-washing and a lot of physical contact. As a result, Ebola spread – in fact, it's hard for Ebola NOT to spread when public urination is common and hand-washing is nearly impossible.

America is one of the cleanest countries in the world, with nearly everyone possessing running water, a nearby hospital, and decent individual hygiene. Furthermore, we are not a very physical nation – everyone loves their personal bubble. Thus, a widespread outbreak of Ebola would be nearly impossible in the United States.

2) The hospitals in the States are on alert and better prepared than nearly all West African hospitals.

A lot of people are saying we aren't prepared. Despite some of the decisions made by the Texas hospital that recently received an Ebola patient, in which two nurses contracted the disease, our hospitals are nevertheless better resourced than those in West Africa. If you think the decisions of American hospitals are risky, the decisions of many health-workers in Liberia were even worse. Some workers in Liberia were protecting themselves by wrapping trash bags around their hands.

If all of the precautions and protocols are followed, no outbreak will occur. The upside of people freaking out, however, is that everyone's being really cautious – making an Ebola outbreak even less plausible.

3) The Centers for Disease Control (CDC) is conservative and on top of things.

Shortly after I was evacuated from Liberia, those of our family who were in the States were quarantined with very conservative regulations. While a lot of the decisions were made from public opinion, they were at least going above and beyond what was required to make sure Ebola did not spread. (This was primarily on a county and state level.)

They're trying to implement similar protocols in Texas, which makes me confident that even if multiple Americans get exposed to Ebola, the disease will not spread much farther than that. At this point of the disease there will not be a big American outbreak. Period. So don't freak out.

How Do We Stop Ebola and Keep It From the United States?

Simple answer? Stop it in West Africa. The way it's going, Ebola could become a second HIV, a disease that occurs with near-regularity in third world countries. That's not acceptable, and it's certainly a huge public health risk for the States. Maybe there won't be an outbreak here, but “Ebola Scares” could occur with more regularity.

Let me be frank. Americans frustrate me. While the outbreak spiraled out of control in West Africa, America was preoccupied with Who Shot Who and celebrity scandals. Now that three cases have emerged in the States, everyone freaks out. People have been dying and families have been ripped apart for months now. I've lost friends to Ebola. And America doesn't care until it affects them personally...and then they vastly overreact.

The best way to stop Ebola in the United States is to stop it in West Africa. If we set up precautions in our airports, educate our hospitals; if we send in money, resources, health workers, to West Africa – everything possible to stop the disease, the risk to the world will be nil.

Got it?

How Do We Protect Ourselves?

The odds of you or someone you know coming into contact with someone is symptomatic with Ebola is extremely small. (There are hundreds of millions of people in the United States, and three have contracted Ebola and had minimal contact with several dozen people, and those people are under quarantine or fever watch.) That means you're more likely to get hit by a car or die of the flu or win the lottery than to come in contact with (much less contract) Ebola.

That being said, there are two very simple things you can do to make your odds go from one in one million to...well, even lower odds.

One: wash your hands often. Obvious? Maybe. But if that had been done in West Africa, we wouldn't be looking at a global crisis.  Not only does it protect against Ebola, it'll also help you fight some of America's more minor viruses.

Two: don't touch any stranger who is sick. Most expatriate health workers quarantine themselves, or watch themselves for symptoms – so the most likely candidates for coming to the States with Ebola are native Liberians or Guineans or those from Sierra Leone. This is what happened with the Liberian man who got sick while in the States.

The fact is, you pretty much have to touch a person with Ebola to get sick. If you maintain these two ridiculously easy precautions, the already low odds will get even lower.

In Sum

You can't contract Ebola except through direct contact with infected fluids. Furthermore, the possibility of the average American coming in contact with Ebola fluids is extremely low, especially with our hygiene. Because of this hygiene, the worst case scenario is that a handful of Americans will get sick – assuming several Ebola patients do not go to the hospital and come in contact with people instead.

The danger of an American outbreak is low, but the danger will be nothing if we help West Africa and stop Ebola in its tracks.

Conclusion: don't panic. Know the facts. Don't touch sick people. Help West Africa. Spread the word.


Bob said...

Good job Jake.

Sarah Pennington said...

Thanks for posting this, Jake. I've been really concerned about this ever since you or Rye mentioned it (I can't remember who did so first), and I'm glad to have the facts rather than my worried wonderings.

phyllis lloyd said...

very well done, Jake. I thought that was you when i started reading. Teenager with great sense and communication skills! Now if only the adults would take a chill pill and put all that fear energy into being helpful.

MKKevDude said...

Great post Jake, appreacite it.

Anonymous said...

Question: is saliva considered a bodily fluid? if so, when an infected person sneezes/coughs near you and you breath it in or have it on you, can't you then become infected?

Jake said...

