HealthTap hosted a summit of Infectious Diseases experts who discussed current developments in the Ebola outbreak in West Africa, and our preparedness and ability to treat any Ebola-exposed travelers from Africa.
How can HealthTap help provide guidelines and recommendations for the monitoring of Ebola?
By creating a forum for the discussion of current medical events and emergencies, HealthTap facilitates the dissemination of up-to-date medical information to doctors across specialties. This type of discussion and collaboration fosters the development of improved practices by enabling doctors across the nation to connect and gather the most relevant health information for their practice. Doctors are invited to join the Medical Expert Network: bit.ly/HTapDoctors Healthtap doctors perform an important service during this Ebola outbreak, by providing timely information and advice to anxious patients who would have otherwise tried to contact overwhelmed emergency departments, urgent care centers, and primary care offices for answers. Doctors are invited to use the HealthTap platform to deliver virtual care to their patients: bit.ly/HTapConcierge
How is Ebola diagnosed and treated?
Early diagnosis is based on initial serology, which is confirmed by ELISA testing, PCR, and virus isolation test. Later in the disease course, IgM and IgG diagnostic tests can be performed for diagnosis. Supportive treatment for Ebola includes IV fluids and electrolyte management, oxygen and blood pressure maintenance, and ongoing treatment of secondary infections. Experimental vaccines and treatments for Ebola are in progress, but none have been fully tested for effectiveness.
What is the length of the incubation period for Ebola?
Incubation can be as short as a few days. Typical incubation time is 8-9 days. Occasionally incubation has lasted up to 20 days. We declare the risk of infection as nil after 21 days.
What’s the best way to distinguish a patient who has Ebola or the flu?
If someone has been exposed to a person with active Ebola infection (meaning that they traveled recently from one of the affected African countries), then that person should be assumed to have Ebola. If no such exposure occurred, then no additional testing for Ebola is required.
How infectious are different body fluids, ie. sweat, semen, blood, etc?
All body fluids from someone with Ebola infection are potentially infectious. Blood, vomit, and stool are the most common fluids that transmit the infection.
How long is Ebola viable on surfaces outside of the body?
Ebola can be long lived in fluids at room temperature. Full dessication and exposure to ultraviolet light (sunlight) appears to kill the virus, as does application of bleach.
Can the Ebola virus be transmitted by mosquitos and fleas?
The virus is carried in mammals (for example, humans, bats, monkeys and apes). There have been no documented cases of transmission via mosquitos or fleas.
Is Ebola an airborne virus (contradicting statements)?
Ebola is not airborne the way measles or chicken pox is. You could acquire Ebola if you stand within several feet of an infected person who is actively coughing, vomiting, or experiencing explosive diarrhea, and the droplets reach you. Droplets must come in contact with your eyes or mouth, or land on your hand or skin, if you then touch your eyes or mouth.
Is it safe to fly at this time?
There is no risk of contracting Ebola from travel on airplanes for flights that originate in the U.S. Flight on airlines in African countries that have Ebola epidemics could have individuals on board who were previously exposed, but are not showing signs of infection, because the airlines are screening passengers for symptoms prior to boarding. In prior documented cases of a person with active Ebola infection traveling by air on a flight originating in Africa, no one on the flights traveling with those patients acquired the infection.
What is the best advice to protect myself, my patients, and my family?
The best advice is to have everyone understand that the risk of Ebola is vanishingly small. Unless you yourself have traveled to a country with an outbreak, or you come in contact with someone who did and who is showing signs of infection, such as a fever, you are more likely to be killed by lightning, and you are more than 1000 times more likely to die in a car accident this year than to acquire Ebola in the U.S. (you are even more likely to die from a shark attack than from Ebola).
What are the risks with newborns and children with Ebola and what are best practices for keeping them safe?
The only way to contract Ebola is to be exposed personally to the bodily fluids of a person infected with and showing symptoms of Ebola. Newborns and children will not be exposed or at risk unless they come in direct contact with someone who is symptomatic after coming in contact with someone with Ebola. Currently, only people returning from the affected African nations, who took care of Ebola patients there, are potential source of contact.
What advice is given pregnant women during this Ebola outbreak?
Pregnant women should avoid contact with symptomatic individuals who have returned from African countries after taking care of Ebola patients.
Are survival rates inversely proportional to the initial contaminating viral load? If so, do we have a quantitative viral test?
We do not have good evidence on this issue, but it does appear that very high viral load in body fluids that occur at the terminal phase of infection is more likely to transmit the infection to those who come in direct contact. After the infection begins, the illness is just as severe in anyone, independent of the dosage of the initial inoculum.
What is the most frequent cause of death from Ebola? Coagulopathy?
Ebola virus affects every cell in body, and severe fluid loss occurs from diarrhea and vomiting. Coagulopathy and internal bleeding are common, and encephalopathy often precedes systemic collapse and death.
Is there a cure for Ebola?
The survival rate for Ebola is 30-50%, improved with symptomatic and full supportive care. Multiple experimental treatments are being tried now, including serum transfusion from survivors, and new medications like ZMapp, but their effectiveness is still under investigation.
How close are we to developing an effective vaccination, and why have there been problems with this so far?
There are multiple vaccines under development, and clinical trials are underway. More extensive human trials are being planned for as early as January, 2015.
What is the best way to screen for Ebola rapidly?
Taking a history and excluding travel from Africa, or direct contact with anyone who is symptomatic with Ebola infection is a sufficient screen – absent that contact, there is no risk of Ebola.
What are the current statistics about trial worldwide cases, percent deaths, doubling time, projected for the coming months?
See this discussion from the CDC http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-mmwr-estimating-future-cases.html
What are the national and state quarantine regulations for managing Ebola?
As of October 27th, new guidelines are expected to be unveiled by the White House in the coming days. According to a white house official, the administration is consulting with the states as they develop new rules.
What can and should ambulatory medical practices (physician offices, urgent care etc.) do to prepare for Ebola?
The main goals of preparing ambulatory medical practice for Ebola are identifying, containing and supportively managing the infected patient. You can read about best Ebola management practices for ambulatory care settings from the Assistant Secretary for Preparedness and Response here: http://www.phe.gov/Preparedness/responders/ebola/Documents/ebola-preparedness-considerations.pdf
How should we respond in our offices when a patient is positive for screening questions of symptoms and possible exposure?
If a person who has traveled from an epidemic area (one of the following countries: Sierra Leone, Liberia, Guinea, Mali) where they came in direct contact with people suffering from Ebola presents with fever or other systemic symptoms, isolate the patient and notify the public health department. Note: Nigeria previously had Ebola but is now free of any one with the disease.