Answering Your Patient's Questions About Ebola

As if the pictures of the deadly disease ominously referred to as hemorrhagic fever aren't enough, Ebola has made its way into the United States. For those of you living in a cave that haven't seen the headlines splashed across your TV screen, yes, the first case of the deadly virus has been diagnosed in the United States. Understandably, people are concerned. Will the virus spread?

Whenever a public health scare like this strikes, our patients understandably have questions. While the vast majority of healthcare providers have not treated Ebola personally, and probably did not even learn about the virus during our training, as nurse practitioners we are expected to have answers. 

This morning, I talked Ebola with news anchor Heather Childers on Fox and Friends First. Up nearly all night researching the disease and this most recent case on our home turf, I have boiled down the pages and pages of information into a brief (well, not that brief) Q&A to help keep NPs informed so they can address patient concerns. 

What actually happened in this case of Ebola in the U.S.?

A man arrived as a passenger on a plane from Liberia in the United States. He was not showing symptoms at the time of travel. Four or five days after he arrived in the U.S. he began to develop symptoms of Ebola virus. He presented to a Dallas emergency department but was ultimately sent home. It wasn't until two days later when he returned to the hospital that he was tested for Ebola based on his travel history. Blood test results released later that day confirmed an Ebola diagnosis. 

What measures are being taken to prevent this from happening again?

All travelers from countries where Ebola is present are having a temperature reading prior to boarding the plane. Anyone with a fever cannot board. The idea behind this is that Ebola is not contagious until the infected individual actually has symptoms of the virus which start with a fever. Symptoms usually start 8 to 10 days after exposure but may take up to three weeks to develop. In this case, the infected individual was at home or out in the community for about four days when he was contagious. 

How do you catch Ebola?

Fortunately, Ebola is harder to catch than many other viruses. It cannot be transmitted through the air but rather is spread through contact with bodily fluids in blood, saliva and sweat. Is it possible that, for example, if someone vomits on a subway or sneezes on another person's open wound that Ebola could be spread? Yes. But, transmission of the virus is usually seen among closer contacts such as family members and healthcare workers. The virus can also be passed on by contact with objects such as dirty bed linens used by a person infected with Ebola. 

Once someone becomes infected with the disease it has up to a 90 percent mortality rate. 

What are the symptoms of Ebola?

Symptoms of Ebola include a high fever- usually greater than 101.5, severe headache, muscle pain, vomiting, diarrhea, and contact with someone who is suspected to have the disease or travel to an area where the disease is active. Eventually a rash and hemorrhaging- bleeding from the eyes and nose develop. Most patients eventually die of shock and/or multiple organ failure. 

Do I need to worry about an Ebola outbreak in the U.S.?

It is certainly possible that close contacts of this infected individual could contract the virus. These individuals are being closely monitored for 21 days after exposure (the incubation period of the virus in which it infects the body but shows no symptoms) to make sure they do not become sick. 

However, in the country as a whole, we shouldn't see an outbreak like we are seeing in West Africa. Infrastructure in African clinics and hospitals is extremely limited. Hospitals often have dirt floors, poor ventilation, and many patients are kept in a single room. Infection control protocols are often nonexistent. Here in the U.S. we are much more capable of identifying and isolating potential Ebola victims to remove the threat of the virus spreading in the community. 

How is Ebola treated? Can it be cured?
 
At this time, treatment for Ebola is largely supportive. This means close monitoring, IV fluids, and blood transfusions as needed while the virus runs its course. There is no definitive cure.
 
A few experimental Ebola treatments are in the pipeline. A new Ebola drug, ZMapp, has also been developed. The drug's safety and efficacy has not been tested in humans however it was given to a few healthcare workers stricken with Ebola and saw positive results. Unfortunately, since the ZMapp is not currently mass manufactured, the drug supply has run out for the time being. Some patients have also been given blood transfusions from Ebola survivors with the idea that antibodies from the survivors will help fight the infection. This has also been a promising development in treatment of the virus. Researchers are also working to develop a vaccine against the disease.
 
Is our medical system prepared to handle an Ebola outbreak?
 
It's debatable. Larger hospitals are better equip to handle outbreaks and new medical problems as they have access to a greater number of lab tests and equipment, for example. When Ebola was first brought to the U.S. in the case of doctors transported to out of West Africa, even Emory University had a few logistical problems in treating the disease. The sanitation company contracted to sterilize the hospital's linens refused to take those contaminated with Ebola. So, healthcare workers at Emory had to make a trip to Home Depot purchasing 32-gallon plastic containers for waste storage until the CDC was able to broker a deal with the sanitation company. 
 
If a patient with Ebola or with suspected Ebola comes to the hospital, what precautions need to be taken?
 
According to the CDC, the patient should be isolated in his/her own room with an accompanying private bathroom. The door is to remain shut and a log book must be kept of all who enter. Healthcare workers are to follow standard contact and droplet precautions. This means protective eyewear, gloves, gowns, and a face mask. Hands should be washed before and after touching the patient and the room kept clean and disinfected regularly. 
 
Ebola virus will be much more easily contained in the U.S. than it has been in West Africa, but as nurse practitioners we need to remain on high alert. Questions patient with fevers about their travel histories. As cough, cold, and flu season is upon us we don't want to let a more serious diagnosis fall through the cracks.