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  October 3, 2014

What's Behind the Ebola Crises and are U.S. Americans at Risk?

In an interview with Telesur's The Global African, Johns Hopkins Infectious Disease Program co-director Taha E. Taha discusses the roots of the Ebola crisis and what can be done about it. Courtesy of Telesur
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BILL FLETCHER JR., HOST, THE GLOBAL AFRICAN: Helping us to better understand this, the extent, scope of the Ebola crisis is Dr. Taha Taha. Dr. Taha is a professor of epidemiology and population, family, and reproductive health. He's a codirector of the infectious disease area of concentration in the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland. Dr. Taha is a physician with extensive training and experience in infectious diseases, community medicine, public health, and demography.

Dr. Taha, welcome to the program.


FLETCHER: Thank you.

TAHA: Thank you for having me.

FLETCHER: Could you give us some background on the epidemiology of the Ebola?

TAHA: Ebola, it was known as Ebola hemorrhagic fever until recently. And now it is called Ebola virus disease. It is a severe disease, infectious disease, and often it is fatal. As we see from the reports today of those who are infected, a proportion of over 80 percent will die. So it is an infectious disease. It is a severe disease.

However, we know very well what Ebola is today. Since 1976, we have been through several outbreaks. And what is happening in West Africa today we believe is not that different from what has happened in the past. It could well be more severe as far as the numbers are concerned, but we have enough experience about Ebola virus disease.

FLETCHER: Tell us, how does it spread? I heard President Obama assure the public that it's not airborne. How precisely is it spread?

TAHA: Yes, indeed the major mode of transmission is not airborne. It is not like several infectious diseases we have seen recently, emerging infections that are spread airborne.

However, Ebola is transmitted through direct contact, be that the patient or the secretions from the patient. Any bodily fluid, be that urine, the vomitus, the fluids that come out from the body, any of these could be infectuous. And the virus can remain infectious for a couple of days outside the body as far as there is fluid and there is material. But contact, direct contact or indirect contact, is the main mode of transmission. It is different, for example, from HIV. It is different from some other infectious diseases we know that are airborne. So as far as being infectuous, we know the mode of transmission, and it requires intimate contact with an individual who is infected or dealing with infectious material from that individual. It is not transmitted through the air.

FLETCHER: So a person can actually transmit this when they're showing symptoms or before they show symptoms.

TAHA: The incubation period--and this is a period through which the virus will enter the body, and then it will start transmitting or the individual will start shedding the virus. This period is about two to 21 days or about three weeks. So during this period, the individual can transmit the virus or will remain shedding the virus.

Certain symptoms we know, clinical features, occur early, and then some others occur relatively late, for example fever, headache, muscle ache. And these early symptoms occur early, and probably universal--everyone will probably show fever and headache.

And then the main features for which this disease has become known--and that is bleeding, the hemorrhage--that comes probably during the second or the third week. At that time, the individual will be seriously sick and there will be bleeding probably from every orifice or every opening in the human body. So the infectiousness is during this period.

FLETCHER: Can this be stopped, this outbreak?

TAHA: Yes. I think thinking of preventing or controlling this outbreak, we need to probably, for better of understanding, consider two settings. One is the community, and one is the health care system. The health care system, especially the hospital, acts as an amplifier. Individuals who are sick go to the hospital. Usually during the early days of the outbreak it is not well known. It resembles so many diseases, like malarias, and so many--typhoid fever, respiratory diseases, that are quite prevalent in these remote areas where these outbreaks occur. So what happens in the hospital is very important, and a degree of vigilance and management--throughout the year or throughout all times, the hospital should be alert, and doing the appropriate and reasonable management for these contacts.

However, these health care systems, the infrastructure is very poor. The personnel is not always [sterile (?)]. So there are breaks in the system. Therefore, when these outbreaks occur, the health care system is not able to handle it. And therefore it becomes another source that actually facilitates transmission. So this is the health care system. So management of this crisis in the hospital is very important, is very critical.

FLETCHER: What did you make of the stories that we were hearing about entire villages that would not allow medical personnel to enter?

TAHA: So this is the part of the community. So we said something about the health care system. The community is very important. Usually these outbreaks occur in very remote areas where the communities are not accessible, being alert or knowledgeable about this outbreaks is not all the time present. There is a stigma, there is lack of information, rumors, and so many other negative things. When these diseases occur, these outbreaks occur, people become more not allowing the health personnel or others from outside to get to the village and know what is happening.

So what happens in the community is probably natural, but it requires community participation, education, and some level of trust.

FLETCHER: And I understand that there are burial processes or rituals that are followed in many West African communities that actually help to perpetuate the spread of this disease.

