Thursday, October 9, 2014

Some things you're being told about Ebola are wrong.

About that 21-day quarantine

I had been under the assumption that the 21-day isolation period was sufficient to contain the Ebola virus, but this morning KGW News showed a short video of a microbiologist in Seattle hinting about the insufficiency of the 21-day period.  Naturally, I had to do the research to find out what he was talking about.

Of course he was right.  In 2011, a group of researchers analyzed data from a 1995 Ebola (Zaire subtype) outbreak in the Democratic Republic of Congo, and discovered that 4.1% of people had incubation periods longer than 21 days.

Without going into the methods of their determination, let's just say that they're relying on statistical analysis to reach their conclusion.  This does not mean that 4.1% of people exposed to Ebola will become sick after 21 days; it means that after 21 days, your risk of getting sick is reduced to roughly 4.1%.  While that is small, according to the researchers, the risk could be further reduced to a 1% chance by extending the quarantine to 25 days.

I think this additional risk reduction is important.  In a smaller outbreak with good controls in place, a 4.1% chance of getting sick is rather inconsequential.  In a widespread and uncontrolled outbreak that is already larger than all past outbreaks (in the last 28 years since it was discovered), there are many people who will make it past the 21-day quarantine but get sick -- statistically speaking.  Those who do get sick may easily and falsely conclude that they are infected by Influenza, Rhinovirus, or even Malaria, as opposed to Ebola.

On the impossibility of aerosol transmission

From the start, I've known that contrary to what has been said about how Ebola is spread, if you are close enough to a visibly sick person, their coughing may result in transmission.  While it is true that it is not as infectious as Influenza or the common Rhinovirus, it is nonetheless possible in close quarters.  The virus, being rather large (970-14000 nm), does not travel in the air as easily as Influenza (80-120 nm).  Still, it has been shown that it can be transmitted in primate species via aerosol, which has some important implications if you're treating a sick person.

In a study on a related hemorrhagic virus (they're of the same class), Marburg, the authors noted that, "a relatively close contact is needed for virus transmission from man to man, although the possibility of aerosol transmission of the infection may be appreciably increased in case of the hemorrhagic syndrome with a high level of viremia."  Viremia, meaning someone who has the virus in their blood.

On the survivability of Ebola outside of a host

It has been implied that you require direct physical contact to become infected -- this is not exactly true.  The easiest path to infection is direct contact, but this study showed that the Ebola virus can survive for nearly two months in moderately cold temperatures (4°C), on dried tissue cultures on glass slides, and two weeks at room temperature.  I had always suspected this to be true (that the virus could survive outside of the host as many other viruses do), but only now did I do the research to confirm it.

In this separate study with a small sampling, positively infected fluids included tears, saliva, breast milk, stool, semen and of course blood.  If you cough into your hand, your hand has the virus on it.  If you then touch a door handle, you've deposited the virus onto it.  Inside of a hospital's isolation ward where there is a strict protocol of repeated cleaning and disposal of equipment, this is not an issue.  Outside of this zone, things are different.

Nevertheless, you won't catch it

Even though some of the information being circulated are half-truths or technically wrong, you still won't catch Ebola.  We're six months into this outbreak in West Africa and we're still talking less than 10,000 cases.  By comparison, annually some 60M Americans will catch the flu and somewhere between 3,000 and 49,000 will die from flu-related complications.  Ebola might be scarier because of its high mortality rate, but its transmission rate is so low as to be relatively unimportant.

On the other hand, you can reduce even this minimal risk by simply avoiding touching things, and immediately sanitizing your hands after touching foreign objects that are high risk infection zones -- in other words, best practices to avoid transmission of any virus.

And I have a suggestion: When you're sick, STAY HOME!  I don't care if you have Ebola, Rhinovirus or Influenza, you shouldn't be going to school or work and spreading your virus, ever!  Do you have to go to the grocery store?  Don't cough into your hands, don't wipe your nose or face with your hands, and don't go touching everything at the store.

My two cents.

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