With the death of the first person to be diagnosed with Ebola in the United States, as well as its first transmissions in this country, concern about the deadly virus is growing.
The Atlanta-based Centers for Disease Control and Prevention is working with other groups to clear up myths and quiet fears about the spread of Ebola in the U.S.
The numbers are staggering -- at least 8,033 people in West Africa have been infected with Ebola and more than 4,000 have died, according to the World Health Organization. The WHO notes that these figures underestimate the true scope of the outbreak, as overwhelmed responders fall behind in their ability to report cases. Health care workers also continue to fall ill: 232 of the 401 health workers stricken by Ebola in West Africa have died.
With the spread of the virus to the U.S. can be cause for alarm, Centers for Disease Control and Prevention Director Dr. Thomas Frieden said there are protocols in place to stop Ebola.
"The existence of the first case of Ebola spread in the U.S. changes some things and it doesn't change some things," Frieden said on Oct. 13. "It doesn't change the fact that we know how Ebola spreads. It doesn't change the fact that it's possible to treat Ebola safely. But it does change substantially how we approach it."
What are the symptoms?
Initial symptoms include fever, intense weakness, muscle pain, headache and sore throat. These symptoms are followed by vomiting, diarrhea, rash, impaired kidney and liver function and sometimes internal and external bleeding, according to WHO.
Symptoms usually appear 8-10 days after infection, according to the CDC. WHO says lab tests of contaminated individuals find low white blood cell and platelet counts.
Ebola only spreads when people are sick, the CDC says. A patient must have symptoms to spread the disease to others.
After 21 days, if an exposed person does not develop symptoms, they will not become sick with Ebola, according to the CDC.
Ebola can be spread to others only after symptoms have begun. Symptoms can appear from two to 21 days after exposure. There is currently no vaccine for the Ebola virus.
Progression of illness if left untreated:
Days 5 to 9: Fatigue, headache, fever, chills
Day 10: High fever, vomiting, blood, rash, passive behavior
Day 11: in a small fraction of cases, bleeding from nose, mouth eyes and anus.
Day 12: Patients may develop seizures, internal bleeding, loss of consciousness, death
The CDC emphasizes the point that unlike the flu and measles, Ebola does not spread through the air.
Ebola is transmitted by direct contact with the body fluids of a person who is sick with symptoms.
What does direct contact mean? Body fluids have to come in contact with your eyes, nose, mouth or broken skin, like a cut, wound or abrasion. Ebola isn't airborne, and it doesn't spread by water.
What body fluids can spread the virus? Body fluids include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen.
What about shaking hands? Shaking hands could pose a low-risk if an Ebola patient's hands are soiled with body fluids. The skin-to-skin contact alone is not risky. But patients are only contagious when they're symptomatic or sick. And at that point, the patients are rarely out and about, shopping or working or traveling because they're so sick.
Can Ebola spread through kissing? It can spread through kissing and sex. But it can only be spread when the patient is symptomatic or sick. And they get very sick very fast.
What about touching a common surface? Ebola can survive for only a few hours on dry surfaces like doorknobs and countertops. When it dries, it dies. It can be killed with household bleach or alcohol-based hand sanitizers. In body fluids, like blood, the virus can survive several days at room temperature. In semen, it can survive for several months.
What if the patient is coughing or sneezing?
The patient would have to be symptomatic first. Then he or she would literally have to cough or sneeze on you. Finally, that saliva or mucus would have come into contact with your eyes, nose or mouth or through a cut in order for you to be at risk. Coughing and sneezing are not symptoms of Ebola. However, in the later stages of the disease, there can be lung damage and coughing is sometimes that side effect.
What if a patient licks an envelope and sends it off? The CDC says it won't live long enough to be a threat. The CDC describes Ebola as a "wimpy" virus. It doesn't live long outside the body.
Can mosquitoes carry the virus? There's no evidence of that. But some bats and monkeys are considered carriers. And you can get Ebola with a needle prick it's contaminated with the virus. That's one reason healthcare workers have to be so careful.
Ebola virus is NOT spread through:
- Casual contact
- Food grown or legally purchased in the U.S.
The current outbreak of Ebola in West Africa is the largest since the virus was first discovered in 1976. Until Sept. 30, no cases of this disease, which has a 50% fatality rate, had been diagnosed in humans in the United States.
ROUTE OF EBOLA TO USA
• Sept. 19. Thomas Eric Duncan leaves Monrovia, Liberia, for a trip to the United States. He has been exposed to Ebola but is not exhibiting symptoms, so he is not contagious. It is unclear whether he knew he had been exposed.
• Sept. 20. After changing planes in Brussels, Belgium, and at Washington Dulles International Airport, Duncan arrives in Dallas to visit his sister.
• Sept. 24. Duncan's family members tell U.S. authorities this is the day he first felt sick. That is when he likely became contagious.
• Sept. 25. Duncan seeks treatment at Texas Health Presbyterian Hospital Dallas and is sent back to his sister's apartment with antibiotics.
