Ebola for Beginners, by Jeff R.

CentOre’s February 7, 2012 article “Signs of the Times: What are the SHTF Tipping Points?” briefly touched on one point that I would like to expand on: Ebola and Marburg viruses.  I am not a physician–I’m not even in the medical field, but I have had the occasion to learn a little more about these viral hemorrhagic fevers (or VHFs) from a research project while pursuing my Bachelor’s degree in Emergency Management. The information available on this subject is constantly changing and involves advanced knowledge in a number of scientific disciplines, so what I can provide is just sort of an Intro to Ebola 101.  I know there are people out there who are better trained and more knowledgeable on this topic than I, but maybe this will get the conversation started.  God forbid that one of these plagues should ever come to our shores, but should that happen, I hope this will help SurvivalBlog readers be a little better prepared for it. 

An Ebola Primer

Most of the viral hemorrhagic fevers in the Ebola family originate in sub-Saharan Africa.  The only exception is variant Ebola Reston, which originates in the Philippines. Ebola Reston causes only asymptomatic infections in humans, but devastatingly lethal infections in other primates.  As we will see, it is important in this discussion because it is the only known variant contractible via airborne transmission.  Ebola viral hemorrhagic fevers all begin with fever, body aches, and chills, but soon progress to vomiting, hematemesis, diarrhea, bloody diarrhea, hemorrhaging, and often, death.

Marburg virus
A cousin of Ebola, this virus is fatal in up to 90% of human infections.  First identified in Marburg, West Germany in 1967, it came to Behring Laboratory in a shipment of African Green Monkeys. Lab workers became infected while using the monkeys and their tissues in polio research. The outbreak spread into Yugoslavia before it was halted.  In 2007, the Egyptian Rousette, a species of African fruit bat, was identified as the reservoir of the Marburg virus (Institut de Recherche, 2007).   It is a wide ranging, migratory species found throughout sub-Saharan Africa and the Nile River valley, which brings the primary reservoir into the same area as the major metropolitan areas of Cairo and the Nile River delta (Egyptian Fruit Bat, 2003).  These cities are a mere six hours by air to Paris’ Charles de Gaulle airport, and twelve to New York’s JFK airport. Or as Dr. Robert Swanepoel of the South African National Institute for Communicable Diseases stated in 2006, “Los Angeles is as close to Ebola as Kinshasa [Democratic Republic of the Congo] with air travel,” (Stoddard, 2006).  Air travel has already brought Ebola to our doorstep. 

Ebola Zaire
Identified in 1976 during an outbreak around Yambuku, Zaire, this variant killed 88% of those infected, making its lethality virtually equal with that of Marburg. The reservoirs of this and all other known variants of Ebola have not been identified, in spite of decades of effort.
Ebola Sudan
Near simultaneously with the above Ebola Zaire outbreak, a second Ebola outbreak occurred in the Nazara and Maridi areas of Sudan in 1976.  The infective agent in this outbreak was also identified as Ebola, but a less aggressive variant, killing only 53% of those infected.

Ebola Bundibugyo
The first outbreak of this variant occurred in the Bundibugyo district of Uganda in December 2007 through January 2008. Ebola Bundibugyo differs significantly from other Ebola variants in that it causes more vomiting and was fatal in only 25% of infections.  Its presentation departed so much from previous expectations that only after laboratory analysis was it identified in August 2008 as a new Ebola strain (Powhall, 2007).

Ebola Tai/Cote D’Ivoire/Ivory Coast
 In November 1994, a Swiss ethologist contracted the fever while performing a necropsy on a chimpanzee found in the Tai National Forest in Ivory Coast. She had used poor barrier protection, and was most likely infected by aerosolized fluids during the necropsy. She was later transported to Switzerland for treatment, and made a full recovery after six weeks. In spite of transportation and treatment without strict isolation, no other human cases occurred (Waterman, 1999).

Ebola Reston
As noted above, Reston causes only asymptomatic infections in humans. Researchers discovered it during a 1989 outbreak at a primate quarantine facility in Reston, Virginia. A second outbreak occurred soon after at another primate quarantine facility in Alice, Texas.  No human illnesses or deaths resulted from the few human infections that occurred.  During the outbreaks, primates housed in different sections from the infected primates soon contracted the virus as well.  Since there was no contact between these groups and the second group had been in quarantine beyond the incubation
period for Ebola, it appears that this variant is communicable through airborne transmission.

