Ebola FAQ: Questions Asked by Doctors

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?

EbolaInfographic_jpgBy 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.


Five Fun Facts About Healthy Halloween Snacks

513234365October is National Dental Hygiene Month! It’s probably not a coincidence that this falls on the same month as Halloween, a celebration notorious for sugary treats and candy-filled feasts. The American Dental Hygienist Association reminds us that while it’s okay to indulge in the avalanche of sweets that comes with Halloween parties, we still need to maintain healthy dental habits to prevent tooth decay and disease. Are there healthy alternatives to Halloween candies? Here’s what our HealthTap doctors have to say.

1. Is one type of candy better than another?

Dr. Pamela Lindor weighs in saying that dark chocolate may be slightly better.  But really, “Anything in small amounts, or for special occasions, is fine.” “Dark chocolate contains higher levels of antioxidants than other forms of chocolate however, chocolate is not considered a ‘health food’,” adds Dr. Douglas Fronzaglia And one final advice about chocolates: Dr. Lonna Larsh says that “If your chocolate is less that 70% cocoa, it is dessert. If it is >70%, it is therapeutic in small quantities. Chocolate is usually very high in saturated fat, which is why you should only eat small quantities.”

2. What are some healthy alternatives to holiday candy?

176810850Dr. Anthony La Barbera recommends the following:

  • Sugar free treats.
  • Limited sugary treats.
  • Fruit and nuts.

For other healthy snacks, Dr. Yolanda Wade recommends:

  • Cheese sticks/cubes
  • Yogurt
  • Edamame
  • Hummus

3. Is it okay to eat a piece of candy every now and then?

Dr. Ratna Dhingra says that “A candy now and then is fine.”  She goes on to emphasize that complex sugars—like those found in fruits such as cherries and strawberries—are better. While Dr. Neigatha Graney advices that “Enjoying candy in limited quantity is allowed. Processed foods are often sweetened with table sugar (sucrose), fructose (fruit juices), or corn syrup and offers minimal nutrition or fiber but lots of calories. Complex sugars found in fruits, vegetables offer nutrients, fiber & more. Do limit Carb intake to 45-65% daily calories.”

4. Is sugar-free candy okay?

LittleWitchCostumeDr. Rachel Chastanet says yes, in moderation.  “Sugar Free does not mean free of calories, and sugar free candy generally is made with sugar alcohols.  Sugar Alcohols are poorly and incompletely absorbed by the intestines, so eating a lot will give you bad gas and diarrhea. Taken in moderation, sugar free candy is better for your teeth than regular candy, and is a useful tool for diabetics and people on low carbohydrate diets.” “Depends on sweetener,” says Dr. Melissa Young. “Some sugar free candies are calorie free but some are not. Part of it depends on the sweetener used. Sugar alcohols can still raise your sugar. And some sugar free foods have just as many calories as the “regular” version, so they may not raise your blood sugar as much, but “lots” will cause weight gain and eventual increase in blood sugar. “lots” of anything is bad.”

5. What is the best kind of holiday candies to get that do the least damage to children’s teeth?

Dr. Arnold Malerman says to give chocolate as an occasional treat. “Stay away from hard candy…sticky candy and starches that linger on the teeth. Drink a glass of water to help clear the sugars off the teeth. Remember, all things in moderation.” One final advice from a dentist: “The least damaging candies are sugar free and sweetened with xylitol. You may be able to find them at a health food store in your area. Too much xylitol can cause stomach discomfort so don’t overdo it. Uncoated gummy candies are alright due to their non-sticky properties.” - Dr. Charles Kattuah

Have more questions about dental health? Ask a HealthTap doctor for free or schedule a live consult with a dentist today!

