A group of vetted scientists took to Reddit to answer all of your questions about an Ebola outbreak in the United States. While Reddit generally isn't the first place we go to for medical information (although their sub-Reddit on lighting farts on fire was very illuminating), for this AMA, only verified scientists in relevant fields were allowed to answer. Here's what you need to know:
Thanks to a stronger medical infrastructure, more personnel, better supplies and a greater knowledge base, the type of wildfire spread we've seen in Africa is not likely to happen in the U.S. "At the moment in the USA, we can out-doctor Ebola faster than it can infect new hosts," explains one epidemiologist.
One overlooked concern that could be a major problem in the U.S., says the epidemiologist, is how to dispose of infected waste. Ebola patients produce about 60 pounds of contaminated waste, including blood, feces, vomit and any items they come into contact with while sick. "In order to be certain the contamination threat is dealt with, everything has to be thoroughly incinerated," he/she says. "This gets expensive very quickly, and any failure to decontaminate increases the risk of the virus being propagated from the improperly sterilized waste. This is already an issue in West Africa, and is potentially the most difficult to cope with part of an infection in a place like the USA. All of that personal protective gear has to go somewhere, and it represents a red-hot source of potential contamination, if mistakes are made."
One graduate student studying epidemiology and pathology comments that, "Nigeria is an excellent example of what might happen here in the U.S. They have a solid medical infrastructure, and the cases in Nigeria arrived in the cities out of endemic areas. They were quarantined, their contacts were quarantined, and the spread there has been halted."
This is only a little comforting because it implies that the disease will infect more people, even if we can control it more effectively. He does say, however, "This case in DFW will not have the same opportunity to amplify that the Sierra Leone/Liberia/Guinea infections had."
The parts of Africa that have been hit hardest by Ebola are some of the poorest parts of the world. Because of more readily available food and health care, our baseline health is better, giving us stronger immune systems to fight the illness, according to the epidemiologist. Cultural differences also come into play as Americans typically do not handle our own dead (especially if they died of an infectious disease) and have a greater trust in medical authority than many rural Africans. In addition, we are able to spread accurate information faster and get sick people to the resources they need. (None of which is to slam the African people or governments of the afflicted nations. They're doing an admirable and often heroic job of trying to contain the disease. The disparity in resources unfortunately means a wide disparity in treatment.)
Despite widespread news stories of possible vaccines, treatments using the blood of Ebola survivors and anti-viral therapies, we still don't have a sure antidote. Treatment now still consists of supporting the body while it fights off the infection. Ebola mortality rates vary depending on the strain, but this current outbreak is said to be on the more deadly end of the spectrum.
A microbiologist points out that as far as we know the U.S. does not have a "reservoir" of the disease, meaning a place or animal where the virus survives outside of humans. This means we can only catch it from another infected person and then only through contact with bodily fluids. It does not spread through sneezing, coughing or breathing. Plus, people are only contagious when they're showing symptoms of the virus.
A professor of biophysics and microbiology confirmed that it cannot and will not spread through sewer systems. "Enveloped viruses like Ebola are not hardy enough to survive in the sewer system. In addition to their fragility, there is a tremendous dilution factor. The available evidence supports the idea that infection is only by direct contact with body fluids of an infected person."
Another scientist answers a concern about septic systems saying Ebola isn't "THAT receptive to the environment," but it wouldn't survive long in lakes or septic tanks and he/she stands firm that Ebola can only be contracted through direct contact with bodily fluids.
A professor of biophysics and microbiology explains that the best prevention is an effective quarantine and to do that we need to be adept at not only identifying the sick people but also anyone with whom they had contact with during the period they were contagious and isolate them as well. This is why for anyone who isn't sick, limiting travel is currently the best protection. This procedure is known as contact tracing and it's nearly impossible to do in Africa.
"Early symptoms are extremely non-specific so we have to go on patient history," says a health care scientist. "Fever, muscle aches, headaches, sometimes a sore throat are the symptoms for so many different conditions, e.g., malaria, cholera. Even when you progress to diarrhea you're not going to jump to Ebola or a hemorrhagic fever unless you know the patient's history." Right now, travel to or contact with someone from West Africa is the number one question.
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