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Dr Chireka: Let's talk about Ebola
14/10/2014 00:00:00
by Dr Brighton Chireka
 
 
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I DELIBERATELY did not compile an article on Ebola as I thought that every media on earth was covering it and the message was being spread to everyone. But I was taken aback when I visited my former school Rusununguko in Bromley Zimbabwe to introduce the foundation I formed to help students who were facing financial hardships. I gave a speech encouraging students to work extra hard to achieve their goals and I encouraged them to have a vision and a strategy to achieve that vision. I left them with the message that, If one does not have a vision, that person is like a bus without destination; lack of destination means any direction is ok but one may end up moving in a circle. 

But as I was walking to the car ready to leave the school, I was approached by several students asking different questions. I was seriously concerned when one student asked me about the Ebola virus. What concerned me was that after talking about Ebola, he went on to say that the Ebola virus was made in the laboratory to wipe black people out and also attributed the same reason to HIV. My diplomatic answer to him was that there was no evidence to support his views and also that I do have white patients who are HIV positive and if the idea was to wipe black people then it failed as white people are also getting infected and dying. After this encounter, I think I need to compile an article on Ebola and share with readers of this column. Please feel free to comment or share with as many people as possible. My aim is to make sure that the correct information does reach as many as possible.

It is inevitable that an Ebola case will surface in many countries even in Zimbabwe but I do not expect Zimbabwe to be unprepared as we have enough time to prepare and learn from those countries that have the outbreak. 

This current outbreak is likely to spread worldwide if the arrogance we are noticing continues. How can The director of the Dallas County Health & Human Services in America give a press conference saying, "health officials are ready: This is not Africa. We have a great infrastructure to deal with an outbreak". This statement was made soon after confirmation of the first US Ebola case. Sadly they had to swallow their words as the person soon died regardless of being in the US.

Ebola virus

The Ebola virus first appeared in 1976 in two outbreaks at the same time, one in Nzara, Sudan and another near Ebola River in Democratic Republic of Congo, from which the virus takes its name. There have been several outbreaks since 1976 and the current one in West Africa started in March 2014 and is the largest and most complex. As I write this article there are more than 8,900 cases and more than 4,000 deaths recorded so far and these figures are more than the total figures from all previous outbreaks combined. It is projected that if no proper action is taken there will be about 5,000 to 10,000 new cases per week and over a million people will be affected by December this year. So far, the virus has spread from Guinea, Sierra Leone and Liberia and cases have been reported in Nigeria, Spain, German and USA. On August 8, the WHO Director-General declared this outbreak a Public Health Emergency of International Concern and the world is starting to take action now - two months later. 



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How is Ebola virus spread?

This is very important to understand as an informed population will play an important role in preventing the spread of this virus. I urge you to spread this information to your friends and if each person reading this article can pass this information on to at least three other people and each person continues to reach three more new people then we will get this message to a wider audience.

It is thought that fruit bats are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (e.g. bedding, clothing) contaminated with these fluids. This means that it is not passed through air and you do not get it by being in the same bus or plane with an infected person unless you come into direct contact with the infected person or body fluids of infected people.

Health-care workers (Doctors and nurses etc.) have frequently been infected while treating patients with suspected or confirmed Ebola Virus Disease. This has occurred through close contact with patients when infection control precautions are not strictly practiced. It is advisable that the wearing and removal of protective clothing by healthcare professionals is properly monitored. Failure to monitor this can result in healthcare professionals getting infected. There is also need for continuous training of healthcare professionals on the latest information on Ebola virus and also on preventative methods. In an outbreak, there is need to limit the number of healthcare professionals that are in close contact with infected people.

Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. I know our African culture can make infection control difficult. We need to remember that dead bodies are still infectious; traditional burial rituals may spread the disease. Nearly two thirds of the cases of Ebola infections in Guinea during this current outbreak are believed to have been contracted via unprotected (or unsuitably protected) contact with infected corpses during certain burial rituals. There is need to understand people's traditions and find ways of preventing the spread of the virus. This needs to be done before death as approaching relatives during the funeral can be violently resisted as witnessed recently in West Africa where healthcare officials were attacked.

