This spring, Craig Manning of the Centers for Disease Control was in the West African country of Guinea, responding to the country’s recent outbreak of the Ebola virus. A health communicator in CDC’s Viral Special Pathogens Branch, he had just met with the director of Guinea’s national radio and television ministry. At the end of the meeting, Manning extended his hand to shake — but the director held back.
He was “very, very, very reluctant,” Manning said.
There could have been a number of factors in the director’s hesitance. It could have been that people had been warned not to shake hands, as there is a slight chance that the virus might be present on the skin of an infected person. Manning attributed the reticence to a rumor circulating that white people had brought the disease to Guinea.
“In the absence of any information to the contrary, he was just erring on the side of caution,” he said.
Manning explained that shaking his hand would not put the director at risk of an Ebola infection because there was no likelihood that he was infected, and the two finally shook. For Manning, the incident made it clear that aid workers needed to not only prevent and treat the disease but also address rumors about how a disease with no vaccine and no treatment was being transmitted.
“The belief in rumors that might have no scientific basis, we might think of that as being limited to people who are just less informed and less educated,” Manning said. “But in fact, even among the educated, there was a level of suspicion that we found a bit surprising.”
That may be because Ebola has a reputation for being a particularly fearsome disease. It’s not that the virus kills millions. In the most recent outbreak, the worst since 2007, there were at least 281 suspected and confirmed cases of Ebola in Guinea, Liberia and Sierra Leone from late March through May 28, with at least 200 succumbing to the disease, according to Reuters.
Rather it’s that with no vaccine and no effective treatment, a diagnosis is akin to a death sentence. In the most recent episode, more than two-thirds of those thought to have contracted the disease have died, a figure in line with those of other outbreaks from the past 40 years. Mortality rates can be as high as 90 percent.
An Ebola infection can be difficult to diagnose in the early days. Early symptoms, such as red eyes and a skin rash, can occur with a host of other diseases.. More distinctive symptoms, such as swelling of the eyes and genitals and bleeding from the eyes, ears, nose, mouth and rectum, occur only when it has become advanced.
“It’s very hard to tell whether you’re even dealing with an Ebola case or some other disease that presents like Ebola,” said Patrick Pithua, a professor of veterinary epidemiology at the University of Missouri.
The recent outbreak carries the distinction of being the first to strike western Africa, as well as the first to spread to a city. The virus was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of Congo. Since then most outbreaks have occurred in central or eastern African countries, according the CDC. Worryingly, they seem to be occurring more frequently. From 1976 to 1999, there were seven outbreaks of the disease that killed two or more people. Since then, according to CDC data, there have been 13.
What makes Ebola so dangerous is that the virus is not naturally found in humans, so our immune systems have not evolved to be able to defend against an infection, Pithua said.
“It’s more or less kind of like an infection by an alien that you’re not familiar with,” he said. “It can do terrible damage.”
Chimpanzees, monkeys and fruit bats are thought to carry the disease, Pithua said. In many cases an outbreak has occurred when a hunter found a sick or dead animal and carried it home.
Once the disease spreads to humans, it can be transmitted from person to person through direct contact with blood, mucus, saliva, sweat or other fluids from infected people, as well as through exposure to objects that have been infected.
Health workers in rural clinics in Africa often lack protective equipment, and one grim early warning sign of an Ebola outbreak is the death of health workers, Manning said.
Also most at risk are those who provide care for relatives and friends infected with Ebola — often a patient’s husband or wife. Those who prepare a victim’s body for funeral rituals can also be infected if they don’t take proper precautions.
It’s not just our immune systems that are unfamiliar with the disease; researchers, too, are still working to understand it. In the U.S., the CDC is currently studying a colony of Ebola-infected fruit bats (in a confined setting) that allows scientists to observe how the virus affects bats and how it spreads.
In addition, researchers at Thomas Jefferson University in Philadelphia and at the National Institute of Allergy and Infectious Diseases are studying two possible vaccines, though neither is ready for human trial. Researchers at Canada’s public health agency and at private firms in the U.S. are also studying a number of possible treatments, but the studies are hindered by the fact that investigators must wait for an Ebola outbreak to occur to try them on humans, according to the U.S. National Library of Medicine.
With no vaccine or cure in sight, the main way to combat Ebola is through education.
Manning, of the CDC, said the first priority should be to educate the most vulnerable, particularly those in rural areas of Africa where people might eat dead animals in the forest that can potentially carry the virus. Efforts should also include educating people about funeral preparations that can contribute to the disease’s spread, such as washing the victim’s body.
Uganda is a “shining example” of a place that has learned how to watch for the disease and catch it before outbreaks expand, he said. Rural clinics now stock more protective gear, and new labs allow for faster blood testing and diagnosis.
Pithua said there should also be a commitment at universities to training the next generation of responders, such as physicians, nurses and more, and providing them with the skills necessary to respond to outbreaks.
“Investing in education is going to be key,” he said.