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Residents of Bawa and other nearby villages listen to the regional prefect speak about Ebola in their district.

In Bawa, Guinea, villagers listen to an official speak about the recent outbreak of Ebola virus.

Photograph by Samuel Aranda, The New York Times/Redux

Karen Weintraub

for National Geographic

Published July 29, 2014

As the worst Ebola outbreak in human history rages across West Africa, the obvious question Americans are asking is: Could it come here?

The answer is yes, it probably will. But it's not worth losing sleep over, experts say. (See "Q&A: Ebola Spreads in Africa—And Likely Will Spread Beyond.")

The virus is one of the deadliest ever seen, killing up to 90 percent of its victims. And the death isn't pretty. About half of patients exhibit the gruesome bleeding symptoms typical of any hemorrhagic fever—seared into the American consciousness by the 1995 movie Outbreak. But it can also resemble other tropical diseases, like dengue with its high fever, so Ebola is sometimes missed in its early stages.

That may be why a feverish man was able to board a plane last week from Liberia to the Nigerian city of Lagos, Africa's most populous city. He fell ill on the flight and was taken directly to a hospital, where he was isolated and later died.

Ebola outbreaks grow

The deadly Ebola virus has been devastating parts of Africa since the first outbreak in the Democratic Republic of the Congo in 1976. In the latest outbreak, the World Health Organization has reported 1,201 cases and 672 deaths since March of this year, in Guinea, Sierra Leone, and Liberia. Last Friday, a Liberian man died after his plane landed in Lagos, Nigeria, one of the world's largest cities.
Map of Ebola virus.
Note: Suspected, probable, and confirmed cases and deaths as of July 23, 2014
MAGGIE SMITH, NG STAFF; JOEY FENING. SOURCE: WORLD HEALTH ORGANIZATION

The same thing is likely to happen again, with a passenger ending up in Europe or the United States, said Stephan Monroe, deputy director of the U.S. Centers for Disease Control and Prevention's National Center for Emerging and Zoonotic Infectious Diseases, at a Monday news conference.

Air Passengers Monitored

Several West African nations are planning to set up monitoring at airports to try to identify people with fevers before they board planes. It makes more sense to put checkpoints in West African countries than to scan incoming passengers in the U.S., said Martin Cetron, the CDC's director for Global Migration and Quarantine.

There are few direct flights from West Africa to the U.S., so most feverish passengers entering American airports will have something far more routine and less risky than Ebola.

Ebola is contagious only when symptomatic, so someone unknowingly harboring the virus would not pass it on, Monroe said.

Even passengers showing symptoms are unlikely to pass the disease on to fellow travelers, he said.

Blood and stool carry the most virus—which is why those at highest risk for Ebola infection are family members who care for sick loved ones and health care workers who treat patients or accidentally stick themselves with infected needles.

Theoretically, there could be enough virus in sweat or saliva to pass on the virus through, say, an airplane armrest or a nearby sneeze, said Stephen Morse, an epidemiologist and virologist at the Mailman School of Public Health at Columbia University in New York. But droplets would still need a way to get through the skin.

Health authorities are tracking the passengers and crew who flew from Liberia to Lagos, Monroe said, to ensure that they didn't catch Ebola from the sick man.

Airplane Risk Uncertain

The fact that experts are still unsure about the risks of airplane travel shows how unusual the current outbreak is. In the past, outbreaks have been focused in small rural villages, mostly in central Africa. Rural hunters generally bring the virus to their villages via infected monkeys killed for meat. But such villages are remote and can be easily quarantined, allowing the virus to burn itself out.

The current outbreak seems to have started in rural Guinea, but it was able to spread for some time before being reported to the World Health Organization.

These Guinean villages hadn't see the virus before, Morse said. A lack of familiarity with the disease, coupled with porous borders and burial rituals that exposed family members to the bodily fluids of the dead, led to much greater spread, he said.

"In places where they've seen Ebola outbreaks, both the local people and health authorities have some idea of what precautions to take," Morse said.

Lack of training and experience is compounded by the lack of basic infection-control equipment such as gloves. Using protective gear safely requires training and practice for health care workers, "especially how to take it off without accidentally contaminating equipment and themselves," Morse said. "It's partly a training matter and partly an equipment issue."

