Presently, it's virtually impossible to read a newspaper or check the news online without seeing some mention of the current Ebola virus outbreak.
It's been declared a "Public Health Emergency of International Concern". More people have died as a result of this present Ebola outbreak, than from all other historical outbreaks combined. There are projections of its spread and infection rate in the many thousands, with experts commenting on the potential global impact.
Healthcare workers seem to be struggling in their efforts to both treat and contain the current Ebola outbreak - with a lack of protective clothing and equipment, and a lack of isolated units in which patients can be treated - further contributing to the spread of the virus.
But what exactly is Ebola?
About the Ebola Virus
The Ebola virus causes a patient to initially suffer fever and headaches, muscle and joint pain, a sore throat and a general feeling of weakness in the early stages of infection. In this respect - it's very like many other infections that we face around this time of year, particularly severe colds and the flu.
As infection develops however, diarrhoea, vomiting, a rash, stomach pain and impaired kidney and liver function follow. The patient then bleeds internally, and may also bleed from the ears, eyes, nose or mouth.
Ebola Virus Disease is fatal in around 50% of cases, however in the vast majority of cases seen at the present time (a very high percentage are centred in western Africa) adequate care is not available and so the fatality rate may be a lot higher than it should be. The earlier a patient is given care, the better the chances that they will survive. Providing supportive care - such as rehydrating patients who have diarrhoea and vomiting - can help recovery.
Ebola is infectious, and can spread from person to person. However, it is not as infectious as many other viruses and by taking correct precautions, its spread can be limited. It's particularly important to note that it is not an airborne virus.
Ebola – a Timeline:
1976 – The Ebola virus disease was first recorded, with outbreaks in the Democratic Republic of the Congo and Sudan. One of these outbreaks occurred in a village in the Democratic Republic of Congo near the Ebola River. It is from this river that the disease takes its name.
1979 – The Ebola virus disappeared, and wasn't recognised again until 1994.
1994 onwards – Further outbreaks were recorded in Central Africa, with increasing frequency.
March 2014 – The current outbreak was confirmed in Guinea, West Africa. The most severely affected countries - Guinea, Sierra Leone and Liberia - have relatively weak health systems. They are lacking in human and infrastructural resources, having only recently emerged from long periods of conflict and instability.
8th August 2014 - The World Health Organisation Director-General declared this outbreak a Public Health Emergency of International Concern.
Ebola was first identified in the mid-1970s. The current outbreak that was first recorded in March 2014 has been the most serious so far. By August 2014 the outbreak had killed more than 1,000 people across Guinea, Liberia, Sierra Leone and Nigeria.
In August 2014, a British nurse who was treating patients in Sierra Leone contracted the Ebola virus and was flown back to the UK for treatment in a London hospital.
While there are cases being reported of health/aid workers being infected in western Europe and in the United States of America, it's important to note that in all but 2 of the cases recorded so far, the patient was infected in western Africa.
Most recently, a nurse has become infected whilst working in Texas, in the United States of America; having contracted the virus from a Liberian patient. Early reports from this incident suggest that this nurse, and other co-workers, worked for "days" without adequate protective clothing, and without having received proper guidance on how to prevent the spread of the virus.
How do Ebola outbreaks start?
Healthcare experts believe that the Ebola virus has been living harmlessly in fruit bats for many years - building up in the fruit bat population, and spreading to other forest animals including chimpanzees and gorillas.
It is likely that the virus makes its way into humans after they butcher or handle dead animals that are contaminated with the virus.
Humans can become infected with the Ebola virus if they come into contact with the blood, body fluids or organs of an infected person.
Most of those who are infected come into contact with the Ebola virus by giving care to other infected people - either by directly touching the victim's body, or by cleaning up body fluids that carry infectious blood. Handling unsterilised needles or medical equipment that was used in the care of the infected person can also pass the virus on.
Sexual contact with an infected person without using a condom can spread the virus from person to person.
The Ebola virus generally is not spread by normal social contact (for example a hand shake) or by rubbing shoulders, bumping into or being in close proximity with patients who do not have symptoms.
The Ebola virus is not as infectious as diseases such as the flu, as airborne transmission is much less likely. A person is only infectious for a short period before they begin to display infections, so it's very likely that if a person isn't symptomatic, they will be unable to pass the Ebola virus onto you.
Who is at Risk of Infection?
Anyone who cares for an infected person, or handles their blood or fluid samples, is at risk of becoming infected. As a result of this hospital workers, laboratory workers and family members caring for a patient are at greatest risk.
What are the Symptoms of Infection?
An infected person will usually develop a fever, headache, joint and muscle pain, sore throat, and intense muscle weakness. These symptoms typically begin suddenly usually after 5-7 of being infected (however this can be between 2 and 21 days after infection).
Symptoms then worsen to include diarrhoea, vomiting, a rash, and stomach pain. Impaired kidney and liver function follow. The patient bleeds internally, and may also bleed from the ears, eyes, nose or mouth.
Ebola virus disease is fatal in 50-90% of cases. The sooner a person is given care, the better the chances that they will survive.
How is Ebola treated?
There is currently no licensed treatment or vaccine for Ebola. Potential vaccines and drug therapies are being developed and tested presently.
Patients should be placed in isolation, in intensive care. Dehydration is common in persons infected with the Ebola virus, and fluids may be given directly into a vein (intravenously). The patients blood oxygen levels and blood pressure need to be maintained at their correct levels, and the patients body organs need to be supported, while the patient's body fights the disease.