Complications

Recombinant viruses
Samples of Ebola Zaire obtained from six dead gorillas and a chimpanzee were found to have different genetic sequences.  In other words, Ebola viruses are capable of recombination, a capability seen rarely in RNA viruses and never before seen in filoviruses (Mackenzie, 2007). Remember the “milder” Ebola variants Bundibugyo and Tai, and airborne but asymptomatic Reston?  Should any of them find their way into a common host with one of the fiercely pathogenic Zaire, Sudan, or Marburg variants, recombination could occur and result in a slower burning but just as deadly new variant of Marburg, or a murderous and airborne variant of Zaire. Had that been the case in Reston, Virginia or Alice, Texas, instead of a few dead Macaques, the result could have been much worse, perhaps even TEOTWAWKI
           
Increasing risk to North America
Ebola has long been in intermittent scourge in sub-Saharan Africa, and has extended it reach into Europe once.  It has not been a major concern to North America for a couple of reasons: 1) outbreaks tend to occur deep in the African bush, and 2) the disease is so aggressively pathogenic that it kills its carriers before they can spread the disease further.  As illustrated above, the potential for an emerging, less aggressive variant is an ever-present risk.
Sub-Saharan Africans have been immigrating to Europe in record numbers. Such immigration to France doubled between 1982 and 1990. By 2005, the African immigrant population of metropolitan France was an estimated 3.6 million (ISEE, 2005). This growth has triggered a rapidly growing demand for illegal bush meat, any of which could carry one of the Ebola viruses or some as-of-yet unidentified hemorrhagic virus.  And it isn’t just Europe’s problem. The black market bush meat trade is a growing problem in the United States and Canada (BCTF, 2009). Anyone who handles Ebola-infected bush meat is likely to contract that disease, and likely to transmit it to others as it progresses through vomiting, hemorrhaging, and death.

Carrier states
According to the Special Pathogens Branch of the Centers for Disease Control, Ebola viruses have no carrier state; that is that there can be no “Typhoid Mary” of Ebola—no person who carries an infective form of the virus yet has no symptoms (CDC, 2009).  While it may seem like sophomoric hubris for one to differ with the CDC on the issue of disease, research indicates that their position may not necessarily be accurate.
Research performed during two outbreaks of Ebola hemorrhagic fever in northern Gabon in 1996 discovered that “asymptomatic, replicative Ebola infection can and does occur in human beings” (Leroy et al, 2000, p. 2210). This same research demonstrated that there were no genetic differences between the Ebola strains found in symptomatic and asymptomatic persons, indicating that that the cases were not the result of viral mutation.  This raises the ugly probability of the Ebola version of Typhoid Mary; persons without the disease but still infected and very much infective.  A further complication arises during convalescence after acquiring Ebola, as viable virus has been isolated from the seminal fluid of convalescing Ebola victims two to three months after the disease has resolved (Leroy et al, 2000, p. 2210).  It is therefore only prudent to assume that Ebola is also sexually transmitted.

Another potential carrier of Ebola viruses are dogs.  During the Ebola outbreak in Gabon in 2001-2002, research was conducted on pet dogs in the area of the outbreaks. Blood samples were taken from dogs living in areas where outbreaks had occurred, major cities, and as a control, dogs in France. In short, testing on the dogs showed an increase in seroprevalence of Ebola as a function of their distance from the outbreak areas. Villages in the outbreak area with an animal source, such as a dead primate, also had the highest level of seroprevalence when compared to villages without an animal source, major cities, and the dogs in France (Allela, Bourry, Pouillot, Delicat, Yaba, Kumulugui, 2005). The researchers concluded that the dogs had been infected with the Ebola Zaire virus that circulated in that area, and that the infections had been either extremely mild, or completely asymptomatic. During these asymptomatic infections, dogs “may excrete infectious viral particles in urine, feces, and saliva for a short period before virus clearance” (Allela et al, 2005, p.389). Ebola is a highly infective pathogen requiring exposure to relatively few virus particles to produce symptoms.  An affectionate lick from an asymptomatic dog might be all it takes to contract the disease.

