What We Are Not Asking About Ebola and Why It Might Be Fatal

The Ebola virus currently wreaking havoc in West Africa is a new strain. It first appeared in Guinea as early as December 2013 and has now spread to Liberia and Sierra Leone — three countries in which Ebola had never made an appearance until now. The spread has been much quicker in this outbreak than others, affecting both urban and rural areas. The usual protective measures to prevent the spread of Ebola appear to have been less effective in this epidemic. World Health Organization Director-General Margaret Chan outlined the challenges in the international fight against Ebola and called for immediate action on Friday, August 8. Chan announced that an Emergency Committee will be convened next week to discuss the outbreak in the international context. The outbreak has caused international concern after it made its way from Liberia to Nigeria.

While myths and rumors about the Ebola virus outbreak in West Africa are causing panic and paranoia in the United States, what we are missing is a discussion about how ebola is spread and the potential for worldwide impacts. This deadly virus is naturally transmitted from wild animals to people and spreads through human-to-human transmission.

What do we mean by “natural transmission”? Their natural reservoir has not been definitely identified, but certain species of African bat have been associated with Ebola and Marburg infections. Bats appear to carry more deadly human diseases than any other animal. This is largely because different species of bats often stay together in large quantity within small areas. This helps the spread of virus between individuals and species. Bats are the most abundant and widely distributed non-human mammalian species in the world. Overall, more than 60 percent of emerging infectious diseases over the last six decades — from HIV/AIDS to severe acute respiratory syndrome (SARS) to chikungunya — have originated in bats, primates and other animals. Of an estimated 1 million animal viruses out there, only about 2,000 have so far been identified.

Fruit bats are considered to be the likely source of the Ebola virus. These fruit bats are hunted for food in parts of Africa and carry the Ebola virus without exhibiting signs of illness. While cooking the bats would kill the virus, the United Nations Food and Agriculture Organization (FAO) is urging people to avoid the bats altogether because handling the animal in food preparation could put them in contact with the virus. The virus is killed when meat is cooked at a high temperature or heavily smoked, but anyone who handles, skins or butchers an infected bat is at risk of contracting the virus. The animal is widely viewed as a local delicacy and served either dried or in a soup.

Some worry that we may be experiencing the onset of a deadly mutation anticipated and feared for almost four decades. Possibly the most feared scenario is a mutation of the ebola virus that is efficiently airborne transmitted. Since at least the 1980s, epidemiologists have known it’s a possibility. Preston cited Gene Johnson’s 1986 experiment showing airborne transmission of both Ebola and Marburg between monkeys in The Hot Zone. More recently, airborne transmission between species has been documented in a laboratory setting. A BBC article on a recent study, published in Scientific Reports,suggested that airborne transmission could even have affected rates of contagion in some human outbreaks.

Here is where it gets a little scary. We do not know nor or we assessing future threats posed by zoonotic viruses of bats and our knowledge of the factors underlying zoonotic disease emergence are not completely accurate. Because of these shortcomings, we lack an effective zoonotic surveillance plan which enables a rapid response system. The current outbreak in West Africa is our most recent example of our unprepared approach to zoonotic diseases.

What we are failing to do is to address Ebola at its source. A different approach, called one health, seeks to address this problem. The one-health movement seeks to increase awareness of the connections between the health of the environment, animals and human beings, and the importance of collaboration across both disciplinary and political borders. The interdiscipinary cooperation necessary to making this new approach work is in its infant stages and its success will determine our collective ability to address this new breed of deadly zoonotic diseases.

So, could the Ebola virus come to the United States, aside from the two patients currently being treated at Emory Hospital in Atlanta? Count on it. Would it spread widely? Very unlikely. Our hospitals are experienced and excel in infection control measures that will prevent the spread of the disease. American health care workers know how to keep themselves safe while treating infectious patients. And the CDC’s health alert and EPI-X systems of reporting illness will identify infected patients very quickly, allowing the disease to be contained and controlled.