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Photo of a nurse in protective clothing in a hospital in Uganda.

A nurse wears protective clothing in the Ebola isolation ward of St. Mary's Hospital in Lacor, Uganda, in February 2001. He wrote the messages on his face shield after surviving the virus himself.

Photograph by Tyler Hicks, Hulton Archive/Getty

Marc Silver

National Geographic

Published March 27, 2014

At least 60 people have died from an outbreak of the Ebola virus in Guinea. This particular outbreak has moved from the jungle to Guinea's capital city, Conakry, and reportedly crossed into Liberia and Sierra Leone.

The virus is transmitted by blood or other body fluids. Victims bleed internally and externally. The fatality rate can reach 90 percent, according to the World Health Organization. To learn more, we spoke to Ian Lipkin, the John Snow Professor of Epidemiology at Columbia University's Mailman School of Public Health in New York City.

How do humans contract this virus?

The original source is likely to be an affected animal—a bat or sometimes a primate. In the preface to human outbreaks, we see the loss of gorillas and other great apes in the vicinity where people become ill. We haven't heard anything of that sort [regarding the loss of primates in this outbreak]. (Related: "Ebola in Uganda: Why Can't We Cure It? Where Does It Hide?")

What causes the virus to move from animals to people?

The initial infection is through bush meat. If there are infected bats—or primates used as protein—in the process of butchering them, a person gets in contact with blood.

How does it move from person to person?

It's not easily transmitted. But there's this ritual behavior [in some areas, where] they wash bodies by hand to prepare for burial—a loving way of sending the spirit into the next world. This kind of behavior brings people into very close contact with body fluids that are infected, and that's how people become infected.

Typically these outbreaks are relatively easy to control if you can get people to stop washing dead bodies.

What about sexual contact?

There's some evidence of sexual spread, but I don't think that's a major issue. The major way it's spread is by butchering of infected animals and ritual funeral practices.

In this case, the virus seems to be moving—from rural regions into Guinea's capital, and across borders.

That's a little bit unusual and suggests a human carrier. These outbreaks typically occur in jungles or rural areas where people come in contact with bush meat.

It will be interesting as we do the postmortem [on the Guinea outbreak] to figure out how it crossed borders. It suggests to me probably [the transportation of] a dead body was involved. When an individual dies in a given area, if his relatives take care of him or her in that location, it doesn't spread any further. If they decide they want to move the body to bury it someplace else or somebody who lives in the city goes out to the country and takes care of someone and returns to the city, they may bring the infection with them.

Is Ebola always fatal?

There are cases where people survive, but it's an extremely dangerous infection. The majority of people who show signs of infection die.

Can the disease be treated?

We don't really have any good drugs. People are working on this.

Would a vaccine work?

The thing about vaccines is you don't generally vaccinate people for something that doesn't occur commonly. Even if you have a vaccine that is effective, there's always a potential risk associated with using vaccines. What may make more sense is to bring [treatment] online when people have been infected. There's a lot of emphasis on therapeutic antibodies from people who've survived infection, which could create instant immunization, or drugs that can prevent the virus from replicating. There's nothing on the market as yet. But in some of the animal models, people have infected the animals and then vaccinated them and achieved protection.

Will this new outbreak be contained at some point?

What normally happens is that international groups like Médecins Sans Frontières come in and cordon off the area, use a variety of diagnostic tests to exclude the worried well from truly sick, and try to interfere with some of these funeral practices. Then the episode dies out. But [this outbreak] seems to have moved. It's not as well contained as we would have hoped. I anticipate we will lose many people, but it will be a self-limited outbreak. We've lost less than 70 people. But it's terrible.

26 comments
Mariyam A
Mariyam A

Marc Silver's main argument is the outbreak of Ebola, and if it is controllable. He states that Ebola is transmitted by blood or other body fluids; victims bleed internally and externally, with the fatality rate reaching up to 90 percent. In addition, he states that the virus is not easily transmitted; unless people are cleaning a dead body in a ritual, then they are more likely to become infected because they are getting in close contact with infected body fluids. Silver argues that if we are able to prevent people from washing bodies that are infected, we can "easily" control the outbreaks of the virus. He also argues that people generally do not get vaccinated for something that does not occur commonly; "even if you have a vaccine that is effective, there's always a potential risk associated with using vaccines. There's a lot of emphasis on therapeutic antibodies from people who've survived infection, which could create instant immunization, or drugs that can prevent the virus from replicating" (Silver). In addition, he states that Ebola is not well contained, and anticipates that we will lose many people. Overall, Silver does make a good point, however he does not have enough evidence to support it. For example, when he speaks about vaccines not working, he does not mention concrete evidence; everything seems to be already from his knowledge.

