A nation takes notice

From the Winter 2015 edition of Vanderbilt Medicine Magazine

Ebola virus disease, previously known as Ebola hemorrhagic fever, is caused by infection with four of the five Ebola virus strains, and can cause disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees).

Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa, but this has been the first widespread outbreak.

Symptoms of Ebola may appear anywhere from 2 to 21 days after exposure, but the average is 8 to 10 days. Early signs and symptoms include fever, severe headache, joint and muscle aches, chills and weakness, but over time symptoms can become increasingly severe and may include nausea and profusive vomiting and diarrhea, red eyes, rash, chest pain, stomach pain, weight loss, and unexplained bleeding and bruising.

The natural reservoir host of Ebola virus remains unknown. However, researchers believe that the virus is animal-borne and that bats are the most likely reservoir.

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response.

In mid-January, according to the Centers for Disease Control (CDC), there had been 21,171 cases in Guinea, Liberia and Sierra Leone in West Africa, and 8,371 deaths.

“The official case count is but the tip of the iceberg,” said William Schaffner, M.D., professor of Preventive Medicine at Vanderbilt and a world renowned expert in infectious diseases. “There are many patients who come in for medical care who aren’t being tested, and many many more who never even make it to medical care. The people in West Africa who have the best indication of the magnitude of the problem and its continuing impact are the people who bury the bodies, and they are working overtime in those three countries.”

Although the likelihood of a widespread outbreak in the U.S. is extremely low, the presence of Ebola created pockets of panic that resulted in incidents of quarantine that some felt unnecessary, the closure of businesses where those who were infected had shopped prior to becoming symptomatic, and enhanced entry screening at five U.S. airports that receive over 94% of travelers from Guinea, Liberia and Sierra Leone.

“An infected person doesn’t become hazardous to others until he becomes sick, and that’s a difficult concept to implement in the middle of a population that’s scared stiff,” said Schaffner, who fulfilled numerous requests for national media interviews to explain Ebola to a worried viewing audience. He did 55 live shots resulting in 90 appearances on networks, cable networks and national and international radio during the first 17 days of October. He did 16 live shots at Vanderbilt’s VUStar Studio in two days for outlets including NBC Nightly News, CBS Evening News, CNN, ABC’s Good Morning America, BBC and NBC’s Today Show.

At Vanderbilt, health care teams at the Medical Center drilled and prepared during the fall and came up with a working plan for how Ebola patients would be cared for. Front and center in the planning—making sure that health care providers know not only how to wear the personal protective equipment (PPE), but that they know how to take it off as well.

“We’ve been talking a lot with folks from Emory and Nebraska Medical Center (where two people infected with Ebola in West Africa have been treated) and the CDC. We learned a lesson from SARS (Severe Acute Respiratory Syndrome) 10 years ago,” said Thomas Talbot, M.D., MPH, associate professor of Medicine and Chief Hospital Epidemiologist. “The health care workers didn’t get ill because they weren’t wearing the right things, it was because they took the right things off incorrectly and contaminated themselves as they removed the equipment.”