The words “Ebola Virus” are terrifying to those that hear them. The same words are equally terrifying to those who get the disease and just as frightening for the relatives of the infected victim. All the fear is with due cause. Ebola or Ebola Virus Disease (EVD) is certainly something that proves a serious cause for concern. The virus can spread quickly and can prove deadly.
The disease has no existing vaccination, although researchers are working on developing a vaccination at this time, and, in time, they may be able to save thousands of lives with a simple injection. While people seem to know to fear the disease instinctively, many people hear the word Ebola, and remain unsure what the disease is or if it is treatable.
Here we will examine everything from the symptoms of Ebola, to the therapeutic modalities and supportive care used to care for unlucky victims.
Definition of the Ebola virus
A potentially painful and deadly illness, the Ebola Virus Disease (EVD) is a baneful illness that can cause hemorrhagic fevers. The virus is a condition marked by high fever, internal bleeding, and the failure of the organs in the body. In many instances, the disease results in death.
Ebola is related and similar to the Marburg virus, another type of hemorrhagic fever discovered in Germany in the 1970s. This disease is one of the deadliest diseases in the entire world, and one with the power to spread quickly. There are five variants of the disease, with three proving dangerous. Dr. Congo is responsible for the discovery of the virus in the mid-1970s.
The disease enters the body and destroys white blood cells while simultaneously attacking the victim’s immune system. Cells infected with the Ebola virus then spread throughout the body. Blood clots form within the body as clotting agents deplete. Early stages of the disease are flu-like, thereby making Ebola even more insidious as it looks like it is a far less deadly disease in its earliest stages.
The Ebola Virus is one that is not airborne, at least not outside of a laboratory setting. In the lab, the virus has demonstrated evidence of being able to transmit through airborne means to animals. Airborne transmission from primate to human is not an event researchers have seen to date. The virus does not spread through food consumption or from drinking contaminated water. Mosquitoes do not spread the disease.
Where the EDV originates from remains unclear, but there are theories about how the disease spreads. Some theories suggest Ebola passes from an animal infected with the virus to an uninfected individual. There have been reports in Africa where tainted bush meat (wild animals hunted and consumed for food) was believed to be the point of origin. The meat is tainted with the Ebola virus and results in the transmission of the virus between the animal and the individual that encounters the animal.
The types of animals infected with the virus include, but might not be limited to, bats, duikers, baboons, gorillas, chimpanzees, and different species of monkeys. Leading theories suggest animals contract the infection once they eat wild fruit that has been contaminated by a bat that was carrying the virus.
When a person gets EDV is because the individual has contracted one of five Ebolavirus viruses. These five dangerous viruses include Zaire Ebola Virus or EBOV, which is the virus marked responsible as the biggest outbreaks of this deadly disease. The rest of the list is completed by the Bundibugyo virus or BDBV, the Taï Forest virus or TAFV, and the Sudan Virus or SUDV. The Reston virus (RESTV) causes Ebola disease in primates but does not cause the disease in humans.
Headaches, sore throat, body aches and pains, general malaise, bodily discomfort, and fever are the earliest indications that something is amiss. In the latter stages of the disease, the victim sufferers greatly.
The behavior of animals, the production of fruit, and a number of other factors plays the role as to whether or not the Ebola virus spreads. Evidence indicates that the virus can infect pigs and dogs. Pigs have demonstrated the ability to pass the disease on to other primates. Dogmatist dogs do not present with any types of symptoms, but they can become carriers of Ebola.
According to an article appearing in the July 2014 issue of The Atlantic, the disease may begin with bats. In an article entitled, “Where Does Ebola Come From,” by Olga Kahzan, the 2014 Ebola outbreak in Africa was subject to examination.
Kahzan quotes an epidemiologist from EcoHealth Alliance, Jonathan Epstein, who considers whether or not a bat got feces, urine, or saliva on fruit or food, or if bat feces, urine, or salvia was responsible for the transmission of the disease. Whether a bat was at fault for the 2014 outbreak of Ebola remains in question, since there are many bat-attracting pig farms in the country.
The 2014 outbreak of the disease had a survival rate of about 50 percent. There were 16 million people who got the disease who were living in Africa’s infected regions: Guinea, Sierra Leone, and Liberia. Of those who got ill, 8.5 million were 20 years old or younger, and 2.5 million where children younger than the age of five.
Transmission of Ebola
When the big Ebola outbreak occurred in 2014, people were on high alert and asking many questions. One of the chief questions people ask is “How is Ebola spread?”
What is clear is that Ebola requires a live animal host, and once a human makes contact with bodily fluid of the infected animal, Ebola is transmitted to the unsuspecting victim. As per the World Health Organization, a victim must be extremely ill to be contagious and to be able to pass the disease onto others.