Cynthia Blanton
Cynthia Blanton

I always think that it is a good thing to be informed, right. So I like to read about issues and things that are going on. Well, I was kind of concerned about the Ebola outbreaks in some of the areas in Africa. So I started reading "The Hot Zone" by Richard Preston.
This is a true story about earlier outbreaks of Ebola and different strains of it, and researchers trying to find out exactly were it comes from, which species exactly it jumps from.
I'm only on page 104 and I am absolutely terrified. What this virus does to the body is like something out of a scifi novel. And to top it off 90% mortality rate with no vaccine in site. (The Ebola Zaire strain).
Don't read it if you want to sleep at night!
P.S. Let's pray it doesn't leave the continent of Africa.

Ariadne Etienne
Ariadne Etienne

" But there's this ritual behavior [in some areas, where] they wash bodies by hand to prepare for burial—a loving way of sending the spirit into the next world."

This is a terrific example about how religious belief, that is, faith based systems, are going to kill us all.  These people need a scientific education as much as anything else, and the educated world should be providing it to them while preventing corporations from continuing to exploit them (among everyone else in the world)..  That said, the educated world should also be providing education to the approximately 150 million americans at risk of fundamentalism (this is a dangerous disease which ends up killing tens of millions in something called war and since the USA possesses half of the military equipment in the world, this is the most dangerous group of people in the world).

Lee Gonzalez
Lee Gonzalez

Horrible disease. Hopefully find a vaccine or cure so no more living beings die.

Vanda Burns
Vanda Burns

Can vaccination with Reston virus cause resistance to regular Ebola? They used cowpox virus to combat smallpox in the 1900's.

John Gay
John Gay

I admire the work of Dr. Walter Gwenigale, Minister of Health in Liberia, in dealing with the disease.


Robert Greiner
Robert Greiner

I thought it was a hemorrhagic disease, is it or isn't it.  What is the primary COD?

Philipp Vasquez
Philipp Vasquez

Well let´s c how far this spreads now.. Don't remember it spreading in a major city before this incident.

Michael Lopez
Michael Lopez

The absolute last thing I ever want to hear is "EBOLA OUTBREAK"


The deadliest disease on the planet, It concerns me that this guy is so casual about the spread of Ebola. 

Adele Wong
Adele Wong

A small outbreak occurred about a year ago. And it seems to be spreading. Hmmmmm!

Daria Dykes
Daria Dykes

This is pure nonsense, and I wish it was more clear who had answered these questions. Epidemiologists still aren't sure what the natural reservoir is for ebolavirus, and they certainly do not know what human behaviors bring people into contact with it. Blaming "bush meat" is an old trick - it makes westerners feel sorry for all those primitive Africans who make themselves sick... but assures us that we aren't at risk. And funerary rites are not the major cause of person-to-person transmission, either. It spreads more quickly than that - all you need is direct contact with a person who is sick (contact with bodily fluids is a given when the infected person is sweating and bleeding all over the place.) Healthcare workers often contract it, even when they wear gloves. The main reason that outbreaks have not gotten very far in the past is that the infected person very quickly becomes too sick to travel. So it kills only within a small geographic region. But if it has mutated into a form that has an infectious incubation period - well, that would be very very bad for all of us.

River Walker
River Walker

Ignorance as to how to avoid the spread of this disease is what is allowing its progression into more populated areas. I can fully understand a bushman, with cuts on his fingers and feet from living without shoes or proper gloves, butchering and field dressing the carcass of a primate or preparing a bat in order to eat and then exposing his body to fluids from the infected animal via an open wound. I hope the virus can be contained before it jumps to so many bodies that it becomes more virulent and stronger.

DEAN REINKING
DEAN REINKING

Alonzo, hip fractures commonly occur in the elderly.....who repair much slower resulting in long bed stays with traction ,etc.  The immobility leads to pneumonia resulting in death.  Even in the U.S. the mortality rate is nearly the same.

