Ebola Virus – Details for Healthcare Workers

Here are a few things that I learned about Ebola, which every healthcare worker should know.

1) Transmission of the Ebola virus is through direct contact with bodily fluids, especially blood, vomitus, and feces.  Ebola is
not an airborne virus, and it is very unlikely that the virus will mutate to become transmissible through inhalation of the virus.
However, in the case of projectile vomiting, it is possible for large droplets of vomitus to land on a nearby caretaker, and if the
droplet contacts a mucus membrane or a cut then transmission of the virus could occur.  
2) Signs and symptoms of Ebola include fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain,
and unexplained bleeding or bruising.  A patient who has contracted the Ebola virus can exhibit symptoms anywhere from 2-21
days after being exposed.
3) The virus is communicable once a patient exhibits symptoms of the virus, i.e., once the patient develops a fever. The virus
will continue to multiply if unchecked by an adequate immune response, and the patient will therefore be increasingly
contagious until they have fully recovered from the disease. Once the patient is fully recovered, antibodies are present in the
patient’s body and the patient is no longer contagious. However, if a patient dies from Ebola, the deceased’s body is highly
contagious. Therefore, proper training and precautions must be taken when preparing the body for burial.
4) Contact with surfaces contaminated with bodily fluids from an Ebola patient can expose you to the Ebola virus. This is a less
likely mode of transmission, but every precaution should be taken. This means all surfaces, including objects such as needles
and syringes, which an Ebola patient has come into contact with, should be disinfected and all direct contact should be
avoided until decontamination is complete. Proper personal protective equipment (PPE) and training is required for those who
are responsible for this decontamination process.
5) The CDC has very specific and detailed guidelines on administrative and environmental controls for healthcare facilities to
protect healthcare workers and to prevent the spread of the virus. These controls include appointing properly trained site
managers, proper triage and care protocols, isolation, and training staff on all protocols and proper use of PPE.
6) Proper training and use of PPE is key to protecting healthcare workers. No skin should be exposed while wearing PPE.
Donning and doffing of PPE is a process that must be taken slowly and carefully, and must be done under the supervision of
trained monitors (also wearing PPE) in a designated area.  Checklists must be made and followed carefully.  
Ultimately, our greatest defense against Ebola is proper training and practice. Many hospitals and healthcare facilities all over
the country have begun training and drilling on dealing with Ebola cases. While some of the protocols may be unique to Ebola,
many are similar to the infectious disease control protocols hospitals have been following for years.
What we know about transmission of the Ebola virus among humans

Ebola situation assessment - 6 October 2014

The Ebola virus is transmitted among humans through close and direct physical contact with infected bodily fluids, the most infectious being blood,
faeces and vomit.

The Ebola virus has also been detected in breast milk, urine and semen. In a convalescent male, the virus can persist in semen for at least 70
days; one study suggests persistence for more than 90 days.

Saliva and tears may also carry some risk. However, the studies implicating these additional bodily fluids were extremely limited in sample size
and the science is inconclusive. In studies of saliva, the virus was found most frequently in patients at a severe stage of illness. The whole live virus
has never been isolated from sweat.

The Ebola virus can also be transmitted indirectly, by contact with previously contaminated surfaces and objects. The risk of transmission from
these surfaces is low and can be reduced even further by appropriate cleaning and disinfection procedures.

Not an airborne virus

Ebola virus disease is not an airborne infection. Airborne spread among humans implies inhalation of an infectious dose of virus from a
suspended cloud of small dried droplets.

This mode of transmission has not been observed during extensive studies of the Ebola virus over several decades.

Common sense and observation tell us that spread of the virus via coughing or sneezing is rare, if it happens at all. Epidemiological data
emerging from the outbreak are not consistent with the pattern of spread seen with airborne viruses, like those that cause measles and
chickenpox, or the airborne bacterium that causes tuberculosis.

Theoretically, wet and bigger droplets from a heavily infected individual, who has respiratory symptoms caused by other conditions or who vomits
violently, could transmit the virus – over a short distance – to another nearby person.

This could happen when virus-laden heavy droplets are directly propelled, by coughing or sneezing (which does not mean airborne transmission)
onto the mucus membranes or skin with cuts or abrasions of another person.

WHO is not aware of any studies that actually document this mode of transmission. On the contrary, good quality studies from previous Ebola
outbreaks show that all cases were infected by direct close contact with symptomatic patients.

No evidence that viral diseases change their mode of transmission

Moreover, scientists are unaware of any virus that has dramatically changed its mode of transmission. For example, the H5N1 avian influenza
virus, which has caused sporadic human cases since 1997, is now endemic in chickens and ducks in large parts of Asia.

That virus has probably circulated through many billions of birds for at least two decades. Its mode of transmission remains basically unchanged.

Speculation that Ebola virus disease might mutate into a form that could easily spread among humans through the air is just that: speculation,
unsubstantiated by any evidence.

This kind of speculation is unfounded but understandable as health officials race to catch up with this fast-moving and rapidly evolving outbreak.

To stop this outbreak, more needs to be done to implement – on a much larger scale – well-known protective and preventive measures. Abundant
evidence has documented their effectiveness.

Day 1-2: Abrupt fever, headache, joint & muscle pain, asthenia, & anorexia gastrointestinal: nausea, vomiting, watery diarrhoea, & abdominal pain

Day 3-6: Epigastric & RUQ pain, hepatomegaly Bloody diarrhoea, melena, Dehydration, Hypokalaemia Conjunctival injection, Basilar rales,
cough, Substernal burning chest pain. Progressive weakness, Sore throat

Late Day 5-7: Fine rash, sparing face, Bleeding: epitasis, haematemesis, subconjunctival haemorrhage, oozing venipuncture sites, gingival
hemorrhaged, & melena, Circulatory failure, Anuria, ascites, oedema, Tachypnoea, pulmonary edema, Confusion, disorientation, agitation, coma.
Time to death: 10-12 days from onset of symptoms, often less (median Gulu 8 days)
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