• Sept. 28. Duncan is transported to the same hospital by ambulance. He is critically ill and put in isolation in the hospital's intensive care unit.
• Sept. 30. The federal Centers for Disease Control and Prevention confirms that Duncan has been stricken with the Ebola virus, the first patient to be diagnosed in the USA.
• Oct. 1. Duncan's condition is upgraded from critical to serious, and health officials say they are closely monitoring a second patient who had contact with Duncan. Others who have been in contact with Duncan, including paramedics and children, are being observed for symptoms.
• Oct. 2. Four members of Duncan's family are placed under quarantine until Oct. 19. They could face criminal charges if they don't stay inside their apartment; the Red Cross and an area food bank have been bringing them provisions. Health officials are taking their temperatures twice a day, and so far they aren't showing any symptoms.
• Oct. 3. The four family members are moved to a private home during their quarantine because no other apartment complexes would take them.
• Oct. 5. Duncan's condition is downgraded to critical.
• Oct. 8. Duncan dies at Texas Health Presbyterian Hospital Dallas.
• Oct. 9. A deputy who with Dallas County health department officials entered the apartment where Duncan was staying before he was hospitalized tests negative for Ebola, a day after the deputy's wife drove him to a suburban urgent-care center with stomach pains.
• Oct. 10. Dallas nurse Nina Pham, 24, who helped take care of Duncan while he was hospitalized, finds herself with a low-grade fever, reports the information, is isolated and gets referred for Ebola tests.
• Oct. 11. Preliminary tests show Pham to have Ebola. She is the second case confirmed in the USA and the first in this country to contract it from a patient.
• Oct. 14. Dallas County Judge Clay Jenkins says that Pham's condition had been upgraded to "good."
• Oct. 15. A second nurse who treated Duncan, identified by family members as 26-year-old Amber Vinson, has tested positive for Ebola. The CDC says Vinson was a passenger on Frontier Airlines Flight 1143, which flew from Cleveland to Dallas-Fort Worth on Oct. 13. -- the day before she reported symptoms. Vinson is flown to Atlanta for treatment at Emory University Hospital.
• Oct. 16.CDC Director Dr. Thomas Frieden told a House panel that the Obama administration has not ruled out imposing restrictions on travel to and from West Africa to help protect Americans from Ebola.
What is the treatment?
Currently, there is no vaccine. Treatment consists only of "supportive therapy," according to the CDC. There are several vaccines being tested. None are available for clinical use.
How deadly is Ebola?
In past outbreaks, up to 90% of humans who contract the virus have died. WHO describes Ebola as "one of the world's most virulent diseases."
In the current outbreak, the survival rate has been higher. About 47% survive, according to WHO.
How can Ebola be prevented?
It's unknown what the natural host for Ebola is, but it's believed to be the fruit bat. If an outbreak among animals is suspected, the best practice is to quarantine the animals, cull the infected animals and bury or incinerate the carcasses, according to WHO.
In the current outbreak, most cases are the result of human-to-human transmission, when there is direct contact with bodily fluids, secretions, the mucous membrane or broken skin of an infected person, WHO says.
The Centers for Disease Control and Prevention has tightened its protocol for hospitals to follow when they deal with a known or suspected case of Ebola.
It details everything from what health workers should wear to how a body infected with Ebola should be handled.
Here are some key points from the federal recommendations (information from the CDC):
Principle #1: Rigorous and repeated training
Focusing only on PPE gives a false sense of security of safe care and worker safety. Training is a critical aspect of ensuring infection control. Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment, especially in the step by step putting on and taking off of PPE. CDC and partners will ramp up training offerings for healthcare personnel across the country to reiterate all the aspects of safe care recommendations.
Principle #2: No skin exposure when PPE is worn
Given the intensive and invasive care that U.S. hospitals provide for Ebola patients, the tightened guidelines are more directive in recommending no skin exposure when PPE is worn.
CDC is recommending all of the same PPE included in the August 1, 2014 guidance, with the addition of coveralls and single-use, disposable hoods. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single-use, disposable full-face shield. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for U.S. healthcare workers caring for patients with Ebola includes:
· Double gloves
· Boot covers that are waterproof and go to at least mid-calf or leg covers
· Single-use fluid resistant or impermeable gown that extends to at least mid-calf or coverall without integrated hood.
· Respirators, including either N95 respirators or powered air purifying respirator (PAPR)
· Single-use, full-face shield that is disposable
· Surgical hoods to ensure complete coverage of the head and neck
· Apron that is waterproof and covers the torso to the level of the mid-calf (and that covers the top of the boots or boot covers) should be used if Ebola patients have vomiting or diarrhea
The guidance describes different options for combining PPE to allow a facility to select PPE for their protocols based on availability, healthcare personnel familiarity, comfort and preference while continuing to provide a standardized, high level of protection for healthcare personnel. The guidance includes having:
The guidance describes different options for combining PPE to allow a facility to select PPE for their protocols based on availability, healthcare personnel familiarity, comfort and preference while continuing to provide a standardized, high level of protection for healthcare personnel.