Locals watch workers with Doctors Without Borders at a private clinic working to combat the spread of Ebola.
In Teldou, Guinea, locals watch Doctors Without Borders staff take measures to combat the spread of the Ebola virus.
Photograph by Samuel Aranda, The New York Times/Redux

More Equipment, Better Training

Bringing the outbreak under control in West Africa, Morse said, will require more equipment, better training in health care settings, and more outreach to rural healers and leaders to teach them how to reduce transmission.

More help from the outside world is essential, Morse said, adding that one of his colleagues in Sierra Leone is now treating patients "12 to 24 hours a day," according to an email he received Monday.

Because it's exhausting to keep up with all the necessary safety precautions, attention to detail can slip after such long hours of patient care, he said. Perhaps that's why 43 health care workers in Liberia, including two well-trained Americans, have come down with Ebola. The Americans are in stable condition, but are still symptomatic.

One of the Americans, a doctor, sent his family members home to the U.S. before becoming symptomatic with Ebola, Monroe said. His wife and children are on a fever watch for 21 days "out of an abundance of caution," to ensure that they don't come down with the virus, though Monroe said they are thought to be safe. Both the doctor and another American health care worker are still being treated.

Illness among health care workers has generated panic in the Liberian capital of Monrovia, where some hospitals have turned away accident victims because they are so fearful of anyone who is bleeding, said John Ly, medical director of Last Mile Health, a non-governmental agency that has been providing training, supplies, and other support in Liberia.

Raj Panjabi, Last Mile co-founder and CEO, said it is very clear that the epidemic can be brought under control in West Africa by rapidly identifying sick people, treating them, and preventing the disease from being spread.

But all that takes money, of course, and area governments and nonprofits don't have enough resources to tackle the problem on their own, Panjabi said.

Ebola in the U.S.?

So, could the Ebola virus come to the United States? Definitely. Would it spread widely? Unlikely.

"We do not anticipate this will spread in the U.S. if an infected person is hospitalized here," CDC Director Tom Frieden said in a statement Tuesday. "We are taking action now by alerting health care workers in the U.S. and reminding them how to isolate and test suspected patients while following strict infection-control procedures."

American hospitals are adequately supplied with infection-control equipment like gloves, gowns, and masks that will prevent the spread of the disease. American medical care workers—educated by the AIDS epidemic—know how to keep themselves safe while treating sick patients. And the American system of reporting illness would identify a sick patient very quickly, allowing the disease to be contained and controlled.

But it's still in America's interest to control the disease in West Africa, Panjabi said.

"If we respond well to this, we could both impact the epidemic—control it, stop it—but also do it in a way that strengthens the long-term primary care system," he said, which "could protect against future [epidemics]."

RELATED:

"Q&A: Ebola Spreads in Africa—and Likely Will Spread Beyond"

"Ebola's Deadly Spread in Africa Driven by Public Health Failures, Cultural Beliefs"

"Q&A: Challenges of Containing Ebola's Spread in West Africa"

• "Why Is This Ebola Outbreak Spreading?"

34 comments
Patrick Fueta
Patrick Fueta

It is said that the virus first appeared in Zaire in the year 1976, how then were they able to control and extaminate it? only for it to resurface in 2014.

Ellen Briggs
Ellen Briggs

They say that the Ebola virus can be contracted through body fluids.  They said a little toddler girl was the first one to contract this virus.  Then her family contracted it.  Then the people that went to the little girl's grandmother's funeral all contracted it.  How did they when it is supposed to only be contracted  through body fluids?  None of this is making any sense, therefore it tells me that someone doesn't have all the facts or they're lying.

DEB THOMAS
DEB THOMAS

The “Spanish Influenza” of 1918 killed 50–100 million people worldwide, 25 million in one year [10-20% mortality] Within 7 days the disease occurred in every state of the U.S.A.
 

Containment in US [or any metropolis] won't be easy considering incubation period is up to 21 days. Long incubation is a huge factor and I fear it's underestimated. Over 100 healthcare workers have died [per W.H.O.] and they're careful touching infected/ill. this seems to be a high percentage [of 887 dead to date]. I wonder if this new strain is more contagious or contagious sooner than officials think... it's a virus and they mutate. I wish CDC would err on the side of caution as consequences are too great [they're losing credibility with such lack of common sense]. Taking a temp at airport is meaningless unless the flight was 21 days; panic prevention may cost a lot of lives. Ounce of prevention is critical when there's no cure and 50-90 percent mortality. 
Infected travelers have already spread it [Nigeria and Morocco confirmed] and several suspected cases in NYC, Philippines and Saudi Arabia. it probably won't spread in US like in Africa but it's probably trotting around the globe by unsuspecting people right now... one person or 2, a wave after another out of Africa on a regular basis [it is still brewing and in many large cities]. I hope it's not worst-case but this outbreak could be around for a very long time.


