Ebola I - The Basics

I've been thinking about this topic for a while and procrastinating a bit to see where things go, but it's time to write this post. Ebola is coming. What it will look like, what it will mean, and whether it turns into the scare everyone's worried about remains to be seen, but there's no doubt about it, physicians and hospitals need to be prepared. I'm going to spend a few blogs writing about Ebola, not because it in itself is such a remarkable disease, but because its an outstanding case study in learning about the response to new and emerging infectious diseases, the globalization of health, the cultural context of disease, media and public response to threats, disaster preparation, and what it's like to be a physician for these patients.

First things first. Ebola was discovered in the mid-1970s so it's not a disease that's been around all that long. Its origins hint at where new diseases may come from: the transmission of viruses from animals to humans. Many recent infectious agents like HIV, swine flu, and avian flu have animal reservoirs, and perhaps this is what fascinates infectious disease and tropical medicine specialists. The exact host and viral life cycle are unknown so far, though evidence suggests a reservoir in bats. There have been over a dozen prior outbreaks, but each has been limited and has not caught global attention. In medical schools, Ebola and its related viruses are presented probably for five or ten minutes. After the 2014 outbreak, I am sure there will be more focus on it. This, also, is interesting; most physicians learn about Ebola by talking to the experts and reading the publications. I, certainly, was not well-versed in the disease, but when I found out I might be taking care of these patients, I started studying.

One challenge with Ebola is that its presentation is nonspecific; its symptoms could result from any number of diseases. Like most viral illnesses, it begins with fever, malaise, aches, and pains. Over the next few days, its symptoms move to the gastrointestinal tract with nausea, vomiting, and diarrhea. It kills patients due to severe dehydration and resulting metabolic disturbances and organ malperfusion. Diagnosing Ebola lies in the history: where has a patient traveled and who has he been in contact with? For now, while the outbreak remains in West Africa, screening patients is relatively easy, but if Ebola spreads to Europe or the United States, this will become a major problem.

Image is in the public domain, from Wikipedia.