TAHA: Yes. Yes, indeed. And I personally can tell you. I mean, I have greeted or I have managed one or two cases of Ebola. I have seen them. So just casual contact is not the problem. But these burial processes and how they're prepared, the individuals who are infected--and these activities, of course, it is not specific for Ebola. This is what they do all the time, that they take care of the dead [whether someone is not there or not (?)]. So there are certain rituals that these communities--and based on, of course, religious and traditional and so many other things--this is what they do all the time. So not, for example, preparing a case for an individual who has died of Ebola in the same way might not be the norm. But certainly individuals who die are taken to the village and prepared, and then the burial process. So in this process--and usually this is done by, say, for example, some elderly or individuals who have no knowledge of what they are dealing with, and this is certainly very infectious. So washing the individual or preparing the individual for burial, and then the ceremonies that goes with that, is quite substantial. And there are several steps during this process that the individuals who are handling this, the disease, might become exposed.

FLETCHER: Some of what I've read indicates that they speculate that this may originate among bats. And I just wonder whether that is founded on something. And second, there's discussion about the impact of deforestation and cooking and other things that may have contributed also to this. And I just wonder whether you can dispel myths versus the facts.

TAHA: True. One of the mysteries is that we do not know the source of the virus. The first outbreak occurred in 1976 in between DRC, the Democratic Republic of Congo, and Sudan, South Sudan. So that is when it happened. Since then there has been so many studies and investigations to find out what is the source. There are several animals that has been incriminated. One is bats, the fruit-eating bats, and others, including monkeys, including antelopesz So there are several animals that have been thought that could be facilitating this passage from wherever it is hiding to individuals, individuals eating this and these animals are handling these animals, and this is how they get infected.

However, between outbreaks--and this sometimes tend to be 10, 15 years--where is a virus hiding? We do not know. So that is a bigger mystery, to explain where it is hiding. So the bats and the animals antelopes could well be intermediaries where the virus sides. Or are they the real source? No one is able to say that, but certainly there is an association between the virus and these, the bats and certain animals.

FLETCHER: In the recent past, within the last week or so of the outbreak, in the United States there have been some very strange political commentators, particularly on the right, the right-wing, that in responding to this have been sowing seeds of what feel like panic, extreme measures, not letting victims of Ebola return to the United States, and other such things. It would be useful for you to explain what's the relative danger in the United States. And what do you say when a commentator says, shut the border, you can't allow any Ebola victim in the United States?

TAHA: It is probably fair to say that the likelihood of Ebola getting established in the U.S. is almost nil. It is very minimal. There is a very good health care system. The amount of vigilance, the surveillance, and management of these cases, should it ever appear in the U.S., will not be difficult at all.

What is more problematic are in remote areas, in the villages of Africa, that is where these things originate. And then it moves to the urban setting, like is what is happening in West Africa. But it is not a threat to the U.S. It is not spread through handshaking or--people of course need to be careful, but it is not casual the spread. It is not airborne. So there are features that are different from other infectious diseases. So thinking that Ebola can spread in the U.S. is--the likelihood is very minimal. However, precautions should be taken, and this is not any different from other disease.

So it is an emerging infection infection. It happens from time to time. However, managing two individuals or three individuals in the U.S., [incompr.] it doesn't have any chance for the disease to spread.

FLETCHER: What would you recommend for countries in West Africa in responding to this crisis now at this very moment, not if they could do it, if we could rewind it, but right now? What does the West African community need to do?

TAHA: It is management of these cases at the two levels we certainly believe are important. And this is at the community level, and also at the hospital level or the health care system.

Unfortunately, the health care system is already overwhelmed. There are so many diseases. The infrastructure is not good. The number of physicians or the nurses. The system is just overwhelmed. So thinking that the health care system in West Africa alone can do this will not be realistic.

At the community level, much more information is needed, and that is where it originated, and that is where the level of knowledge should be most strong, by educating. However, just thinking that, people can change their level of acceptance and changing behavior very quickly will also not be realistic. So a certain level of education is needed to increase awareness and spread as much as we can to the community that this is a serious disease. They shouldn't hide. They should be forthcoming, And that can only be done by community participation and getting the trust of the community. At the health care level, much more is needed as far as the isolation and all the support that we'll need. Treatment of this disease is supportive. There is no vaccine, there is no treatment; therefore it is supportive to the patient, and also to the health care system itself.

FLETCHER: Dr. Taha, thank you very much for this illuminating discussion and helping to dispel the myths and fears that are being propagated, but also grounding this in the seriousness of the situation facing West Africa. Thank you very much.

TAHA: Thanks very much for the opportunity.

FLETCHER: Our pleasure.

And thank you for joining us on this segment of The Global African. We'll be back in a moment.


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