Ebola: Facts Not Fear

The latest WHO figures put the current death toll of the on-going Ebola outbreak at almost 5000, with over 10,000 cases reported in eight countries, mainly those in West Africa.

In a series of three posts this week we will be answering some of the most important and frequently asked questions on Ebola. Experts at the Wellcome Trust, including our director, infectious disease specialist Dr Jeremy Farrar, head of population health Dr Jimmy Whitworth, and international activities advisor Dr Marta Tufet, will help to provide answers.

There has been heightened media attention devoted to the Ebola outbreak in recent weeks, and many people are concerned about the epidemic. We would like to concentrate on facts, not fear, by sharing information from people working to help bring this epidemic under control.

In this first post, we look at the current situation and explore why this outbreak is worse than previous ones. Tomorrow we will look at the effects of the outbreak and what needs to be done to get the situation under control, and on Thursday we’ll focus on the research currently underway to help find a vaccine or treatment for the disease. We hope that you will find the Q&A format and the information of use.

Is Ebola really the deadliest disease known?

Ebola is certainly up there amongst the deadliest diseases, with up to 7 in 10 people who get infected dying. But other diseases, such as rabies, are almost 100% fatal and so even deadlier.

Is it true that Ebola is more infectious than AIDS (as US Senator Rand Paul claimed)?

Ebola is more infectious than HIV/AIDS, mainly because it can be spread by more routes. Any secretions from a person infected with Ebola, alive or dead, can be infectious. This is unlike HIV/AIDS, which can only be spread by sexual contact, infected needles or blood products, or from a mother to an infant.

How late in the stage of having Ebola do you become contagious? From the moment you catch it or only in the very late stages? 

Ebola only becomes contagious once a person develops signs of illness, such as fever, muscle aches and sore throat. This normally doesn’t occur until several days after a person has become infected. This allows time for health authorities to find people incubating the disease and isolate them.

People who might have been exposed to a person with Ebola should report to the health authorities as soon as possible, and immediately if they develop any signs of infection.

What level of contact do you have to have with the bodily fluids of an infected person in order to contract it? In short: how vigorously would I have to wash up my cups if someone who has Ebola came to tea?

Nobody with any signs of Ebola is going to be well enough to come for tea with you. If they are infected but still incubating the disease, with no signs of illness, they will not be contagious. So a quick rinse with hot water and washing up liquid will be fine.

Is there a danger of getting infected by pets? (In light of the Spanish nurse’s dog that got put down) 

Pet animals are a minimal hazard. There is no reason to believe that they spread Ebola. Even the pets of infected people can be managed by giving them a wash and putting them in quarantine for 21 days just to be on the safe side.

Why is this Ebola outbreak so much worse than previous outbreaks?

This outbreak is bigger than all other outbreaks put together. Transmission of this infection in major cities is what’s different compared to previous epidemics. It’s in urban areas as well as rural areas, and that’s what’s allowed the disease to spread more widely. The concentration of infected people living in very big urban centres is a key reason this epidemic has been so hard to control.

In addition, weak health systems are more likely to blame than unprecedented virulence or a different form of transmission. Two of the countries involved have been weakened by prior years of war.

Why is Ebola so hard to control? 

An outbreak of Ebola is not hard to control if it is caught early. If cases are detected, diagnosed and managed correctly, and contacts are identified and isolated, then it can be quickly controlled. In urban, crowded areas where people are more mobile and have a larger number of contacts this becomes much more challenging.

In Senegal and Nigeria, authorities acted quickly and decisively to the first cases detected and managed to control the spread of Ebola very rapidly. This is what would happen in the UK if any cases were to occur, as our public health services are alert and prepared. It is only once an outbreak has been allowed to spiral out of control and many cases are occurring in several different places that it becomes hard to control.

In addition, there are currently no drugs or vaccines on the market that are effective to treat Ebola, although these are in development.

Should we be worried about the way that this outbreak of Ebola is progressing?

We should be concerned about the situation in West Africa – the impact Ebola is having on the health of the people and on their societies. This is where all our focus must be.

The current risks to Europe are minimal, and if the international community, including ourselves, all act on the commitments we have made, this epidemic can be brought under control.

Do you think that this particular strain of Ebola has mutated to be more infectious than previous outbreaks?

There’s no evidence that this virus is mutating at a faster rate than previous epidemics. But this particular virus does get to higher levels in the body than we’ve seen previously, and that may contribute to how infectious it is.

Will the Ebola virus mutate so it can spread via air?

The way the virus is spreading is consistent with what we’ve seen in all previous 25 outbreaks, only transmitting through blood and bodily secretions. There is no precedent for a virus changing its mode of transmission so drastically. Other viruses such as HIV – which transmit in similar ways, have passed through millions of humans, and are known to mutate more than Ebola – have not become airborne.

The chances of Ebola becoming airborne are extremely small. It’s important that we retain a sense of proportion and not exaggerate the risks for it changing and becoming airborne – there is already enough fear and misinformation surrounding this epidemic.

Rather than causing people to panic, we need to focus our efforts on trying to stop this outbreak before Ebola establishes itself in West African countries.

You can find out more about the Wellcome Trust funding for Ebola research on our website.

Image Credit: Ebola virus structure, visualisatoin – Maurizio De Angelis, Wellcome Images