Ebola: Is it Airborne?

I’m just not convinced it can be wholly said that there should be no concern that Ebola cannot be transmitted through the air.

Even if Ebola Zaire, which is the strain responsible for the current outbreak in West Africa (and is also the most virulent with up to a 90% kill rate) is not airborne– I’d like to highlight the discovery of Ebola Reston as thoroughly discussed in Richard Preston’s nonfiction title The Hot Zone which presents case studies of four Ebola viruses (Marburg, Ebola Sudan, Ebola Zaire and Ebola Reston.) It is a must read.

First of all, these viruses are relatively new. They first showed up in the 1970’s literally out of nowhere. Why do I say that? Because the reservoir for these viruses has never been found. No one knows where it comes from or what plant, insect, or animal it might live in without killing it. It is thought that Kitum Cave in Mount Elgon National Park is a likely candidate but testing of several species within the cave haven’t found the host. 
Ebola is a filovirus or thread virus. It has a distinctive look under microscope resembling a jumbled mass of tangled threads with eyelets or shepherd’s hooks on the end. There are currently five species of Ebola virus: Zaire, Bundibugyo, Sudan, Reston and Tai Forest. All have varying degrees of virulence.

To learn how Ebola kills– check out this video

Let’s get back to Ebola Reston. This strain of Ebola was first discovered in a monkey house in Reston, VA in 1989. This facility housed monkeys from overseas for several months to prove they were healthy before being sold to research facilities. 
There were several different rooms to this monkey house but the facility did share one ventilation system. An illness began to break out among the monkeys that killed them swiftly. The animals would lose their appetite, develop a mask-like quality to their face, become inactive and die within one to two days. At times, they had bleeding from their noses. Necropsy done by an employee of the facility showed large, hardened spleens and evidence of internal bleeding. 
This employee decided to send samples to the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) which was nearby and after testing over days and weeks– it was discovered that this was a new strain of Ebola. At that particular time, only Ebola Sudan and Ebola Zaire were known.
The interesting thing about Ebola Reston is that it is airborne. It traveled through that monkey house, room to room, and began killing animals that hadn’t had any direct contact with one another. It was so concerning to the Army because of the facility’s location to Washington D.C. that a decision was made to “nuke” the entire animal population and gas the building to kill every microscopic living thing inside. This led to hundreds of animals being euthanized.
Then, it happened again. More animals were brought in from overseas and the virus went loose. Likely, the animals brought it with them and it was not present in the facility. 
On autopsy of these monkeys, it can be seen that the virus was located in their lungs– ready to burst from air sacs. This is how airborne transmission works. The virus is coughed up and expelled into the air where another person breathes it in. 
When the second incident of Ebola Reston hit the monkey house– they let it run its “natural course” since they had also discovered it didn’t cause illness in humans. When they did that– 100% of the monkeys died. 
What’s interesting about the Reston, VA monkey house workers was that they all seroconverted from the illness. This means they were infected, their body built up antibodies, but they didn’t get sick. What’s scary is that genetically speaking– researchers don’t really know what makes Ebola Reston all that different from Ebola Zaire. The question becomes . . . how easy would it be for these other Ebola viruses that do cause serious illness in humans to change one protein structure to then be airborne like Ebola Reston?
The answer is . . . they don’t know. What they do call Ebola in general– a slate wiper. People who know a lot about Ebola lose sleep over this virus. 
Personally, as a healthcare provider, I think it’s safest to operate under the assumption that it has the potential for airborne spread. We should be using the same level of protection when working with this virus that the US Army does– which they classify as a Level 4 Hot Agent. You wear a space suit working with these pathogens. People who work with Level 4 Agents are viewed as a little crazy according to Preston’s book. 
I don’t think we respect this virus enough. Here in the US– people are very blase about its potential to kill. Keep in mind that those that survived here were treated early by a highly specialized medical system and received experimental treatments that likely helped them fight off the virus. 

As for me caring for patients– I’d like a spacesuit, too. What you see is what I get. 

Would you consider this adequate?

Ebola in the USA: Part 2/2

One of the aspects I find most fascinating about the two individuals that returned to the USA for treatment of Ebola virus is the experimental serum both of them got called ZMapp. Before these two U.S. citizens became ill– the serum had never been tested on a human subject. Ever. Before this, it had only been tested in eight monkeys. It was far from sure that the drug would actually work.