Scott Brauer
Scott Brauer

We really need to worry about suicidal maniacs that are already willing to blow themselves up, taking a trip to Africa, contracting Ebola and then exposing millions as they travel around the world with a smile. Our nation and the world for that matter needs to quickly implement this technology to detect the ill intent of people. They just completed two 3rd party tests that confirmed accuracy over 90%. I've tried it too. It works, it's cheap and will save lives. https://www.youtube.com/watch?v=YuuvN8QHONU 

Bob Diehl
Bob Diehl

What is going to happen with our troops in Africa that are acting as advisors to stop the Bozo Haram.

Bob Diehl
Bob Diehl

jenna allen, I agree with you.  With the lapses in storage safeguards in the medical research community, how can we in all good conscience bring Ebola infected people into the US?  Why isn't there a ban on travel from Africa to the US??

Debby Steelman
Debby Steelman

So, as an American mother of five (18, 16, 13, 10, and 10 months) what would be my best course of action to protect my family of seven? I have children preparing to go back to school, an infant in our household, my husband works in close contact with Airport Rental Cars and I am preparing to go back to work. Right now what my instincts tell me to do is stay home and start homeschooling our children, however, that is neither rational or possible. 


Does anybody know how effective the following methods I have heard about would be at killing Ebola virus and are their application methods that should be avoided such as that bath method someone spoke of?

1. Soap and Water

2. Household Bleach

3. Young LIving oils - Cinnamon Bark, Thieves, geranium... (about 9 months ago I got the flesh eating bacteria infection and three weeks of antibiotics did nothing. Three days of taking a probiotic and using Thieves Oil and the wound began to heal promptly.)

Peter Ross
Peter Ross

From news reports, infected people are turning up all over the region.  This seems consistent with a bat as vector.  Rabies is carried by bats in the US, but human rabies is quite rare.  Why the human ebola epidemic in this case and not in any outbreak in Central Africa?  Different vector?


Only contagious when symptomatic?   I thought a US researcher who was infected in the lab and survived carried live virus in his semen 60 days after recovery.


With a 20 day eclipse period, this virus can be expected to migrate here soon enough given airline security.  I'm more worried about it than about shoe bombers.  Fortunately, unlike HIV, the CDC knows what this is on arrival. One might expect they're gearing up for the appropriate quarantines and other public health measures to limit spread here.  But, I just got the CDC reports for the last month and find no mention of the ebola virus epidemic in West Africa or any planned or current CDC action to deal with its intercontinental spread.. 

jenna allen
jenna allen

Does anyone else think it stupid that we are bringing two Americans with Ebola back to the USA ? This is the worst outbreak in history, lets bring it to the US where it can spread! 

Donna Lopez
Donna Lopez

In cases of 21 day incubation period for this Filovirus and it's often confusing presentations associated with less dangerous diseases -- this has critical implications for public health contagion no matter whether the virus-stricken victim lies in often poorly equipped, hot, humid hospitals in sub-Saharan Africa or the modern, urban air-conditioned hospitals in the West. The hot, humid climate, lacking the infrastructure for decontamination creates breathtaking odds for health care workers. People with strong, intact immune systems are usually well nourished, not unduly stressed, and probably free of parasitic diseases, including dreaded p. falciparum malaria, endemic in sub-Saharan Africa. The health care workers serving in SSA are under phenomenal stress, both environmental and professional in valiant efforts to save their patients. Novel zoonotic viruses such as ebola affect human naive immune systems dramatically. It would seem that perhaps IV gamma globulin or a variant that includes antibodies from recovered patients might be a consideration for countries that have access to this often high cost intervention. IVIG can increase antibodies that fight infection and can increase platelets that stop bleeding as in ITP (idiopathic thrombocytopenia). But the thorny problem in late stage ebola gets complicated when there is kidney involvement.

What is key to this era's emerging infectious disease is not only a good offense, especially if the strain becomes airborne (droplet infection) but especially a good defense--learning how - in our own bodies - to maintain an optimally functioning immune system. This should be on the agenda for all travelers along with checking CDC website.