In treating a patient, healthcare workers should avoid contact with the bodily fluids of their infected patients by taking the following precautions:
- Always wear face masks, goggles, gowns, gloves and other protective clothing;
- When handling blood, secretions and catheters, and when connecting patients to a drip - exercise extreme caution;
- Correctly sterilise/disinfect medical equipment before it is re-used;
- Correctly sterilise, and then carefully dispose of, used needles and other disposable equipment;
- Correctly dispose of any secretions or body waste from the patient;
- Carefully and frequently wash your hands with soap and water (use an alcohol hand rub if soap isn't available);
- Wash disposable gloves with soap and water after use, and then dispose of them carefully.
What is the Advice for travellers in at-risk areas?
Following these simple precautions will minimise your risk of catching Ebola virus disease:
- Avoid contact with animals;
- Do not handle dead animals or their raw meat;
- Don't eat 'bushmeat';
- Avoid contact with patients who have symptoms or who you think might be at risk of being infected;
- Avoid sexual contact with people in risk areas; use a condom if you do;
- Make sure any fruit and vegetables you eat are washed and peeled before you eat;
- Wash hands frequently using soap and water (alcohol hand rubs when soap is not available), as this destroys the virus.
While travelling, if you think that you or a family member has symptoms of Ebola infection:
- Visit a healthcare provider immediately and inform them that you may have had contact with the Ebola virus (the nearest Embassy or Consular Office can help you find a provider in the area);
- Limit contact with others and avoid all other travel.
It's much more likely that the cause of your symptoms is another disease such as malaria, but you may need to be tested for Ebola as a precaution.
What if I think I might have Ebola in the UK or Ireland?
If you're feeling unwell and are displaying the symptoms that we've mentioned above (such as a fever, chills, muscle aches, headache, nausea, vomiting, diarrhoea, sore throat or rash) within 21 days of coming back from western Africa, you should stay at home.
Immediately telephone your doctor or a health services provider, and explain that you have recently visited western Africa.
These services will provide advice and arrange for you to be seen in a hospital if necessary, so that the cause of your illness can be determined.
There are other illnesses that are much more common than Ebola (such as flu, typhoid fever and malaria) that have similar symptoms in the early stages. A correct medical assessment is vital, to ensure you get the correct diagnosis and treatment.
It is also really important that medical services are expecting your arrival - calling ahead before you visit the hospital can ensure that this happens.
Why is the risk low for people in the UK or Ireland?
Currently, your risk of catching Ebola virus disease in the UK or Ireland is considered very low - unless you've travelled to a known infected area, or if you have had direct contact with a person with Ebola-like symptoms, or if you have been in contact with an infected animal or contaminated objects.
There has (to date) been one single case of imported Ebola in the UK. While it is possible that more people infected with Ebola could arrive in the UK on a plane, the virus is not as easily transmitted as a respiratory virus such as the flu.
Furthermore, people that are infected with Ebola do not become infectious until shortly before they begin to develop symptoms. This means that infectious people are not walking around spreading the disease for a long period, before they're even aware that they have it. It typically takes 5-7 days for a patient's symptoms to develop after they've been infected, so there is time to identify people who may have been exposed, put them under surveillance and if they show symptoms, quarantine them.
Historically in past outbreaks, infection control measures have been very effective in containing Ebola within the immediate area. In the UK and Ireland we have a robust public health system, with trained staff and the necessary facilities available to contain cases of Ebola. Advice has been issued to the UK's Border Force to identify possible cases of Ebola, and there are procedures in place to provide care to the patient and to minimise public health risk to others.
Flight crew are trained to respond swiftly to any passengers who develop symptoms during a flight from Africa. They will take measures to reduce transmission on board the plane.
Can the Ebola virus be transmitted through contact with the sweat of an infected person - for example through a gym?
If a person is displaying the symptoms that are associated with Ebola, it's highly unlikely that they would be well enough to go to the gym. Until they are symptomatic, they are not infectious.
Even if someone who was infectious did go to the gym, the World Health Organization advises that the Ebola virus has never been isolated from sweat.
I may have been on a flight with someone with Ebola. Am I at risk?
You contracting Ebola simply by being on a plane with someone who has it is very unlikely, and to date there have been no documented cases of people catching the disease simply by being in the same plane as an Ebola victim.
It's important to remember that you cannot catch Ebola through social contact. The spread of the virus requires direct contact with the blood or body fluids of an infected person.
Air traffic cabin crew who identify a sick passenger with suspicion of infectious disease on board, as well as ground staff receiving the passenger at the destination, would follow the International Air Transport Association guidelines for suspected communicable diseases. If there is someone unwell on board a flight, the pilot of the aircraft is legally required to inform air traffic control. Arrangements will be made for medical assessments for the person on arrival. The local Public Health Team would be alerted if there was a possibility that the individual was suffering from an infectious disease, and appropriate action can be initiated.
If we get a case of Ebola in the UK or Ireland, would we see an outbreak similar to West Africa?
While we might see cases of imported Ebola, this is extremely unlikely to result in a large outbreak in the UK and Ireland. We benefit from having a world class healthcare system, with very robust infection control systems and other processes and disease control systems that have a proven record.
Why are there media reports of people in the UK being tested for Ebola?
Frontline medical practitioners have been advised to be alert to Ebola, in persons returning from affected areas. An increase in testing following such advice is to be expected. For this reason, Ebola screening is being conducted at several major airports and there are plans to introduce this at major railway stations that are linked to mainland Europe.
The initial symptoms of Ebola are similar to a number of other far more common diseases such as malaria and dengue fever, and testing for Ebola in cases where these similar symptoms is a part of the measures being taken to help prevent it's spread.