HealthTap Launches Nationwide Digital Health Marketplace

HealthTap Launches Nationwide Digital Health Marketplace, Providing 24/7 Fast Affordable Access to Your Doctor and Doctors in 105  Specialties

New “Concierge” Service, Available in all 50 States, Connects People Instantaneously to their Own Physicians and a Network of More Than 1 Million Top U.S. Doctors  – Anytime, Anywhere

Find YOUR Doctor on HealthTap Concierge

PALO ALTO, Calif.—October 22, 2014—HealthTap+, the company reinventing healthcare by connecting millions of people everywhere to the most trusted health information and doctors through its end-to-end Virtual Care platform, today announced the launch of HealthTap Concierge, its affordable pay-as-you-go service.

HealthTap Concierge solves the three biggest problems you face when trying to get fast, reliable medical advice from your own doctor:

  1. It takes too long to get an appointment
  2. It’s inconvenient to travel to the doctor’s physical office and waste time in the waiting room (while getting exposed to health risks spread by other patients)
  3. Doctor visits and even insurance co-pays often cost too much.

Request for a Virtual Consult now or Schedule an AppointmentWith the all-new HealthTap Concierge, you no longer need to experience delays in seeing your doctor, be inconvenienced by traffic and waiting rooms, or pay unreasonable fees for every simple health need. HealthTap now connects you directly with your doctor and other top specialists and generalists of your choice—virtually by HD video, text chat or voice. Using any smartphone, tablet or personal computer you can also get advice and even medication refills with no wait time.

Your instantaneous virtual consult is as easy as clicking a button in a mobile app, privately, safely and securely. Affordably priced at $44 per consult, it’s about the cost of a typical co-pay—so you get real value and quick, ultra-convenient peace of mind. Virtual consults with your own doctors on Concierge are now free for HealthTap Prime members.

With access to the Virtual Practices of more than one million doctors from 105 medical specialties, HealthTap Concierge enables users to discover new doctors and even invite them to be on their Care Team. Starting today, anyone can get a second, third or tenth opinion from top specialist via HD video or secure text chat, from anywhere in the world.

“Millions of users and doctors have spoken, and we’ve listened,” said Ron Gutman, HealthTap Founder and CEO. “With the all new HealthTap Concierge, we’re making Virtual Care an exciting reality by enabling people to interact with their trusted doctors and specialists at more convenient times, eliminating the need to take time off work, pay expensive fees or travel far. Consumer-driven healthcare is the future, and with HealthTap Concierge anyone can be part of this exciting future and invite their own doctors to transform medicine by delivering the most modern care and helping people everywhere feel good every day!”


Dr. Ankush Bansal, a board certified Internal Medicine physician from Miami said: “I’m constantly seeking new ways to provide my patients with the best care in the most convenient way possible. HealthTap has allowed me to help more people than I otherwise would be able to in my regular practice. With my Virtual Practice on HealthTap Concierge, I can significantly improve my patients’ experiences and health outcomes, and stay connected to them while they recover with no additional cost or effort, while practicing from anywhere. HealthTap Concierge is, with all pun intended, exactly what wise doctors order.”

Starting today, HealthTap Concierge will bring to millions everywhere access to secure virtual consults, health information and even reminder and tips, all from top U.S. licensed doctors in all specialties.

Find your doctors on HealthTap today and get immediate access to their Virtual Practices anytime, anywhere.

For more information on getting started with HealthTap Concierge, visit healthtap.com/concierge or download the app for free from Google Play and the Apple App Store.

About HealthTap+

HealthTap+ has reinvented the way people all over the world take care of their health and well-being, connecting millions everywhere with the most trusted health information and doctors. The company is backed by leading investors like Khosla Ventures, Eric Schmidt’s Innovation Endeavors, Mayfield Fund, and Mohr Davidow Ventures. With top-rated web and mobile apps, HealthTap+ offers immediate and free access to relevant, reliable, and trusted health answers from a network of more than 63,000 U.S.-licensed doctors. Sign up today and download HealthTap’s free apps for iPhone, iPad or Android at healthtap.com.

Tips to Improve Health Literacy

HealthLiteracyMonthOctober is Health Literacy Month! “Health Literacy,” according to HealthTap Medical Expert Dr. Jeff Livingston, “refers to a person’s ability to understand health information, which includes things like determining medication doses, judging the quality of health information, and understanding the risks and benefits of treatment.”