Once the virus infects a human there is a period of incubation. The disease passes from one person to another when contact with the bodily fluids occurs between the infected and uninfected. The fluids that carry the Ebola virus include semen, urine, breast milk, tears, perspiration, faces, vomit, mucus, and saliva. The majority of cases are spread when a victim meets infected blood, feces, or urine.
The virus can and will enter the human body through abrasions, cuts, wounds, and the eyes, mouth, and nose. The Ebola virus has the ability to survive a few hours if it is on a dry surface. If, however, the virus is contained in bodily fluid, it can remain alive and deadly for as much as a couple of days. The disease also spreads with the sharing of contaminated hypodermic needles. Sources vary in terms of information on when symptoms manifest.
The Mayo Clinic online suggests the onset of Ebola symptoms is often sudden, unexpected, and they manifest in five to ten days following the contact with an infected animal or individual. Alternative sources suggest the onset of symptoms can begin as early as two days following infection, but can take up to 21 days to appear. The average case takes anywhere from four to ten days to develop symptoms. Still, mathematical models have predicted that approximately 5% of all EVD cases can actually take greater than 21 days for symptoms to appear.
If a victim does not survive, the corpse of the deceased is still infected by the virus. Therefore, anyone handling the deceased remains of a person who has had Ebola will have to take considerable care not to get infected following the care of the deceased’s body. Following the New Guinea 2014 outbreak of Ebola, there are estimates that nearly 70% of all cases was started from contact with a person who died of the disease.
Those in the healthcare professionals are at risk of getting an infection when dealing with a person who has the disease. Risks of the getting the illness increase when the health care practitioner fails to handle the patient correctly or the practitioner fails to use a hazmat suit or other protective attire. To care for a victim, the health professional needs to wear safety attire and the practitioner needs to take firm, even drastic measures to prevent the spread of the disease.
The symptoms associated with EVD are systemic. The infected individual will begin to experience a set of symptoms not unlike those associated with the onset of influenza. The infected may feel fatigued, exhausted, weak, achy, and a fever will develop. Joint pain and muscular discomfort also occur, along with a sore throat and a headache.
A fever will typically rise higher than 101 degrees Fahrenheit or 38.3 degrees Celsius. After the first series of flu-like symptoms appear, the infected may become nauseous, and begin vomiting. Abdominal discomfort is common as is the onset of diarrhea.
As the disease progresses, the symptoms increase in severity. Later Ebola virus symptoms include the onset of chest pain, difficulty breathing, confusion, swelling, and the headaches increase in intensity. About fifty percent of all people who have advanced Ebola virus symptoms end up getting a rash comprised of small, red, flat bumps identified as a maculopapular rash. The rash lasts five to seven days following the onset of symptoms. In severe case, the victim of EVD may develop internal as well as external bleeding.
The latter symptoms may appear with five to seven days following the onset of initial symptoms. Every victim who contracts EVD demonstrates poor blood clotting. In up to 50% of all cases, bleeding from injection sites and from mucous members has occurred. Some victims end up with bloody stools, vomiting, or coughing up blood. Heavy bleeding does not occur often, but if it does, the issue is with the individual’s gastrointestinal tract.
Death is possible and commonly occurs within six to 16 days from when the symptoms first appear. Petechiae (a form of bleeding just beneath the skin that causes a purple rash to appear) may appear. Sometimes victims actually have blood appearing in the white area of the eyes. Below is a chart illustrating when many symptoms occur:
|Days after 4 to 9 days from initial infection||Symptoms Onset|
|Days 1 through 3||The earliest days of the disease when symptoms begin to appear. The symptoms may even be mistaken for the flu.|
|Days 4 through 7||Symptoms progress into anemia, headaches, hypotension, nausea, diarrhea, and vomiting.|
|Days 7 through 10||Internal bleeding, external bleeding, confusion.|
|The disease can lead to shock, coma, and death.|
There are two outcomes for EVD, eventual recovery or death. Some sufferers have demonstrated the recovery process beginning seven to 14 days after the first appearance of symptoms. A victim may die between 6 – 16 days following disease onset from a variety of complications. Below is a list of potential complications one may face from contracting Ebola:
|Days from initial symptom onset||Complication|
|6 to 16 Days||The onset of bleeding is indicative of a poor outcome for the victim. Loss of too much blood can lead to the victim’s death.|
|Fluid loss leading to low blood pressure can lead to the death of the victim.|
|The victim goes into a coma; typically, this symptom occurs prior to the victim’s death.|
Advanced stages of Ebola virus
The early signs of EVD have been examined. As the disease progresses, various parts of the body fall under attack of the virus. One of the chief signs of the disease entering into the advanced stages is identifiable when the victim begins vomiting up blood. Internal and external bleeding occurs. Under the skin and within the body, more negative effects are underway. The disease begins to destroy hepatocytes cells: the functioning cells of the liver.
