Everything You Wanted To Know About Ebola

August 5, 2014 | No Comments » | Topics: Interesting

What exactly is Ebola & how is it caused?

Ebola is one of the filoviruses (Marburg is the other known filovirus). The filovirus family is small and remarkable because both known viruses typically cause a hemorrhagic fever that is fatal in many cases.

We’ll stick with Ebola for now. Ebola has several heavily studied strains, typically named for the location where they are found (A case was made for a strain named Ebola Mayinga, which was isolated from a nurse who was treating a patient from Zaire. Her strain had a case fatality of 90%). Most of the strains are named for locations within Africa (where all, so far, of the human fatalities have occurred). One strain is named Ebola Reston, which was discovered in Reston, Virginia. This strain killed monkeys almost universally. Two people tested positive for it, yet never exhibited any significant symptoms (The book Hot Zone by Richard Preston is one of the hooks that got me heavily into biological weapons and CBRNE work). Until last year the sign for the building was still visible from a major highway just miles away from a major shopping mall in Virginia (the name had been changed).

Another poster mentioned the infectivity of Ebola. It’s incredible. Tests seem to indicate that on the order of 100 viral particles are sufficient to be infective (literature discusses infective doses measured less than that…) The virus is considered to be spread by droplets of infective material, but due to its incredibly low infective dose, aerosols and airborne dispersion should be seriously considered by anyone working with Ebola patients (Your mileage may vary, but I’m opting for a completely sealed suit. Level B or better).

Ebola is small. It gets into the body any number of ways. From there it attempts to get into a cell. Once there it grabs a hold of the cellular machinery and start churning out copies of itself. The cell literally begins to “ooze” out spaghetti threads of virus before ultimately falling apart, shedding thousands and thousands of viral particles to start the next infective cycle. This disease devastates tissue and moves incredibly fast. Organs are horribly damaged before you even realize there is a problem.

Ebola circulates through the blood, therefore it has easy access to the walls of the vasculature (Arteries, veins, and capillaries). It’s perfectly happy to jump into the epithelium lining these vessels, replicating within them and ultimately destroying the cells lining the vessels. As the vessels are damaged, the body responds by attempting to “seal” the leaks in the vessel walls by clotting. The body goes into a clotting overdrive trying to patch all of the damage that is happening throughout the vasculature. Very quickly, the body uses up all of it’s clotting capability.

In a perverse turn, this hyperactive clotting attempt allows the body to bleed freely. From everywhere. Patients will cry blood colored tears, blood will ooze from under their fingernails, their gums will bleed around their teeth. This bleeding isn’t limited to the outside world, either. Within their body, bleeding is happening within the gut as the GI tract lining is destroyed and shed. Some patients freely urinate blood. Early deaths may happen for patients who have bleeding in the brain. The central theme is that the bleeding starts to happen everywhere.

However, the virus is pretty cagey. It doesn’t (typically) devastate the lungs, heart, or brain. The patient is still going, surviving as their body is being destroyed by a runaway virus. This virus is hijacking almost every cellular process it can to make more copies of itself.

Meanwhile, the virus is being shed in all of this blood. Happy to infect any cell it can gain access to. Because of the bleeding in the mouth (and from the GI tract), the patient is expelling virus with every breath. In many cases the patient will suffer from seizures (either due to brain damage from small bleeds or due to metabolic processes that have been deranged by the virus’ activity). These seizures will throw infective fluids far from the body, catching others unaware. Literally everything that comes out of the body is radiantly infective at this point.

Cures… We don’t really have any right now. Supportive care is possible, if you can safely care for a patient this infective, AND you have the infrastructure to pour resources into the patient (Africa is not known for its incredible medical infrastructure). Finding a cure is difficult. We really haven’t had that many cases where we can afford to study the patient (I’m going to guess and say that we have had less than 2000 reported cases, world wide. I’d be comfortable saying 1000, but I’ll be conservative in my guess at the rarity. Contrast with the tens of thousands of people that die from rabies every year. Still no cure, just a vaccine).

The disease is reported to be incredibly painful. For the patient, most of their epithelial linings will be damaged and probably slough off. Imagine the lining of your mouth, throat, stomach, intestines, urinary tract peeling off. Your epidermis tends to stay intact, but frequently horrible bruises mottle the skin as anything beyond the most trivial contact results in massive bruising under the skin. Finally, for many of these patients, they’re mostly conscious throughout the process, saving the occasional seizure (I think there was a study looking at survivability versus seizures in Ebola patients. The less seizures, the better outcome). That means they’re awake for all of this.

Now we have a report that there may be a case in Canada… Yikes. – StaticDet5

Why do seemingly so many potentially catastrophic diseases (Ebola, HIV) start in Africa?

Both of those examples you gave are believed to come from a common source: bush meat. Because we are so genetically similar to other primates, we are at greater of their diseases being able to spread to us (and those diseases may or may not affect us differently than their original hosts, including being more deadly). People in parts of Africa often depend on bush meat (including monkeys or other primates) for protein. During the process of killing, butchering and then consuming the meat, there are a whole range of ways to become exposed to these viruses.

Of course, once started, African countries often have less public sanitation, healthcare, and education to contain or combat the disease. – carrion_soup

Why are they flying people infected with Ebola all over the world to hospitals?

Patients being flown to first world industrialized countries will be treated in a highly contained and adequately equipped medical facility which may be able to save the individual. Secondly, those who are performing the treatment in the US may well learn some things from this outbreak that will help the CDC, which is located in Atlanta.

The threat to the US and other countries is not bringing an infected patient to the care of professionals. The threat is someone flying into other countries with the disease unknowingly. It is not about saving one life, it is about studying and learning that can only happen with our technology. The disease is already here technically. The CDC has it in highly secured labs for study. – theshowroomphx

How much trouble are we in with the Ebola pandemic?

Ebola is a relatively swift killer, which limits its ability to jump from host-to-host. It is also not airborne, meaning that you would have to come in direct contact with contaminated bodily fluids. The predominant reasons it has continued to spread in Africa is the weaker healthcare system and a general mistrust of the health professionals assigned to combat the disease, as well as a general stigma in the region about admitting when you’ve begun to show symptoms. This results in far more direct contact with infected individuals, to the point where they can no longer be reasonably quarantined. – n00bz0rd