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Monday, August 11, 2014

Why Ebola is so dangerous

Health workers in isolation ward, southern Guinea (1 April)Health care workers are among those most at risk of catching Ebola
The Ebola outbreak in West Africa is the world's deadliest to date and the World Health Organization has now declared an international health emergency in response. According to the UN, 961 people have died since February in Guinea, Liberia, Sierra Leone and Nigeria.
What is Ebola?
Ebola is a viral illness of which the initial symptoms can include a sudden fever, intense weakness, muscle pain and a sore throat, according to the World Health Organization (WHO). And that is just the beginning: subsequent stages are vomiting, diarrhoea and - in some cases - both internal and external bleeding.
The disease infects humans through close contact with infected animals, including chimpanzees, fruit bats and forest antelope.
It then spreads between humans by direct contact with infected blood, bodily fluids or organs, or indirectly through contact with contaminated environments. Even funerals of Ebola victims can be a risk, if mourners have direct contact with the body of the deceased.
Molecular model of parts of the Ebola virusThis molecular model shows the parts of the Ebola virus scientists are studying in the hopes of finding drugs that will slow the spread of the disease
The incubation period can last from two days to three weeks, and diagnosis is difficult. The human disease has so far been mostly limited to Africa, although one strain has cropped up in the Philippines.
Healthcare workers are at risk if they treat patients without taking the right precautions to avoid infection. People are infectious as long as their blood and secretions contain the virus - in some cases, up to seven weeks after they recover.
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Where does it strike?
Ebola outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests, says the WHO.
Woman dries bushmeat by the side of the road, Ivory Coast (29 March)Bushmeat - from animals such as bats, antelopes, porcupines and monkeys - is a prized delicacy in much of West Africa but can also be a source of Ebola
It was first discovered in the Democratic Republic of Congo in 1976 since when it has affected countries further east, including Uganda and Sudan. This outbreak is unusual because it started in Guinea, which has never before been affected, and is spreading to urban areas.
Graph showing Ebola deaths since 1976
Map showing Ebola outbreaks since 1976
From Nzerekore, a remote area of south-eastern Guinea, the virus has spread to the capital, Conakry, and neighbouring Liberia and Sierra Leone.
A man who flew from Liberia to Lagos in July was quarantined on his arrival and later died of Ebola - the first case in Nigeria. One of the nurses who treated him has since died.
The medical charity Medecins Sans Frontieres (MSF) says the outbreak is "unprecedented" in the way the cases were scattered in multiple locations across Guinea, hundreds of kilometres apart, and says it is a "race against time" to check people who come into contact with sick people.
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Can cultural practices spread Ebola?
Ebola is spread through close physical contact with infected people. This is a problem for many in the West African countries currently affected by the outbreak, as practices around religion and death involve close physical contact.
Hugging is a normal part of religious worship in Liberia and Sierra Leone, and across the region the ritual preparation of bodies for burial involves washing, touching and kissing. Those with the highest status in society are often charged with washing and preparing the body. For a woman this can include braiding the hair, and for a man shaving the head.
Volunteers bury the body of an Ebola victim in Sierra LeoneStrict precautions must be observed when burying those who have died of Ebola
If a person has died from Ebola, their body will have a very high viral load. Bleeding is a usual symptom of the disease prior to death. Those who handle the body and come into contact with the blood or other body fluids are at greatest risk of catching the disease.
MSF has been trying to make people aware of how their treatment of dead relatives might pose a risk to themselves. It is a very difficult message to get across.
All previous outbreaks were much smaller and occurred in places where Ebola was already known - in Uganda and the DR Congo for example. In those places the education message about avoiding contact has had years to enter the collective consciousness. In West Africa, there simply has not been the time for the necessary cultural shift.
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What precautions should I take?
Avoid contact with Ebola patients and their bodily fluids, the WHO advises. Do not touch anything - such as shared towels - which could have become contaminated in a public place.
A Liberian man washes his hands as an extra precaution for the prevention of the spread of the Ebola virus before entering a church service in Monrovia, Liberia -27 July 2014Washing hands and improving hygiene is one of the best ways to fight the virus
Carers should wear gloves and protective equipment, such as masks, and wash their hands regularly.
The WHO also warns against consuming raw bushmeat and any contact with infected bats or monkeys and apes. Fruit bats in particular are considered a delicacy in the area of Guinea where the outbreak started.
In March, Liberia's health minister advised people to stop having sex, in addition to existing advice not to shake hands or kiss. The WHO says men can still transmit the virus through their semen for up to seven weeks after recovering from Ebola.
A BBC reporter in the Liberian capital Monrovia says that public awareness campaigns around Ebola have been stepped up following the death in July of renowned Liberian doctor Samuel Brisbane.
Liberia has now closed schools, most of its border crossings and communities hit by an Ebola outbreak face quarantine to try to halt the spread of the virus.
The doctor leading Sierra Leone's fight against the virus has also died, prompting the country's president to declare a public health emergency.
British Airways, West African airliner Asky and Nigeria's Arik Air have suspended flights to Liberia and Sierra Leone and more stringent screening is being put in place at some airports. When the outbreak first began, Senegal closed its border with Guinea.
Fighting the fear and stigmatisation surrounding Ebola is one of the greatest challenges health workers face.
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What can be done if I catch it?
You must keep yourself isolated and seek professional help. Patients have a better chance of survival if they receive early treatment.
Emergency entrance to a hospital in Conakry treating Ebola patients (March 2014)
There are no vaccines, though some are being tested, along with new drug therapies.
Patients frequently become dehydrated. They should drink solutions containing electrolytes or receive intravenous fluids.
MSF says this outbreak comes from the deadliest and most aggressive strain of the virus.
The current outbreak is killing between 50% and 60% of people infected.
It is not known which factors allow some people to recover while most succumb.

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