Implications for the Prepper

The sooner you can pick the truth out of the media noise the more time and distance you can put between the generally diseased public and yourself.  Amidst all the media sensationalizing and the government bowdlerizing, listen for a confluence of these reported symptoms. Parenthetical figures are percent of known historical cases reporting each symptom.

  • Fever (90%-100%)
  • Headache (40%-90%)
  • Chills
  • Muscle pain/joint pain (40%-80%)
  • Malaise (75%-85%)
  • Pharyngitis (20%-40%)
  • Loss of appetite
  • Vomiting (59%)
  • Vomiting blood (10%-40%)
  • Non-bloody diarrhea (81%)
  • Blood fails to clot (71%-78%)
  • Abdominal pain (60-80%)
  • Dry and sore throat (63%)
  • Chest pain (83% of Ebola Sudan infected patients; uncommon in Ebola Zaire infected patients)
  • Abnormal susceptibility to bleeding—hemorrhagic diathesis (71%-78%)
  • Maculopapular rash—flat, red rash with raised bumps (5%-20%)
  • Hiccups (15 %)      (Waterman, 1999)

 

 Your first order of business should be to create distance between you and the GDP as you can as quickly as possible. If ever there was justification to withdraw to your retreat, this is it. The CDC and local health departments will be scrambling to isolate and identify this beast, but it could be weeks before they even know what they are dealing with.  If you don’t have your own piece of the American Redoubt, then quarantine yourself and yours from the rest of the population as best you can. Barring some god awful mutation, Ebola is not airborne, so if you can keep people from coughing, sneezing, bleeding, vomiting, secreting, or doing any other kind fluid-slinging on you, you will be safe. 

Since dogs are likely capable of becoming “Typhoid Mutley” and carrying Ebola, keep stray or feral dogs away from your location. Obviously you don’t want anything that is infected spattering or bleeding around your retreat, so if you can passively exclude dogs and any other carnivores and omnivores from your location with fencing or other measures, it might help prevent you having to kill them within your perimeter.  Also, take care to keep your animals away from strays or wild animals, and don’t let them nose around animal carcasses or droppings. I could not find any information regarding Ebola and native North American wildlife, but the possibility of other animals becoming carriers is a real concern.  Keep this in mind as you go about your daily routine.

If Ebola hits home:
With an incubation period of up to three weeks, going into retreat mode and taking Ebola with you is a possibility.  What if, in spite of all your precautions and preparations, somebody in your group develops Ebola?
At the time of this writing, there are no set treatments for acute Ebola, aside from supportive care in managing hydration, electrolytes, oxygen, and blood pressure. Maintaining the comfort of the patient as best as possible is important, as is doing what can be done to improve their chances of survival and recovery. Due to the extreme pathogenicity of Ebola, extraordinary care must be taken to avoid contamination or infection of others.  Below are the bare minimum of what precautions you should take to protect yourself and the rest of your group while there is an active Ebola infection.

  • Isolation
  • Quarantine
  • Barriers
  • Bleach
  • Burning

 

Isolation of the symptomatic Ebola patient from the rest of the group. Time in the isolation “ward” should be  minimized as much as possible while still maintaining humane and compassionate care.

Quarantine of exposed persons until the maximum incubation period for Ebola has elapsed (21 days). This means any person believed to have had any direct contact with any amount of bodily fluids from the patient.

Barrier protection for any person caring for the patient or handling anything used by the patient.  The bare acceptable minimum of protection is a face shield that covers the eyes, nose, and mouth; mask, gloves, gown, foot covering, and hood.  You don’t have to have a positive pressure biohazard suit (although that would be ideal). The goal is to keep bodily fluid from touching you being inhaled or ingested.

Bleach the soles of the shoes when leaving the ward by walking through a pan of bleach solution. Spray down the barrier protection with bleach solution before removing it.

Burn contaminated clothing, medical waste, and anything else not reusable. This is not the time to try to conserve medical supplies by reusing disposable supplies. Re-use of disposables was a primary vehicle of spreading Ebola in the earlier African outbreaks.

The CDC has a detailed manual covering infection control procedures for Ebola. It is available as a PDF download from its web site, as well as are other resources. It might be a good idea to have that manual saved on your TEOTWAWKI flash drive and a couple of hard copies printed out, just in case. The manual can be found at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm.

Putting familiarization with Ebola and other possible agents of pandemic on your preparation list, and adding some basic barrier and infection control supplies to your stockpile should help you gain an edge over any such outbreaks. With adequate preparation and help from the Almighty, you can make it through an Ebola crisis.

