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This Isn’t CONTAGION or OUTBREAK: What You Need To Know About Ebola In The U.S.

Don’t panic.

The first horrible experience you had with a virus was probably the flu. It may have snuck up on you — piercing the cells in your respiratory tract to hijack the cellular machinery necessary for it’s own reproduction – but someone probably transferred it to you by touch or by sneeze. It’s a nasty process from a nasty wad of proteins and DNA.

Getting the same flu virus year after year, it’s understandable to think that all viruses work in the same nefarious way – that it only takes a sneeze to infect a whole room. But viruses are incredibly diverse. Some are highly contagious yet mostly harmless, like the common cold (actually over 200 different viruses), some are far less transmissible but more deadly, like AIDS. The Ebola virus sits somewhere in between.

Hollywood has made dozens of movies cashing in on our conceptions of killer viruses. It’s not exciting for Laurence Fishburne to handle a virus, like Ebola, that is very deadly but also very hard to catch. Instead, movies like Contagion and Outbreak conceive of viruses as wicked sprints of disease, burning through patient after patient like some insatiable fire.

The Ebola virus does burn hot, but it burns out fast. Ebola isn’t straight out of a Hollywood movie, but it has now arrived in the U.S. Here’s what you need to know:

Yes, Ebola is deadly

Ebolaviruses – of which there are five species — have some of the highest fatality rates of any viruses we’ve encountered: up to 90 percent. They are killers second only to viruses like Smallpox and rabies, both of which have fatality rates of effectively 100 percent without treatment. There is currently no vaccine or cure.

But it does not spread easily

Ebola is not airborne like influenza or the common cold. It’s spread by contact with bodily fluids. This means that you would have to get blood, sweat, vomit, or semen into a cut on your body, or into your eyes, mouth, or nose. It’s intimate.

Sadly, this is the reason why doctors and health care workers in particular get struck with the disease. Especially in Africa, where access to health care is low, health care workers are either treating patients without proper supplies like masks and gloves, or are treating patients who unknowingly have Ebola. According to the World Health Organization, over 200 health care workers have died so far.

Still, you would have to go down to Texas and lick the unfortunate Ebola patient to get the disease in the US right now. Texas is not going to look like West Africa.

Ebola doesn’t make you gush blood from your eyes

Now officially titled Ebola Virus Disease, Ebola was once called “Ebola hemorrhagic fever” for the way it would cause infected people to ooze blood from their gums, get reddish eyes, and/or produce bloody stool. But this external and internal bleeding is rarely profuse, and is actually one of the less common symptoms. Typically, Ebola presents itself like a terrible case of flu, with fever, fatigue, muscle pain, headache, sore throat, vomiting, and diarrhea being the normal suite of symptoms.

And these symptoms only come after an incubation period — the time between infection with the virus and onset of symptoms – of 2 to 21 days. Before a person shows symptoms, they are not infectious. That’s a critical point, and how we know the Dallas man who recently brought Ebola to the US likely didn’t infect anyone on his flight from Africa. That science really is sound.

We aren’t positive where Ebola comes from, but we have some idea

In 1976, near the banks of the Ebola River in what is now the Democratic Republic of the Congo, we documented the first case the virus that would go on to share the river’s name. In the intervening 40 years, there have been a number of outbreaks – infecting and killing a relatively small number of people – but no outbreak of Ebola has ever spread this far. We aren’t sure where this serial killer of a virus keeps coming from, but it could be bats.

As I wrote in a piece about the “Simian Flu” of the recent Planet of the Apes film:

As David Quammen noted in his excellent book on emerging infectious diseases Spillover, “Everything comes from somewhere.” In the case of Ebolavirus and many other infectious diseases the place is other animals. Called zoonoses, viruses and bacteria can evolve to spill over from one species of organism into another. Some zoonotic viruses and bacteria don’t handle the transition well, and never fully make the leap. Others are successful but hardly affect the new organisms at all. Still others thrive inside the new hosts. Anthrax, cowpox, H1N1 flu, rabies, and Ebola are just a few.

Scientists aren’t positive what organism Ebola spilled over from, but the study is ongoing. Bats are likely culprits, passing on the virus directly to humans or indirectly through chimps and other apes into us.

Africa is a different case

Unfortunately, though Ebola spreads sporadically, the thousands of cases in Africa are likely to increase, and may increase exponentially by the end of the year. This isn’t so much a testament to the contagiousness of Ebola as it is to the poor state of health care in West Africa. When health care workers do not have the proper supplies or sanitation protocols, the virus gains the advantage. Dirty gloves and needles, poor quarantine procedures and health care infrastructure, this is what is elevating the danger of Ebola, not necessarily qualities inherent to the virus.

As a comparison, the US averages nearly $9,000 in health care spending per person per year. In Guinea, it’s $32.

There are also cultural factors at work that make Africa distinct. The personal washing of bodies – bodies that remain infectious after death – by family members, low literacy rates that make public information campaigns difficult, and fear of foreign health care workers who do not practice medicine in the same way all are contributing to Africa’s dilemma.

We can handle this

The current Ebola outbreak in Africa is going to take worldwide support to get under control. To that end, the U.S. has committed money, troops, and supplies to fight this viral scourge. But if the fight in Africa is a brawl, the fight against Ebola in the U.S. is a pillow fight.

Precisely because the Ebola virus is so different from what we see in movies and TV shows, the unfortunate man in Texas is not going to become a “patient zero” from whom an epidemic starts. We know how to handle sporadic diseases like Ebola, even ones that are incurable and deadly like Ebola is. The patient is in isolation, the dozen or so people he has been in close contact with since he was symptomatic are being examined, and his fellow airplane passengers from Liberia have been cleared. Our doctors and scientists have prepared for this kind of situation, and are handling it.

“CDC recognizes that even a single case of Ebola diagnosed in the United States raises concerns,” the CDC stated in a press release yesterday. The Centers for Disease Control and Prevention acknowledges that this is scary. And fear is totally understandable. But the U.S. is not Africa, to put it bluntly, and our first confirmed case has little in common with the epidemic slowly burning across the North Atlantic.

“We know how to stop Ebola’s further spread.”

The CDC said something similar when they spearheaded a campaign to eradicate malaria in the U.S. The National Malaria Eradication Program effectively eliminated the pathogen in four years.

This isn’t Contagion or Outbreak

The reality is that we can expect more cases of Ebola to show up on our doorstep, but not because it is likely to spread from a single man. As long as people are traveling from infected regions to the U.S., there will always be that possibility. But this is true of any virus, and there are other viruses that deserve our attention (at least in the U.S.).

The flu killed 50,000 people in the U.S. in 2010, but those deaths are largely ignored. Maybe the symptoms of Ebola – popularized by gruesome depictions in movies – are just grim enough to be exaggerated. Maybe the thought of a deadly virus hitching the ride on some hapless traveler and sneaking into you country and then your body triggers a special kind of panic.

Sometimes we should be scared. Guinea, Liberia, Sierra Leone, Nigeria, and Senegal are in a bad way. However, for a single confirmed case of Ebola in a country with vastly better health care infrastructure, more supplies, and more health care workers, U.S. citizens should take the advice on the cover of The Hitchhiker’s Guide to the Galaxy: Don’t Panic.

For more information, check regularly at the CDC’s website, follow Vox’s coverage, or pick up a copy of David Quammen’s excellent book on infectious diseases, Spillover.

Kyle Hill is the Science Editor of Nerdist Industries. Follow @Sci_Phile.


Image: Cynthia Goldsmith/Centers for Disease Control and Prevention

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  1. This is the kind of information that needs mass coverage.