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Ebola Developments: a Burnout or Just a Pause in the Epidemic?


There has been, for the last week or so, a diminution in the rate of new cases of Ebola virus in Liberia, while the epidemic continues to rage in the other two countries affected.  There is no clear explanation as to why, whether the rate is really dropping, or bodies are being secretly disposed of, no one knows for sure.  Another critic has pointed out that the prediction of a million victims by January was a worst case scenario, “if nothing was done”, so the measures that are being taken have proved effective.  In any case, several new hospitals have beds still available for patients, unlike the situation a few weeks ago when patients were turned away because all the beds were full.

Another intriguing issue with Ebola virus transmission is the discovery that the conjunctiva of the eye are unusually susceptible to invasion by the virus.  This makes transmission by finger contact very easy.  Ebola patients, even if they are not vomiting, usually sweat profusely, and as the illness progresses, the amount of virus in the sweat increases.  The corpse is highly infectious due to dried sweat on the skin.

So, if one touches a sweating Ebola patient and then rubs one’s eye, as one often does, the infection is readily transmitted.  Small amounts of virus, on the order of one to ten virions, are sufficient for infection.  Once infection sets in, there is much variability in symptom progression, and older patients seem to be more likely to succumb.  There may also be a significant subset of the population that is naturally resistant to Ebola.

Finally, the two nurses who were infected while treating the Liberian man who died in Dallas of Ebola have both recovered and are being released from the hospital.  No one has said so, but it is clear that they were infected because they were following the CDC protocol, which was inadequate until it was suddenly changed some time after they were exposed (on Sept 28, when he was admitted, until Sept 30, when the Ebola test was confirmed and isolation was much improved).  Specifically, the suits they wore probably lacked goggles and overall hoods, and worst of all, had inadequate protection for the feet.  Now the protocols require an overall Tyvek suit, goggles, a rubber apron, and rubber boots.  However, they still do not require a chlorine spray while de-gowning, something that Doctors Without Borders does in their Ebola hospitals.

It certainly appears that no one who was on the plane with the nurse who fell ill the next morning with Ebola has gotten sick.  Apparently the virus is too busy multiplying within the body before symptoms appear, thus there is not enough virus to be infectious.  Whether the drop in cases in Liberia means that the Ebola epidemic is burning out, will have to wait for future trends.

There has been a great deal of hysterical response to the issue of Ebola transmission from people who are returning from African visits.  A number of people who were nowhere near the three countries affected have been barred from school or work for three weeks.  One victim of this hysterical quarantine has sued the school that imposed it for damages.  From the available evidence, we can confidently say that there is little or no risk of getting Ebola by casual contact with a patient who is not symptomatic, that is, sweating.



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