Karen Sherry Brackett
Karen Sherry Brackett

In addition, other articles state the medical staffers are soaking in bleach for half hour after undressing which means they are most likely using Deacon's Solution.  In a bathe, the water is drawn back up into the bathers bladder.  Deacon's solution is not strong enough to kill Ebola in time to prevent the bathe water from infecting the medical worker.  This bathing procedure needs to immediately stop.  If they want to wipe down or shower in Deacon's then that is fine however bathing in it is a problem.  Personally, if it were me... I would wipe down with hydrogen peroxide just a general precaution from any hospital related bacteria.  Soap and water are the best defense in a shower not a bathe from Ebola after exposure. 

Karen Sherry Brackett
Karen Sherry Brackett

Every single picture I have come across in the media of here for example a medical staff member undressing or in other photos on other articles of medical gloves, robes and boots drying in the sun, all display the problem.  They are completely spreading the disease not containing it, by improper safety precautions.  At this point they might as well be spitting in the wind for all the good they are doing.  8 out 12 Ebola victims being medical staff means the problem is with medical malpractice of containment procedures and in many instances the actual procedures themselves look to me to be the problem.  Seriously, at this point, they have to come to grips with understanding they are part of the problem.                                                                                                                                                                                                                                                                           1)  Use disposable medical gear which is burned not recycled.

      2)  Understand that in Africa's heat and humidity, the suits themselves are becoming incubators of the disease.  The PPE is simply a barrier to slow the virus from reaching the medical provider,  It DOES NOT STOP the virus from reaching the medical provider.  Therefore, it must be changed after every single patient encounter.  All PPE needs to be burned not recycled.  No landfill dumping... only burning will do.

     3)  Patient rooms and hospitals need to be kept air conditioned below 60 degrees Fahrenheit.  All rooms need to have dehumidifiers which are emptied frequently.  The water from the dehumidifiers needs to be microwaved sterile before disposal.  The rooms and hospitals must be kept as cool and the air as dry as possible. 

    4) Lastly, I recommend inducing coma; however I do not have the medical credentials to back this up.  My education is in biology and chemistry.  The virus wants the host to ooze and leak and bleed as much as possible because that is it's mode of transportation out of the host to its next victim.  If you break it's cycle by only chilling the patient and the room to slow sweating and inflammation, then it will look for a new mode such as air through lung irritation.  An induced coma will stop every mode of escape the virus has available to it and at that point it will simply either go dormant and wait or it will die out.  If you induce coma and yet still provide IV the virus will be tricked into thinking it may still leave the body and it's out put will be more easily captured and contained while also keeping the patient hydrated.  This buys time for the victim's body to slowly over come the disease.  Also, I would recommend keeping them hydrated less than normal and with a spike in zinc and vitamin C. 

   5)  All body fluids, bedding and clothing of the victim need to be burned.

TS MacLiam
TS MacLiam

The bottom line in the current situation is that we are in unknown territory here. The potential for a devastating global pandemic cannot be ruled out and Ebola would be a pretty good candidate. This possible scenario has long been recognised by world governments and no doubt detailed emergency plans are in place.

In such a situation, the seriousness of the matter would necessarily be downplayed to minimise panic amongst populations. Mass panic would exacerbate the situation and could lead to the breakdown of social order within days. Scary I know - but forewarned is forearmed !

c v
c v

even though we've never seen it in our major cities/airports travel hubs....you have the gall to tell us it won't spread. ? thank your for your assurance, i don't think so. It looks like the flu!...by fall it will still be bouncing around the world and the USA.. Im concerned, despite what the "Authorities" are telling us.  this has never been seen seen before....you have no idea how the fire will burn do you? no you don't. the authorities don't want to overly scare us...with the truth of our vulnerability.  both to ebola and social panic and subsequent collapse into martial law.  its going to crash you all know that right... this isn't going to go forever like this.. Drones in your skies and robot armies are next, good luck

Paul Scutts
Paul Scutts

Maybe it isn't time to panic, OK, but, if this thing mutates and becomes airborne ... holly ####!

Susan S.
Susan S.

Time to close all borders and entry into the US from areas with Ebola till this disease has a cure?

Jose Ramirez
Jose Ramirez

We are missing something since a supposedly a "perfectly" trained and educated American M.D. DID get Ebola. We don't know if it was because he relaxed his vigilance of appropriate procedure, or if "recommended" procedure as it stands is insufficient. I could also have been an accident. If the "event" has already reached critical mass it WILL take much more than "standard" procedure and "good hygiene" to stop this outbreak.