Saliva is a body fluid, but one that contains less of the virus than other fluids, such as blood, urine, or vomit. It's theoretically possible to get Ebola by inhaling the spit of someone who sneezes on you, but it's unlikely. Especially since a person would have to be very sick at that point - the sicker you are, the more virus there is in your fluids. (In the case of getting sneezed on, I assume you're talking about a public setting. For an Ebola patient to be in a public setting and maneuver about effectively, they can't be extremely sick at that time, making the possibility even less likely.)

All of the cases I have heard of have come about presumably because of contact with the more infected body fluids, not spit or sweat.

Unknown said...

Very proud of you. I appreciate your honesty

Whitney Creath said...

The only thing lacking in this post is legitimate links to places sending aid to Africa! Thanks for a great reminder to bear the burden of those suffering elsewhere.

Jane Johnson said...

Thanks very much for this. :)

Emily Buller said...

Great Job on this article. I appreciate your perspective.

Unknown said...

Sorry To disappoint you Jake but CDC says Ebola can survive several hours on DRY, HARD surfaces.

So much for the stay away from liquids claim.


Jake said...

Hey, Will! I haven't heard that, and it contradicts what I know about Ebola from my experiences in Africa.

It would be fantastic if you could back that claim up with factual evidence - a link to a statement from the CDC, for instance. Otherwise, I don't have any reason to believe your claim.

Have a great day.

Jill G said...

Jake, here's a link about the virus surviving several hours on hard surfaces such as doorknobs, etc.

I do agree with the majority of your blog post, but I also think that the utmost caution is warranted while we learn more about the virus.

Jill Dorsey || Made with Moxie said...

This post is great. Thank you. I'm sharing it with every Fearbola person I know.

Unknown said...

Hi Jake, i see Jill G. beat me to providing the link still here it is again from CDC:

Jake said...

Thank you for the link!

I haven't heard that claim before, so that's why it's a bit strange to me that the CDC put it on their website. I doubt that "casual contact" with dried Ebola on a doorknob can lead to exposure, although I would be willing to change my opinion if some studies were done. Just as it's theoretically possible to get Ebola through sweat, it may very well be theoretically possible to get Ebola from a dried surface. Time will tell if you can become exposed to Ebola through dried fluid.

And yes, Jill, I agree completely - utmost caution is warranted, but not panic, which is what I am warning against in this post.

Regardless of whether Ebola can live on dry surfaces or not, the argument of my article is not invalidated. You cannot contract Ebola except through direct contact with infected fluids - still true, since this applies even to dried fluids.

Anonymous said...

Thank you for posting this very helpful information!

Anonymous said...

How did the two nurses get Ebola? That question has not been addressed.

Jake said...

Hey, Anonymous! While there have been a lot of theories flying about that question, my guess is that the PPE (Personal Protective Equipment) that the nurses wore was not sufficient. The protective equipment here in the States is a little more scanty than the Tycam/Tyvek suits used in the West African outbreak.

However, there has been no real consensus.

Anonymous said...

Hey Jake. Thanks for the great article. How did Dr. Brantley get the virus? Didn't he have a full Hazmat suit on? Did it have a respirator?

Vachi said...

Great article, and thank you - RE: CDC link, it in no way contradicts this post. Let's break down that article shall we?

1st, they clearly state that Ebola is only transmitted via direct contact with bodily fluids of an infected person. DIRECT CONTACT. So there you go.

Second, they state that Ebola can "survive" for several hours on a dry hard surface.

Ok, so what? Let's look at Tetanus. It also survives on a dry hard surface. For a lot longer than hours. But you can pick that nail up and touch it all you want, perfectly safely. Unless you actually get it INTO a wound (ie step on a rusty, dirty nail) and do not flush the wound (ie it doesn't bleed well), you are not going to get Tetanus.

So if we want to trust the CDC, we can still trust that Ebola virus is spread via direct contact with bodily fluids. Remember, we were this panicked about HIV once. HIV is a lot lot LOT scarier than Ebola, simply because one is not necessarily symptomatic, but is still contagious. Now, we know how to avoid HIV - (and people still don't wear condoms... but that's a whole other rant)

Shawn said...

My perspective is an anomaly in this thread, because I don't trust the CDC any farther than I can throw it, and that's based on their history of exploding and exploiting the threat of infectious diseases. Your article seems well paced, and I especially appreciate the personal, experienced perspective. What neither the CDC nor any other mainstream outlet of which I'm aware addresses is the possibility of treating Ebola with vitamin C and/or selenium - or any other natural therapy - both proven effective treatments for hemorrhagic diseases, C especially.

Display of disease has more to do with the overall health of each individual - and that would include the immune system - than to exposure to potential pathogens.

Anonymous said...

CDC also posted a zombie apocalypse preparation guide on their website so just take what they say with a pinch of salt. Good work Jake! Wash hands and avoid contact with sick people is the best advice as the truly infected sick people are unable to walk around.

Keturah Lamb said...

Interesting post! I sent a link to my mom.....

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