People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness. This means that these men that have recovered need to be supported and continue to be educated for a period of at least 2 months or else they will spread the virus through sexual contact.

Symptoms of Ebola virus disease

The incubation period, that is the time interval from infection with the virus to onset of symptoms, is 2 to 21 days. Humans are not infectious until they develop symptoms. This means that unless a person has symptoms he or she will not pass the virus to other people. This is very important to understand so that people do not panic unnecessarily. This calls for personal responsibility as the infected individual can make a huge difference if he or she avoids contact with other people and calls for medical help.

At my surgery in Folkestone Kent we have a poster on the window advising patients what to do and avoid coming into the surgery.  First symptoms of the virus are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools).

Diagnosis

It can be difficult to distinguish Ebola virus disease from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made using specialised tests such as antigen-capture detection tests and virus isolation by cell culture to just mention a few tests.

Some countries such as Zimbabwe do not have facilities to carry out these tests, they rely on South Africa. This failure to have testing facilities has been heavily criticised in the social media and people are panicking as they wrongly think that failure to have testing facilities equates to inability to deal with or prevent an outbreak. This disease can be controlled by isolation of infected people, contacting, tracing and protecting the healthcare personnel looking after these patients so lack of testing facilities does not mean disaster. Samples from patients are an extreme biohazard risk; laboratory testing on non-inactivated samples should be conducted under maximum biological containment conditions. These samples, if not handled properly, can be a source of infection to healthcare workers.

Treatment and vaccines

Supportive care-rehydration with oral or intravenous fluids and treatment of specific symptoms improves survival. There is as yet no proven treatment available for Ebola virus disease. However, a range of potential treatments including blood products, immune therapies and drug therapies are currently being evaluated. No licensed vaccines are available yet, but two potential vaccines are undergoing human safety testing. This means that the best way to treat this virus at the moment is to prevent it! Your input is needed and we should stop playing politics with the lives of other people as your individual choices can have a detrimental effect on others.

Prevention and control

Prevention relies on a lot of interventions from proper management of infected people, monitoring the disease pattern, tracing all the contacts (people that have been in contact with infected people), a good laboratory service, safe burials and social mobilisation. The community must fully engage with the health authorities in order to control the outbreak. Irresponsible reporting and false alarms are not needed if the outbreak is to be controlled. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission. Risk reduction messaging should focus on several factors.

I urge you all to make sure that you familiarise yourselves with the following: 
Reducing the risk of wildlife-to-human transmission

Avoid contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.

Reducing the risk of human-to-human transmission 

Avoid direct or close contact with people with Ebola symptoms, particularly with their bodily fluids. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.

Outbreak containment measures

There is need to promptly and safely bury our dead and identify people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, the importance of separating the healthy from the sick to prevent further spread, the importance of good hygiene and maintaining a clean environment.

I hope I have managed to cover the basics about Ebola and I believe that we have to look at what is in our hands before we cry for help. Let's take advantage of our chiefs and rural setups to spread the message and, also, let's use the social media such as Facebook and Twitter and mobile phones to spread the current information about Ebola. Econet is already playing its part in educating the nation on health issues and I urge them to include information on Ebola.  Let us all remember that isolation of suspects of Ebola is not the same as an outbreak of the virus. It is this isolation that will prevent the outbreak and on that note I welcome the efforts by many countries, including Zimbabwe that are trying to prevent the spread of Ebola virus.

This article was compiled by Dr Brighton Chireka who is a GP and a Patient Engagement Advocate (PEA) in Folkestone Kent in UK. You can contact him on brightonchireka@yahoo.com

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. He would like to thank the WHO for the most updated information.


 
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