By Thomas Locke, MD, MPH

Clallam County Health Officer

The Ebola outbreak in West Africa has been very much in the news for the past several months. Almost 14,000 cases have been detected with nearly 5,000 deaths. In the United States, there have been only 4 cases – a Liberian citizen who travelled to Dallas, two nurses who cared for him, and a New York physician who became infected while working in West Africa. There has been one death in the United States. Ebola was first discovered in 1976 and over 20 outbreaks have occurred in Africa since that time. The current outbreak is the largest in history.

Fortunately, we know a lot about the Ebola virus – how it is transmitted and how infection can be prevented. Ebola infection occurs when the body fluids of someone with the disease enters a person’s body through their eyes, nose, mouth, or through a break in the skin. The virus incubates in the body, usually causing symptoms 8-10 days after initial exposure.

The first symptom is usually a fever. Levels of the virus are very low in the body when symptoms first develop and an infected person in minimally contagious. As the infection progresses, the amount of virus soars to extraordinary levels (billions of virus particles in each teaspoon of blood or body fluid) and produce a life threatening infection characterized by dramatic vomiting and diarrhea. At the peak of infection the virus gets into all body fluids, including tears, saliva, and sweat requiring very stringent infection control precautions.

The goal of the international effort now underway to combat the West African Ebola outbreak is containment and eradication. At present, the outbreak has been successfully contained to three countries – Liberia, Sierra Leone, and Guinea. Travel to and from these countries is highly restricted and all travelers are being monitored for 21 days after departure from the outbreak zone. In addition, U.S. health care providers have been alerted to ask all patients with fevers and Ebola-like symptoms about their travel history. In the highly unlikely event they have travelled to West Africa in the last 3 weeks, they would be put into special isolation while being further evaluated.

All hospital and health care workers are trained in the use of Personal Protective Equipment (PPE) and these special isolation precautions. In recent weeks, Olympic Medical Center and Forks Community Hospital staff have been reviewing and practicing their PPE protocols. Although it is unlikely we will ever use this equipment to prevent Ebola transmission, there are other much more common infections – Tuberculosis, Measles, and antibiotic-resistant bacteria – that require very similar isolation techniques. Practicing the rapid detection of contagious disease and methods of protecting health care workers and other patients from these diseases is something all hospitals must do on a regular basis to maintain a high level of preparedness.

The risk of being exposed to Ebola in the United States is infinitesimally small. If the West African Ebola outbreak is not successfully contained, this risk could increase in the future. The heroic volunteer health care workers who are working on the front lines of the outbreak are being carefully monitored when they return to the U.S. Their efforts are absolutely essential to deal with the problem at its source.

It is not really possible for an Ebola outbreak to occur in the United States, largely due to the fact that the disease is contagious only when a person is seriously ill. It is not spread through the air nor is it spread by food or water. We have the skills and technology to rapidly detect and contain the infection. In addition to fighting this disease, we also have to combat the fear and misinformation that accompanies it.

It is ironic that a disease like Ebola, which has killed one person in the U.S., warrants non-stop media coverage while a disease like influenza, which is highly contagious, kills 5,000 to 40,000 Americans every year, and is effectively prevented with a safe and inexpensive vaccine, receives very little attention.

The West African Ebola outbreak should be a wake-up call to Americans. This will not be the last global infectious disease threat – future influenza pandemics are inevitable. We need a robust public health system that is prepared to deal with them. Our current system is well prepared to prevent the spread of Ebola to the United States. Ebola is not something to be afraid of – it is something to be informed about, including the aggressive national, state, and local measures that are in place to prevent it.