Bibliography

Allela, L., Bourry, O., Pouillot, R., Delicat, A., Yaba, P., & Kumulungui, B. (2005). Ebola virus antibody prevalence in dogs and human risk. Emerging Infectious Diseases, 11, Retrieved April 15, 2008, from http://www.cdc.gov/ncidod/eid/vol11no03/04-0981.htm

Bushmeat Crisis Task Force, (2009).  United States and Canada in “Regions affected.” Retrieved February 18, 2012 from http://www.bushmeat.org/bushmeat_and_wildlife_trade/regions_affected/us_and_canada

Centers for Disease Control and Prevention, (2010, April 9). Ebola hemorrhagic fever information packet. Retrieved February 18, 2012, from CDC Special Pathogens Branch Web site: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/Fact_Sheets/Ebola_Fact_Booklet.pdf

Deadly Ebola virus can mutate, French scientists warn. (2007, November 30). Agence France-Presse. Retrieved February 20, 2012 at http://afp.google.com/article/ALeqM5jVqkLb-RTvPTOkzEkrovrzFYqeJg

Egyptian fruit bat. The centre for the conservation of specialized species. (May, 2003). Retrieved on April 10, 2007 from http://www.conservationcentre.org/scase2.html

Institut de Recherche pour le Développement (2007, September 11). Marburg virus identified in a species of fruit bat. ScienceDaily. Retrieved February 17, 2012, from http://www.sciencedaily.com/releases/2007/09/070909205527.htm

INSEE, (2005). Institut National de la Statistique et des Études Économiques – France – statistiques. Retrieved April 9, 2008, from Le recensement de la population Web site: http://www.insee.fr/fr/home/home_page.asp

Leroy, E. M., Baize, S., Volchkov, V. E., Fisher-Hoch, S. P., Georges-Courbot, M-C, & Lansoud-Soukate, J. (2000). Human asymptomatic Ebola infection and strong inflammatory response. The Lancet. 355, 2210-2215.

Mackenzie, D. (November 2, 2007). Ebola evolves deadly new tricks. Virgin Media, Retrieved March 26, 2008, from http://www.virginmedia.com/digital/science/ebola-evolves.php

Parker, J. N., Parker, P. M. The official patient’s sourcebook on Ebola hemorrhagic fever. Icon Health Publications, 2003.

Powhall, K. (2007, December 6). Ugandan health workers hit by Ebola, causing panic. The Seattle Times, Retrieved March 28, 2009, from http://seattletimes.nwsource.com/html/nationworld/2004056966_webebola06.html?lid=seattle_times&lpos=day_txt_ap_report

Stoddard, E. (June 19, 2006).  Ebola could follow bush meat trade routes to west. Reuters, Retrieved February 19, 2012, from http://www.freerepublic.com/focus/f-news/1651716/posts

Waterman, T. (1999). Tara’s Ebola site: Honors thesis Stanford University. Retrieved on February 15, 2012 from http://virus.stanford.edu/filo/filo.html . This site is also a good source of information on Ebola.

World Health Organization, (2007). Ebola haemorrhagic fever. Retrieved April 12, 2008, from WHO Media Center Web site: http://www.who.int/mediacentre/factsheets/fs103/en/index.html

JWR Adds: One of the surest preventative measures for diseases spread by human contact is isolation. I have long recommended moving to farming or ranching country in the American Redoubt region. (Even before I gave it that name.) Ponder these population statistics (as of 2011):

Idaho: 1,568,000

Wyoming: 563,000

Montana: 989,000

Eastern Oregon: Approximately 300,000

Eastern Washington: Approximately 450,000

Total Population of The American Redoubt: Approximately 3,870,000

Versus:

Tennessee: 6,403,353

Virginia: 8,096,604

Michigan: 9,876,187

New York (Entire State): 19,465,000

Queens County, New York: 2,230,750

Bronx County, New York:1,385,100

Thus, the combined population of The American Redoubt is about the same as just two boroughs of New York City.

The bottom line: If you want to survive a pandemic spread by casual contact, then your best chances will be in lightly-populated places like the American Redoubt region. Just be sure to stock up on plenty of storage food and fuel, so that you won’t have to make any trips to town for the first 18 months of a pandemic.

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