Dale Rys
Dale Rys

not worth losing sleep over...easy for u to say...this is and has been for some time now,try'in to be contained..they have been working very hard at this...but the truth is the number of dead is going up........

Cynthia B.
Cynthia B.

I think the experts are lying through their teeth to keep us from panicking. I don't care if we have a hospital on every corner; that is highly unlikely to keep this from spreading since a victim will be pretty far along before anyone even knows it is Ebola. And our hospital staffs have little experience with this type of thing. We can barely  control MRSA.

Christopher Lotti
Christopher Lotti

@Patrick Fueta The populations that it affected in 1976 were in remote locations where the population was small.

DEB THOMAS
DEB THOMAS

@Debby Steelman 

I think your instincts are completely rational; prevention and commonsense may save your family. It's important to be rational but we live in a global world...the long incubation period and high mortality rate are alarming [I'm taking break of enlightening documentary on youtube,'EBOLA: THE PLAGUE FIGHTERS - NOVA - Discovery/Science-]. I wish I had all the answers. We're making contingency plans and I think we need a lot at this stage... hope it's just for practice.. thankfully we homeschool youngest already but unsure what to do about the [stubborn] one in college. We do our best to plan and prepare for emergencies for too many reasons; pandemics being one, but it's hard to know when to come in and shut the door to the world... yesterday would be good but the bills will surely come. Hope for the best but plan for the worst. I think we'll see Ebola virus in US, I pray not much, but mass panic may set in and you can imagine... yikes. Infected people are unknowingly spreading it so regardless of where,  I think this outbreak will be around for a long while and unless more drastic measures are taken so will risk of pandemic. If only the world would take a 3 week staycation. Hopefully you have stored food, water, essentials and personal protection...food insurance is priceless and always a great idea.  I hope your husband can and will protect himself at work...CDC just released guideline for airlines,,,may apply to airport car rentals  http://www.cdc.gov/quarantine/air/managing-sick-travelers/ebola-guidance-airlines.html

GOOD LUCK--

here's link to Ebola documentary...i'm back to it,it's not for squeamish but helpful w/research  https://www.youtube.com/watch?v=8j6JCIrgmT8

Ellen Briggs
Ellen Briggs

@jenna allen  sounds like another one of Obama's plans to me!  There was talk concerning the One World Order and killing off a large percentage of the population.

Pamela Thompaon
Pamela Thompaon

@jenna allen Im not even 10 miles away from Emory... It's really cool how this dude's being flown in on a special Gulf Sream Jet. Thing is, planes don't land at Emory. I have no idea how they plan to transport him after landing. I hope helicopter but, no room for a bubble. On the road? Well, this is Atlanta....

Ellen Briggs
Ellen Briggs

@Donna Lopez  They say that the Ebola virus can be contracted through body fluids.  They said a little toddler girl was the first one to contract this virus.  Then her family contracted it.  Then the people that went to the little girl's grandmother's funeral all contracted it.  How did they when it is supposed to only be contracted  through body fluids?  None of this is making any sense, therefore it tells me that someone doesn't have all the facts or they're lying.

This sounds like it is also airborne to me.

C. Felch
C. Felch

Droplet differs from airborne

Janice Owens
Janice Owens

@Karen Sherry Brackett What is Deacon's solution? Are you talking about Dakin's solution? 

TS MacLiam
TS MacLiam

@Karen Sherry Brackett

While I would agree with your suggestions regarding provision of very intensive care procedures on an individual basis, this is just not possible in a situation where the spread of infection is out of control. At the moment we are talking about a region in Africa where basic hygiene procedures are minimal and mortality from water borne infections and other illnesses such as measles and malaria are not uncommon. Unfortunately, despite the obvious potential for a devastating spread of this disease, I don't believe that the powers with the finance to provide this kind of care are prepared to step up to the plate ! Maybe when it hits New York ? 

M. Ryan
M. Ryan

@Cynthia B.  Ebola isn't contagious until symptoms show, and as they said, fairly difficult to spread unless you are in direct contact with victims. Our healthcare practices alone give us an upper hand as healthcare officials use gloves and masks as a rule.

C. Felch
C. Felch

Masks are not always required especially for airborne spreading types. Which makes me wonder what they're hiding...

Donald Inks
Donald Inks

@M. Ryan @Cynthia B. 
"Our healthcare practices alone give us an upper hand as healthcare officials use gloves and masks as a rule."

What do you think those American doctors were using in Africa when THEY contracted the disease?

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