The guidance includes having:
-Two specific, recommended PPE options for facilities to choose from. Both options provide equivalent protection if worn, put on and removed correctly.
- Designated areas for putting on and taking off PPE. Facilities should ensure that space and layout allows for clear separation between clean and potentially contaminated areas
- Trained observer to monitor PPE use and safe removal
Step-by-step PPE removal instructions that include:
- Disinfecting visibly contaminated PPE using an EPA-registered disinfectant wipe prior to taking off equipment
- Disinfection of gloved hands using either an EPA-registered disinfectant wipe or alcohol-based hand rub between steps of taking off PPE.
PPE is Only One Aspect of Infection Control
It is critical to focus on other prevention activities to halt the spread of Ebola in healthcare settings, including:
- Prompt screening and triage of potential patients
- Designated site managers to ensure proper implementation of precautions
- Limiting personnel in the isolation room
- Effective environmental cleaning
Think Ebola and Care Carefully
The CDC reminds health care workers to "Think Ebola" and to "Care Carefully." Health care workers should take a detailed travel and exposure history with patients who exhibit fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, unexplained hemorrhage. If the patient is under investigation for Ebola, health care workers should activate the hospital preparedness plan for Ebola, isolate the patient in a separate room with a private bathroom, and to ensure standardized protocols are in place for PPE use and disposal. Health care workers should not have physical contact with the patient without putting on appropriate PPE.
Aid workers are providing everything from medical care to protective gear to education as the Ebola virus continues to spread.
About 350 U.S. troops are already in West Africa and the number could rise to 4,000 in the coming weeks to support civilian health efforts.
There have been 8,033 confirmed or suspected cases and more than 3,879 deaths attributed to the current outbreak of Ebola in West Africa, the World Health Organization reports.
The first man to be diagnosed with Ebola in the USA died on Oct. 8
A widespread outbreak like the one in West Africa is highly unlikely to happen in the USA, said Tom Frieden, the director of the Centers for Disease Control and Prevention, after the man was first diagnosed.
How can you help? USA TODAY Network has compiled a list of organizations responding to the Ebola outbreak on the ground. All of the charities listed have received three- and four-star ratings from Charity Navigator.
In addition to providing supplies, UNICEF has launched a campaign to tell people about how Ebola is transmitted and how it can be prevented.
"Part of the disease is a medical response, but a great deal of getting it under control is really the community education piece," said Caryl Stern, president of the U.S. Fund for UNICEF.
About 400 UNICEF staffers are working on the ground in West Africa . Communication is largely done door-to-door, Stern said.
"You're talking about places where there is no power, where radio and TV and newspapers are not a part of their normal day," she said.
UNICEF estimates it needs $200 million in funding for its immediate Ebola response efforts. So far, the organization has raised more than $40 million, Stern said.
"The main thing we need right now are dollars," she said. "Many times, people say, 'I want to send shoes or coats.' But the cost of getting something there is more expensive than sourcing it more locally."
One of the top needs in the Ebola response? Chlorine.
The non-profit sent five chlorine generators to Liberia for hand washing and to disinfect surfaces, producing about 440 gallons of chlorine a day, said Bill Horan, president of Operation Blessing.
"Soap and water is better than nothing, but chlorine and water is what will kill the virus and stop the spread of Ebola," Horan said.
Operation Blessing staff and volunteers are distributing chlorine to the Liberian government and directly to residents, he said.
The non-profit is shipping another generator later this month, this one with the capability of producing 640 gallons of chlorine a day, Horan said.
IMC operates a 70-bed Ebola treatment facility in Liberia and is opening a 50-bed facility in Sierra Leone by month's end, said Margaret Aguirre, head of global initiatives for the organization.
These facilities are expensive to run. The Liberia center costs $1 million per month and requires 200 staffers when the facility is at full capacity, Aguirre said.
In addition to doctors and nurses, IMC is deploying water and sanitation experts, she said.
The organization currently has about 300 staffers in West Africa and is sending hundreds more to help in response efforts, Aguirre said.
The Ebola outbreak is now at a "tipping point," says president Carolyn Mills on the organization's website.
Save the Children has health ministries in Liberia, Sierra Leone and Guinea. The non-profit has trained health workers and community members about how to limit their risks, according to its website.
The organization has sent more than 3,000 staff working in the region, according to an e-mail from Tim Shenk, spokesman for the organization.
Doctors Without Borders runs six Ebola management centers with more than 600 hospital beds in isolation, according to Shenk's e-mail.
How much do you know about the Ebola outbreak? Test yourself with these questions based on information from the Centers for Disease Control and Prevention.
Gannett stations across the country hosted conversations about Ebola on Oct. 16 to provide facts and information about Ebola while steering clear of panic.
Sources of this story include Centers for Disease Control and Prevention, USA Today research, Jolie Lee/USA Today, 11Alive, Jennifer Leslie