How Ebola started, spread and spiraled out of control

With 20:20 hindsight, one can speculate that this information could have been used by local governments to educate their citizens and better train and prepare their front-line health-care workers; a higher proportion of whom have, throughout history, been infected during Ebola virus outbreaks.

Experts repeatedly tell us this virus can be easily contained with early intervention. Had this population been prepared, perhaps more personal protective equipment and bleach would have been ready to go, and the rapid transmission of the West African Ebola virus outbreak might have been contained.

No airborne transmission
Transmission of ebolaviruses between humans is by direct contact in which the broken skin or exposed mucous membrane (mouth, eyelids, genital tract) of susceptible humans is exposed to an infectious dose of Ebola virus-laden fluid (blood, vomit, feces, sweat, saliva and semen) from a patient showing signs of the disease.

Semen can remain infectious weeks into the convalescence period. Propelling wet droplets onto a mucous membrane is also a form of direct contact.

But regardless of what one might read in The Hot Zone (or the New York Times), there is no direct evidence that any ebolavirus species, strain or variant is transmitted via an airborne route.

The scientific evidence suggests that while aerosols can be used in the lab, it is the wet droplets in these rather than the dried down airborne fraction that are most likely involved in ferrying virus. Even the researchers involved in the events of the dramatized book version caution us to keep in mind that “aerosol and droplet transmission” is not the same as “airborne transmission.”

This does not sit well with some who see ebolavirus lab workers in lab containment “space-suits” and erroneously compare that to the personal protective equipment worn by diagnostic scientists, Médecins Sans Frontières workers, doctors, nurses and gravediggers, and draw the conclusion that more is always better.

What is missing from their concern that only an airborne Ebola virus can explain current health-care worker infections, is that simply including a more advanced mask (respirator) or a battery-powered air pump and hood does not cover all the potential sources of infection in or out of an Ebola virus disease treatment center.

Mounting a global response
West African health-care workers are in short supply. They are overworked, exhausted, under-equipped, insufficiently trained or can be fallible.

In the early days of the outbreak, personal protective equipment use was rare and risk of infection was high. In some instances, protective equipment is still not used to the extent that it should be.

But an Ebola treatment center is not the only source of Ebola virus infection when in the midst of a raging epidemic in crowded cities. Health-care workers have been infected in maternity wards. And when away from treating patients they have the same risk as the rest of the population of contracting an infection from others, such as in their hotels.

Another population taking a heavy toll are families. When an infected and sick member cannot get into an already full Ebola virus disease treatment center, they return home, unrecorded, for care and another single case becomes many.

We are all part of a shrinking global village, and right now some of its homes are ablaze. We can and should expect each of our governments to do more than pay someone else to buy, fill and carry a few buckets to throw on the inferno, as the Australian government has done.

Instead we should follow and build upon the example set by the United States. Every neighbor in this village has a duty to mount an equally robust response. And from the ashes we must build a stronger, more communicative and sustainable alliance to watch for and respond to global health emergencies.

Ian Mackay is Associate Professor of Virology at The University of Queensland; Heather Lander is a science writer; Katherine Arden is Postdoctoral researcher in Virology at The University of Queensland.This story is published courtesy of The Conversation (under Creative Commons-Attribution/No derivatives).