With the long-expected news that the United States has just experienced its first case of a person coming down with the Ebola Virus Disease, we would like to give our readers some accurate, factual scientific information about the nature of the illness caused by the Ebola virus – its symptoms, methods of treatment and preventative measures that can be taken to reduce transmission rates.
There is no doubt now that the international response of the capitalist world to the outbreak of Ebola in Africa has proven to be – typically and quite predictably – completely inadequate, resulting in an uncontrolled outbreak of the disease there. It is just a matter of time before more cases start popping up in the United States and the rest of the world. The advanced capitalist countries are in a position to potentially limit the casualties resulting from this virus; it remains to be seen if they are as prepared to spend the money necessary to deal with this serious health crisis as they should be. The tremendous suffering of the victims of EVD in Africa today is a direct result of the greed and indifference of the capitalist world to the endemic poverty, lack of adequate health care, food and clean water that exists in Africa as a result of centuries of colonial exploitation of Africa and her people – our brothers and sisters. Just as the greed of the capitalist classes of the world caused them to cut funding for UN health care services for Africa just before the epidemic began, the greed of the US capitalist class – which has refused to provide a comprehensive national health care system for ALL the citizens of the United States – could well prove fatal for many US workers – as well as for many others all over the world. The US working class may very well pay an extraordinarily high price in the near future for its continued support of the US capitalist class and its rotten capitalist system.
Historically, the fatality rate of the Ebola virus ranges from 25% to over 80%; but that is based on outbreaks confined to very poor countries in Africa, where medical care is almost non-existent, especially in rural areas. We would expect that with the far more comprehensive and advanced medical facilities in the leading industrialized nations of the world, the fatality rate should prove to be far lower than what has been experienced in the outbreaks in Africa – but this is in fact a very serious disease and must be taken seriously by workers all over the world. It is not a hoax cranked up by the government to scare people: the Ebola virus is very real; it is very deadly if not treated promptly; and it is now here in the US.
Knowledge is power; we need to educate ourselves so we can understand what it is we are up against. As we learned from the AIDS epidemic, the initial belief that exposure to the virus was essentially a death sentence proved after the first deadly years of that epidemic to be not true. Initially, the fatality rate was extremely high, but as scientists and the public came to grips with the illness, ways were found to reduce transmission rates and to provide drugs – very expensive drugs – to keep H.I.V.-positive people healthy for years. Ebola patients who survive a bout with the illness are said to be immune from a recurrence for up to 10 years. Thousands of people in Africa have been sickened by the Ebola Virus Disease and have survived and never again experienced a recurrence of it. Panic is not a helpful response to any kind of health crisis. We don’t live in the Dark Ages – we can plan ahead and prepare to deal with the challenges that this Ebola epidemic will present to us – if we educate ourselves as to what exactly it is we are dealing with. And so we republish here the World Health Organization’s Fact Sheet on “Ebola Virus Disease”.
Ebola virus disease
- Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
- The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
- The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
- The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa has involved major urban as well as rural areas.
- Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
- Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
- There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.
The Ebola virus causes an acute, serious illness which is often fatal if untreated. Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The latter occurred in a village near the Ebola River, from which the disease takes its name.
The current outbreak in west Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined. It has also spread between countries starting in Guinea then spreading across land borders to Sierra Leone and Liberia, by air (1 traveller only) to Nigeria, and by land (1 traveller) to Senegal.
The most severely affected countries, Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources, having only recently emerged from long periods of conflict and instability. On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern.
A separate, unrelated Ebola outbreak began in Boende, Equateur, an isolated part of the Democratic Republic of Congo.
The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first 3, Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus have been associated with large outbreaks in Africa. The virus causing the 2014 west African outbreak belongs to the Zaire species.
It is thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.
Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids.
Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.
Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.
People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.
Symptoms of Ebola virus disease
The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms. First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made using the following investigations:
- antibody-capture enzyme-linked immunosorbent assay (ELISA)
- antigen-capture detection tests
- serum neutralization test
- reverse transcriptase polymerase chain reaction (RT-PCR) assay
- electron microscopy
- virus isolation by cell culture.
Samples from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be conducted under maximum biological containment conditions.
Treatment and vaccines
Supportive care-rehydration with oral or intravenous fluids- and treatment of specific symptoms, improves survival. There is as yet no proven treatment available for EVD. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated. No licensed vaccines are available yet, but 2 potential vaccines are undergoing human safety testing.
Prevention and control
Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation. Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission. Risk reduction messaging should focus on several factors:
- Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
- Reducing the risk of human-to-human transmission from direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
- Outbreak containment measures including prompt and safe burial of the dead, identifying people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, the importance of separating the healthy from the sick to prevent further spread, the importance of good hygiene and maintaining a clean environment.
Controlling infection in health-care settings:
Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).
Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff and processed in suitably equipped laboratories.
WHO aims to prevent Ebola outbreaks by maintaining surveillance for Ebola virus disease and supporting at-risk countries to developed preparedness plans. The document provides overall guidance for control of Ebola and Marburg virus outbreaks:
When an outbreak is detected WHO responds by supporting surveillance, community engagement, case management, laboratory services, contact tracing, infection control, logistical support and training and assistance with safe burial practices.
WHO has developed detailed advice on Ebola infection prevention and control:
- Infection prevention and control guidance for care of patients with suspected or confirmed Filovirus haemorrhagic fever in health-care settings, with focus on Ebola
Table: Chronology of previous Ebola virus disease outbreaks
[NOTE BY IWPCHI: The fatality rates shown here are accurate, but we caution our readers not to “speed-read” through these stats. Where the fatality rates have been shown to be “100%” we see that in almost every case, there was only one person who got sick – and that person died, hence a “100% fatality rate”. These are indeed very sobering statistics; but we repeat that these outbreaks took place in very poor countries with limited (or no) medical facilities capable of dealing with a disease such as Ebola. The fatality rate in the industrialized nations like the US therefore should prove to be much reduced from the numbers you see here.]
|Year||Country||Ebolavirus species||Cases||Deaths||Case fatality|
|2012||Democratic Republic of Congo||Bundibugyo||57||29||51%|
|2008||Democratic Republic of Congo||Zaire||32||14||44%|
|2007||Democratic Republic of Congo||Zaire||264||187||71%|
|1996||South Africa (ex-Gabon)||Zaire||1||1||100%|
|1995||Democratic Republic of Congo||Zaire||315||254||81%|
|1994||Cote d’Ivoire||Taï Forest||1||0||0%|
|1977||Democratic Republic of Congo||Zaire||1||1||100%|
|1976||Democratic Republic of Congo||Zaire||318||280||88%|
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