There’s a significant gap between how health issues are communicated, and the ability of most people to understand them and to take appropriate action. Low health literacy is associated with medication non-adherence, condition mismanagement, increased hospitalization rates, and higher healthcare costs.

Consider these stats:

  • The U.S. Department of Health and Human Services states that 9 out of 10 adults currently lack the necessary skills to properly manage their health and prevent diseases.
  • A Columbia University School of Nursing study found that 40 percent of patients with pacemakers and defibrillators did not property understand their cardiac health, including how the devices work or what to do in the event of irregular heartbeats.
  • About 50% of the 2 billion prescriptions filled each year are not taken correctly due to forgetfulness, dosage or duration confusion, ambivalence, or lack of understanding of the drug’s importance in the patient’s treatment regimen.

Dr. Reid Blackwelder, a Board Certified Family Medicine Doctor from Kingsport, Tennessee adds, “the biggest issue is usually when the provider does not check to see what literacy level the patient has, and uses words or phrases that are not understood. People often are embarrassed to admit they did not understand, so important parts of diagnostic or treatment decisions aren’t clearly reviewed.”

What you can do about it:

  • Be proactive about your health. Before speaking with your doctor, make a list of your symptoms and when they started, and write down all the medications you currently take—prescription and over the counter.
  • Don’t be afraid to ask questions. If something is not clear with the doctor, nurse or pharmacist’s instructions, ask them to use more familiar language, explain thing further, or write things down.
  • Stay connected to your healthcare provider. Make sure you have the contact numbers of your healthcare providers in case you have questions in between visits.

You can also use a service like HealthTap to reach one of our 63,000+ doctors to ask general health questions for free or schedule live virtual consults 24/7 via secure HD video or text chat with HealthTap Prime.



5 Things You Need to Know About the Ebola Virus

EbolaVirus | HealthTapOn September 30, 2014, doctors in Texas diagnosed the first case of Ebola in the U.S. in a patient who recently returned from Africa. With more than 4,000 known cases and a fatality rate of up to 90%, this Ebola outbreak is the deadliest in history, since the virus was discovered in 1976. As fear of an outbreak in the United States continues to spread, health officials urge everyone not to panic, stating that the U.S. healthcare system is fully equipped to deal with the virus.

Here are five of the most commonly asked questions about Ebola, along with answers from top doctors from HealthTap.

1. What is the Ebola Virus?

Ebola was first recognized in 1976 as the cause of outbreaks of disease in the Democratic Republic of the Congo (then known as zaire) and in Sudan. Ebola produces one of the most deadly forms of viral hemorrhagic fevers. Exactly how the ebola virus enters cells is unknown at present. The ebola virus appears to infect many different cell types. It can infect various mammals, not just primates. - Dr. Robert Kwok 

Ebola is a type of virus which causes hemorrhagic fever. It is a severe, often deadly illness in humans and some animals (like monkeys, gorillas, and chimpanzees). There is no cure for the disease as today. - Dr. Victor Nwanguma

Ebola Virus causes hemorrhagic fever, a viral disease that causes bleeding and shock in patients. - Dr. Jeff M. Livingston

Ebola virus is a filovirus found primarily in Central Africa that causes a hemorrhagic fever that is frequently fatal. - Dr. Larry-Lutwick

Of 5 species of ebola, 3 (BDBV,EBOV,SUD: Africa) have 90% fatality. Spread by contact blood, secretions & body fluids, broken skin and mucus membranes. - Dr. Forrest Jones

2. What are the symptoms of Ebola?

Early signs and symptoms include fever severe, headache joint, and muscle aches, chills, sore throat, weakness over time. Symptoms become increasingly severe and may include: nausea and vomiting, diarrhea, red eyes, raised rash, chest pain and cough, stomach pain, severe weight loss, bleeding. - Dr. Ahmad M Hadied