There’s a lot about this Ebola outbreak that is fiction worthy and definitely has my author wheels spinning. Bringing infected patients onto U.S. soil. Do you think this five month long outbreak got media attention because three U.S. citizens were infected? This is what one editorial piece theorizes. Add to that the largest Ebola outbreak in recorded history. And on top of that, an experimental, life-saving serum tried in humans for the first time.

ZMapp was given to both these patients overseas. According to this editorial, Dr. Kent Brantley felt he was close to succumbing to the disease when he was given the treatment and had such an impressive response that he was able to walk from the ambulance when he arrived at Emory Hospital. Nancy Writebol’s symptoms also improved though she required two doses.

Some of the ethical questions posed in the piece are whether or not it was fair to just give the drug to these two people? Wouldn’t it have been better to give it to everyone infected? Why wasn’t something tried sooner for the existing patients? The CDC states there are few doses of the treatment available. Experimental drugs are not produced in large quantities. But the other issue always is, are people who are near death able to give true informed consent? Does it even matter if they’ll die? In the case of these two individuals the FDA allowed it under a compassionate exemption.

ZMapp is an engineered monoclonal antibody designed specifically to attach to the Ebola virus like your immune system normally would. In the case of the two U.S. citizens, mice were used to generate the antibodies. Tobacco plants are also being used.

To learn more about ZMapp– check out this video.

Ebola in the USA: Part 1/2

There are few headlines right now grabbing more attention than the two cases of confirmed Ebola virus that are now being treated on U.S. soil. Even before these two arrived in the U.S. did you know that the biggest Ebola outbreak is happening and is not contained at this time?

First of all, as a healthcare provider, I think it was risky to bring these individuals back. I’m not saying the U.S. should not have provided medical assistance to these individuals but bringing the virus onto U.S. soil is, at worst, potentially dangerous and, in the least, panic inducing. There have been at least nine patients tested for Ebola in the U.S. (Mt. Sinai in NY, Atlanta, Ohio and six other non-disclosed tests.)

Thus far, these tests have been negative.

What is Ebola?

Ebola is a virus. This means it cannot be treated with antibiotics. What’s left to the medical team is what is termed “supportive care” which means we support the patient and the symptoms they are having but we have to let the virus run its course. If you can’t breathe, we put you on a breathing machine. Best prevention would be a vaccine. Right now, there is no available immunization for Ebola though there are some in development.

There are some antiviral drugs that can shorten the length and severity of the illness. The one most familiar is Tamiflu. However, antivirals are not effective against all viruses.

Ebola is transmitted to people from wild animals and outbreaks occur near villages close to tropical rain forests. Then it spreads from human to human via close contact with their secretions. One interesting transmission of the disease is through semen up to seven weeks after recovery from the illness. Most patients feel that once they are symptom free– they are no longer at risk for transmitting the illness. People are infectious as long as their blood and secretions contain the virus. This comes from the World Health Organization.

While it may be hard to contract Ebola, the problem is, if you do, the mortality rate can be as high as 90%. This current outbreak seems to be running a mortality rate between 50-60%.

Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. These symptoms can appear two to 21 days after infection.

Which is another potential problem with Ebola spreading worldwide. You can be contagious but be symptom free Although it is hard to determine from multiple news reports if this is a hard and fast rule. Some sources say you have to be symptomatic to spread the disease. There are respected organizations (as stated above) who say the opposite which, if bears out, makes the standard of monitoring people at the airport (and other transportation hubs) for fever not 100% effective. 

Besides this, these symptoms can mimic other less life-threatening illnesses like the flu. 

After these mild symptoms– the disease progresses and attacks major organ systems that can include internal and external bleeding. Bleeding is exhibited in about 20% of cases. Death usually results from shock and multi-system organ failure.  

Outbreaks are considered contained after there hasn’t been a new case identified for 42 days which is twice the incubation period of the disease. 

What I find most interesting was the creation of a serum called ZMapp that has antibodies to combat the disease. I’ll cover that next post.

What do you think? Should these U.S. citizens infected with Ebola have been brought back to the U.S. for treatment? Why or why not?

**All italicized portions come from the linked articles.**