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Stop with this EbolaMay 08 '11 Write an essay on this topic.
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The Bottom Line A fun medical piece about a topic everyone is interested in, unfortunately. But let's stick a fork in ebola and move on.
Most infections in the United States are from endogenous organisms. That is to say, from bugs that are supposed to be in the human body; bugs like E. coli. We need E. coli in our colon, or we would probably get sick. E. coli is very well-behaved and beneficial when it is in our colon. When E. coli finds its way into our urinary tract, our bloodstream, and even our brain, it has no idea how to behave, and we can end up with some horrible diseases. E. coli is a very important germ and it is everywhere - I guarantee you if your toothbrush has been in your bathroom for longer than a day, it is on your toothbrush. The bug is spread along the entire spectrum of familiar friend to fearsome foe; it absolutely belongs in the medical discussion as much as it belongs in our colons. You know what doesn't belong in your colon? Ebolavirus. As well, ebola is unfit to be in any discourse except the most specialized discussions. Ebola is such a yeti of medicine, it may as well not exist, and yet it has infected the public imagination to the point where its significance is overemphasized even by our educators, our health experts, our physicians. Ebola popped up in my high school education when "The Hot Zone" by Richard Preston was on the required reading list and billed as non-fiction. Ebola popped up in my undergraduate microbiology class when my professor echoed Preston's warnings about "liquifecation and bleeding from every orifice." Ebola popped up in my formal medical education even with a couple of more toned down lines, "know that this virus causes severe hemorrhagic fever and is a potential bioterrorism weapon." I will reiterate my sentiment about this subject: ebola is the yeti of medicine; it might as well not exist. My fascination with ebola, and why I bothered to actually read some real non-fiction on the topic, is from my need to look the devil in the eye in order to realize the devil doesn't exist. Your imagination is the only thing that scares you and you don't fear something you understand. Doing a little bit of research, it is obvious that people who are otherwise experts in the health conditions they witness personally (HIV, E. coli, and whatnot) are clueless when it comes to ebola, and a combination of laziness and the human need for an antichrist to be out there, somewhere, turns ebola mythology into truth. Ebola mythology, i.e. Preson mythology, has infected even World Health Organization (WHO) policy when they put this yeti with the saltwater crocodile that is anthrax in the bioterrorism category A agents. Ebolavirus just does not compare to anthrax, a bacteria that can turtleshell it and become near invulnerable. You can boil anthrax spores and not kill it. You can bleach it; you can dry it; you can shoot it into outer space, and not kill it. Anthrax can rest in a dormant state in some crevice in some attic, wait until you die of natural causes, and get your grandchildren. With ebola, the trick is not how to kill it, but how to keep the bug alive long enough to cause any mischief. It's not going to survive in an envelope; it's not going to survive in your Kool-aid. The outer layer of ebolavirus is like vegetable oil. If that layer dries even a little bit, the virus becomes harmless. If you heat the virus to just 130F, the virus becomes harmless. A little bit of bleach or alcohol? Guess what happens. Despite all this, a few individuals from a Japanese cult apparently posed as aid workers, travelled to Africa during an ebola outbreak, and tried to obtain a sample for the purposes of terrorizing. Nothing came of this probably because, as described above, ebolavirus is so fragile and requires a lot of special attention to survive transport outside of a living host. But, my other theory is that ebola simply is not impressive enough to these potential terrorists. For the morbidly fascinated, ebola will be a letdown. I mean, why does ebola capture our morbid fascination? Because it is a hemorrhagic fever right? Hemorrhage means bleed, and blood is scary, especially in the instance of a virus causing uncontrollable and fatal bleeding. There are many infectious diseases that can cause bleeding. Your liver makes the clotting proteins your blood needs to clot, and any disease that destroys the liver can cause you to bleed. A bad case of Hepatitis A or B can be considered a hemorrhagic fever, if you want to you put faith in the meanings of words. Of course, it is unusual for hepatitis to cause overt signs of bleeding. But, as far as hemorrhagic fevers go, ebola doesn't cause a lot of bleeding. Ebola can attack the liver and blood vessels as well, but loss of blood is not going to be the cause of death in ebola. The exotic viruses of the hemorrhagic fever group that are apt to cause a lot of bleeding go by the names of junin and machupo (these are much less lethal, however). Ebola causes bleeding in less than half of patients, and it is not rare to have someone die of ebola and not spill a drop of blood. And it doesn't liquefy any organs. I don't know where this notion came from, and if you just do a little of thinking this makes sense: we are not made of ice. Unless your name is Frosty the Snowman, when your organs die, there is no reason for them to liquefy. One thing ebola does have going for it as a "scary bug" is that it is very deadly. If you are infected, there is very little medicine can do, and there is a good chance you won't recover - this is the reason for the space suits - to protect researchers from a very dangerous organism. This is not to say ebola is dangerous to the public in general because it is not very contagious, and it cannot decide to mutate into something that is airborn. If a researcher gets him or herself ebola, there would be minimal if any spread. The only reason a few quasi-large outbreaks have occured in Africa is because they used to re-use needles in hospitals, and family members like to kiss deceased love ones. In an American setting, ebola will get nowhere, especially with our hypersensitivity to this disease. And the man or woman (let's say he is a man) who gets ebola will get a very nonspecific illness. Ebola will lay him out because there is no such thing as a mild case of ebola, and patients invariably become bedridden and apathetic. But aside from that, there is no specific ebola syndrome. He likely won't bleed, he may not even develop a fever (~10% of patients don't). Curiously, about a quarter of people with ebola get the hiccups. In fact hiccups are one of the few ways you can tell clinically a patient has ebola and not malaria or typhoid. Hiccups, not blood gushing from every orifice - if blood is gushing from every orifice, the diagnosis is that you are in a work of fiction. Classically, ebola is reported to have a "up to 90% fatality rate." "Up to" is really key here, as 90% represents some of the worst epidemics in some of the worst conditions. Marburg, a very similar virus causing an almost identical disease, broke out in a German research facility in 1967 and had a 25% fatality rate, and so that is what was reported. Then, the same virus broke out in Africa in a recent large outbreak in Angola and had a 90% fatality rate. So now Marburg is reported to have a "up to 90% fatality rate," and is no longer "ebola's little sister" and is now every bit ebola's equal. This is not to claim if ebola were to cause an outbreak in a developed nation, the fatality would be 25%, but I doubt it would be as high as 90%. Luckily, there have been no ebola outbreaks in developed nations and there probably never will be because ebola is, once again, not very contagious and very fragile. But, here's what happened when a German scientist in 2009 jabbed herself with a needle containing ebola: nothing. They gave her an experimental vaccine and she didn't even get the hiccups. Ebola will inevitably continue to be a disease of the imagination, but let's make it a unicorn and not a yeti. There are many strange things about this virus that separate it from other bugs that I won't go anymore into, except to say that being a threat to humanity is not one of those things.  |
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