Rodolfo Alonzo
Rodolfo Alonzo

I had an Aunt who heard that over in Russia. That if you broke your hip, you died. She got together a team of Drs and Nurses and they taught them how to sanitize a hospital room and tools. And how to perform a hip transplant. Do not how many lives she has saved since then. She has passed away. But I hear they have a hospital in her name. Maybe 1 meek and mild mannered Mortician should make a heartfelt trip and educate them on how to prepare a corpse. Who knows maybe they will name a Hospital after you.

KENNETH LANE
KENNETH LANE

Mother Nature ca be a cruel mistress at times.  

Joselyn Schutz
Joselyn Schutz

@Ariadne Etienne 100 million people were killed by fundamentalism in the last century, but it was atheist fundamentalism, that is, communism.  However, I don't blame atheism for these murders.  Blaming atheism in general for the mass murders of communist dictators (communism is always inherently atheistic) is just as stupid as blaming spiritual practices or religion in general for jihad or other historic religious violence, or incidental deaths from scientific ignorance.


To blame ebola on religious belief, though, is unbelievable.  In any other era than the modern one, these people would be handling the dead bodies simply because there was no one else to do it, whether they surrounded such handling with spirituality or not.  The problem isn't the faith surrounding the handling; it's the ignorance that in this particular circumstance with this particular rare disease, no one should handle the body without extreme protective measures.  

Richard Tyll
Richard Tyll

@Daria Dykes  My fear is this Ebola mutates so that it creates Human carriers who do NOT get sick but, are able to pass along. Kinda like 'Patient Zero'.

If EBOLA can survive in Primates without them getting sick & dying, who is to say a random DNA sequence in Humans couldn't have the same effect?

After all, WE are Primates too.


Another dangerous thought is Terrorism. What is there to prevent a terrorist to take tainted blood, fly to the USA & randomly inject people with Ebola?

It could be done either by tainting Blood bank supplies or even spreading it through Drug users who use needles. They in turn would share a needle or come in contact with others before signs of Ebola showed up.


Foreign Students coming to study at our Colleges, spreading it throughout the college campus rapidly.


I'm so very glad I live secluded in the Rocky Mountains, far away from Civilization !

helen shmulkin
helen shmulkin

@Rodolfo Alonzo This whole thing does not make sense. Your Aunt was in Russia? Was she Russian? Who was she to be able to collect a team? Where did she get a team, and who did they teach? And how does hip replacement relates to fracture - I thought that the technique is to insert a titanium rod into the hip. 

Authorities in Russia are very reluctant to name anything after foreigners. What is your Aunt's name - I would like to look up the hospital.

Still, being myself born in Russia, I know that the hospitals there are plagued with infections and shortages of everything from bed sheets to medicines. The latter is mostly from hospital staff stealing everything they can and selling it on the streets. At least this was the sad state of affairs when I left 20 years ago. Having said that - how any team can help hospital staff stop stealing equipment and supplies in lieu of pay?

Kimberly Lewis
Kimberly Lewis

@Rodolfo Alonzo It has nothing to do with a lack of knowledge; it has to do with deep-rooted religious and cultural beliefs.  You could teach them how to prepare a body until you're blue in the face, and some more modern, younger generations who aren't as closely tied to their cultural beliefs may follow your lead, but those who hold fast to tradition will balk at your teaching them the "proper" way (which they may see as the wrong way) and will go on doing things the way their traditional beliefs mandate.  You cannot simply overrun a culture.  You must first seek to understand it and then try to educate people on safe techniques within the context of their beliefs.

Dire Randall
Dire Randall

That's because atheism isn't a belief. Religion is. You may kill someone and say "god wanted me to," but no atheist is going to say "entropy commanded me to kill him." The comparison is a poor one. Atheism and communism aren't synonmous either, and suggesting they are basically means you don't understand either one very well.

Ebola is being spread in large part because of religion and superstition. That's not a matter of debate; it's confirmed.

Kierra McCullough
Kierra McCullough

@Dire Randall It's not confirmed, it's a matter of debate. In case you didn't know, it's a Tradition, not a religion. I hate how people are so quick to jump to conclusions. Also, if you truly hate religious people that much to blame them for this situation without any true factoids, I suggest moving far, far away from civilization. I hear the Gobi Desert is good for people like you, to.


Oh, and I must remind you that communism exist because of Atheism. The to-be-rulers of communist countries almost always hate religions. Look at 북한, or old Deutschland. Both hated religion and sorts one way or another.

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