The virus also attacked the endothelial cells, which are responsible for forming the lining of one’s blood vessels. Diarrhea is a sign of the advance stages of the disease, as is sudden kidney failure. The organs are being damaged and begin to shut down. Further, the virus will attack blood cells in the arteries, phagocytes, which are responsible for the absorption of particles foreign in the body.
In advanced stages of EVD, the patient will develop blood clots in the body, all of which begin to destroy organs. The blood will then start to have trouble clotting. The body turns on itself and, in what is identified as a cytokine storm, the immune system begins to attack the body instead of foreign entities.
The kidneys, liver, genitals, eyes, intestines, and brain are all subject to attack. The victim’s vascular system also endures damage. External and internal bleeding sets in as blood vessels are damaged and the patient begins bleeding from orifices, mucous members, and wounds. The patient can also bleed from injection sites.
Recovery and long term repercussions
Following successful Ebola treatment, the individual develops natural antibodies against EVD. However, the question remains as to whether or not such antibodies will prevent the individual from getting Ebola in the future. Unfortunately, the victim who suffers from EVD may experience long-term problems. It can take months to recover and some of the issues an Ebola survivor may experience include:
- Anxiety attacks
- Cessation of menstrual cycle
- Chest pain
- Diminished appetite
- Hearing loss
- Issues with memory
- Issues with recovering weight lost during the illness
- Neurological issues
- Muscular pain
- Pain in the joints
- Poor health over the long-term
Even after recovery, males may still have the Ebola virus present in their semen; this can prove problematic as it means the individual can still transmit the disease through sexual contact with another. Likewise, women who are breastfeeding who contract the virus may carry the virus in the breast milk for up to three months following recovery. The female will have to cease breastfeeding entirely.
One case occurring in the year 2014 revealed a recovered Ebola victim who still had signs of the Ebola virus in their eye a full two months following their recovery. Ultimately, some unfortunate victims who are lucky enough to survive are not lucky enough to escape Post-Ebola syndrome and its symptoms listed above.
There is no existing medical treatment or vaccine to prevent or cure Ebola. When a person gets the illness, all the medical community can do is offer the victim supportive treatment and deal with the medical complications as they arise. Those who offer supportive care to the victim, particular health care professionals, are at substantial risk of getting the virus if they do not follow the appropriate protocol to prevent the spread of the disease.
The disease is most prevalent throughout parts of Africa where the health care is relatively poor. In some hospitals, there is no running water and needles are even reused and it is here that Ebola can spread in a hospital setting. Poor sanitary conditions will definitely contribute to the spread of the disease.
In the United States, preventing the disease from spreading requires that health care workers learn and follow correct safety protocol. The health care professional has to wear special attire to prevent accidental exposure to the virus. It is imperative that the supportive care team does not come into contact with the infected’s bodily fluids. The disease is transmitted through blood, urine, saliva, feces, and sweat.
Treating the patient involves nothing more than treating the symptoms and not the disease. The victim is quarantined, kept hydrated and symptoms are handled as they occur. Health care professionals have to offer the victim wound care, preventative care and treatment of secondary infections, blood transfusions, intravenous fluids, oxygen therapy, and pain management solutions.
Health care protective attire
Health care professionals need to wear safety attire when dealing with the infected. The Center for Disease Control has made recommendations pertaining to what the professional should wear while dealing with the victim of Ebola. The CDC even updated the former guidelines to reflect the newest safety recommendations. The previous guidelines required that the health care worker don on a respirator or mask, safety goggles, one pair of rubber gloves, and no shoes or leg coverings.
The latest guidelines have changed considerably, and such changes are indicative of the Center for Disease Control’s recognition of the extremely serious and dangerous nature of the virus and the health care workers requiring defense against it. The new guidelines recommend that a health care worker wear a disposable full-face shield, respirator, a waterproof apron, a fluid resistant gown or coverall, two pairs of protective gloves and fluid resistant pants and shoe coverings.
The Center for Disease Control has also provided complete guidelines on how the health care worker is to wear each piece of equipment. The goggles must be snug against the face, and the facemask must cover the entire face and past the person’s chin. The rubber gloves have to, not just cover the hands, but the wrists of the protective gown too so it holds snugly in place. Removal of attire is planned with equal care to ensure that the health care worker is not exposed to the virus.
What is clear after examining the negative effects of a disease like Ebola is that the disease is, on all counts, terrifying. The World Health Organization and Medecins San Frontieres, from Doctors without Borders, have identified Ebola as one the most deadly diseases on the entire planet.
Since the disease is incredibly infectious; its early symptoms are deceiving and make it seem like a person has the flu, and the absence of a vaccination for the disease allows Ebola to take thousands of lives each year. The disease has an extremely high mortality rate, with as many as 90 percent of all victims dying from contracting the virus. Thus, researchers are working vigorously toward producing a vaccine to prevent to the disease, and hopefully soon, they will develop a cure.