Abrupt onset of fever, muscle aches and headache followed by nausea, vomiting, abdominal pain, chest pain, cough and sore throat. Other common features are photophobia, swollen lymph glands, yellow jaundice and pancreatitis. Central nervous system symptoms up to and including coma develop and as the disease progresses bleeding manifestations develop. 50-90% of patients die. - Dr. Michael Ein

The symptoms of Ebola virus infection are relatively non-specific in a diagnostic sense. You must develop fever, nausea, vomiting, diarrhea followed shortly by liver, kidney failure and problems with hemostasis. This must occur in the appropriate epidemiologic context for one to think about Ebola as a possible cause. There are other causes of hemorrhagic fevers, including Dengue. - Dr. Martin Raff

EbolaInfographic_jpg3. How is it spread?

The virus may be acquired upon contact with blood or bodily fluids of an infected animal (commonly monkeys or fruit bats). Spread through the air has not been documented in the natural environment.Fruit bats are believed to carry and spread the virus without being affected. Once human infection occurs, the disease may spread between people as well. Male survivors may be able to transmit the disease via semen for nearly two months.   Dr. Michael Finkelstein

By contact with the body fluids of infected people. Some animals presumably serve as reservoirs of infection between human outbreaks, but the details haven’t been worked out. - Dr. Joel Gallant

Ebola is spread by direct contact with an infected individual or the body and fluids of an infected person. So unless you are planning a trip to West Africa, you almost certainly cannot encounter Ebola. - Dr. Richard Bensinger

4. Is there a cure or treatment for Ebola?

Ebola has no cure or meaningful treatment other than to provide support to failing systems until the person recovers. The patient must be place in a level 4 isolation to prevent spread. In a rural village in an area with no real medical care calling in medicine sans frontiers might help, but most likely the village or at least all who are sick are doomed. - Dr. William Walsh

No treatment yet for Ebola. Thus it is best to focus on prevention. The health authorities in western Africa have been trying hard to educate and limit this outbreak, but it’s more difficult than they realized. A good reminder to us all to take health prevention seriously– everywhere and at all times. It’s the best way to stay healthy. - Dr. Stephen Scholand

Currently, there isn’t a cure for Ebola. The patient may be hospitalized, placed in isolation & provided intensive care measures such as: oxygen, medication to maintain blood pressure, blood transfusions (platelets or fresh blood), intravenous fluids & electrolytes & treatment of co-existing infections. Zmapp is a biopharmacuetical drug that is being used experimentally for Ebola.  - Dr. Heidi A. Fowler 

“Supportive care” is the best treatment. Basically treat the symptoms as they appear with; -Intravenous fluids (IV) and electrolytes -Maintaining oxygen status and blood pressure [Symptoms=vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases bleeding] Some experimental immune and drug therapies have been administered to Westerners that contracted the virus. - Dr. Varun Verma

5. How can we protect ourselves?

Prevention includes decreasing the spread of disease from infected monkeys and pigs to humans. This may be done by checking such animals for infection and killing and properly disposing of the bodies if the disease is discovered. Properly cooking meat and wearing protective clothing when handling meat may also be helpful, as are wearing protective clothing and washing hands when around a person with the disease. Samples of bodily fluids and tissues from people with the disease should be handled with special caution. - -  Dr. Michael Finkelstein

Avoid areas where the disease is occurring. Stay away from infected individuals and corpses of victims of the disease. - Dr. Phillip Goebel

Prevention – avoid travel to countries in West Africa affected by Ebola epidemic. Medical personnel should don gown, gloves, & mask when dealing w patients who may be infected with Ebola. - Dr. Heidi A. Fowler 

Cases must be isolated, caregivers enclosed in hazard suits, and the dead cremated to destroy the virus. Unfortunately during the day or two of pre-manifestation, the victim could be shedding virus without know of the infection. - Dr. Richard Bensinger

For more information, visit the Ebola Virus page on HealthTap or ask our  doctors for advice now.