“One of the big problems with this disease is it impairs adaptive immunity. You don’t develop an antibody response initially, so you’re not killing off the virus appropriately,”
James Sexton, MD, an assistant professor of medicine in pulmonary and critical care at Upstate University Hospital, told medical staff Tuesday in a lecture about the disease that’s on everybody’s mind.
Infectious disease precautions are part of standard training for doctors, nurses and other hospital staff. They have been practicing how to care for a patient with Ebola since before Upstate was designated one of eight hospitals in New York State that would handle Ebola patients.
People who arrive at Upstate are asked whether they have traveled to West Africa or had contact with anyone who has been diagnosed Ebola. “The priority here is identification and safe handling of that patient and protection of our staff,” explains Christopher Dunham, Upstate’s director of emergency management. Anyone suspected of having Ebola would be placed in an isolation room. Then as their treatment began, a doctor from Upstate would confer with Onondaga County and state health officials, and the Centers for Disease Control and Prevention.
Part of the preparedness training at an academic medical center such as Upstate includes educating staff in the science of the disease, which is what Sexton’s lecture accomplished.
He said most people develop symptoms five or six days after they are infected, although the incubation period for Ebola is considered 21 days. Some people have developed symptoms beyond those 21 days.
An infection with this outbreak of Ebola has typically begun with flu-like symptoms of fatigue and fever. Initially, the virus affects white blood cells called macrophages and the dendritic cells, which are part of the immune system.
The diarrhea that develops can be severe, with patients losing up to 10 liters per day. “Obviously you’re going to have all sorts of problems from fluid and electrolyte losses if you’re putting out that much diarrhea,” Sexton said.
Ebola also causes vomiting, loss of appetite, headache, abdominal pain and muscle aches. Weakness comes from dehydration.
Patients have reported nonproductive coughs and sore throats with the sensation of a lump in the throat. Some have developed eye infections, and some have seen their mouths become dark red in color.
A rash may develop that later peels.
A patient who is pregnant when she is infected is likely to miscarry.
Some patients struggle with a low platelet count, which impacts their blood’s ability to coagulate. Bleeding, however, is not a common symptom.
People are not infectious until they have symptoms, and Ebola has no respiratory spread. “You can only catch it if infected fluids contact mucous membranes or somehow get direct contact with blood, through breaks in the skin or needle sticks,” Sexton said.
He said the virus damages the tissue of the liver, adrenal glands and spleen. Even though the body at first does not create antigens, it does mount an inflammatory response. Cells that are damaged release chemicals that cause swelling, which helps insulate the tissues from the virus.
“When you do develop an antigen response is really when you start to get better, if you’re going to get better,” Sexton said. “People who never develop an antigen response die.”
Improvement or death usually occurs between day 6 and day 16. People who die from Ebola suffer multiple organ failure and septic shock, a full body infection that leads to a dangerously low blood pressure.
People who survive Ebola face a lengthy convalescence. Weakness, muscle aches and fatigue are liable to linger, and weight regain can be difficult. Sexton said there may be hair loss and extensive sloughing of skin. Also, the virus may remain present in semen and breast milk for weeks or months.
People who survive Ebola likely develop an immunity to that strain of Ebola, Sexton said. “No one, as far as I know, has been exposed to the disease a second time, but because you now have an antibody response, you may not be able to get the disease again.
Sexton said experts believe “the antibody response is key. Once you develop that, you get over the disease,” he said. “The big problem with the disease is you don’t develop that for so long — until it’s gotten so bad that it’s caused all these other problems.”
Christopher Dunham explains how the hospital has prepared for Ebola
Timothy Endy, MD, tells the science of Ebola
Facts about Ebola
Almost 1.07 million people in Africa do NOT have Ebola.
Ebola belongs to the same order of viruses — called the Mononegavirales — as measles, mumps, rabies and Marburg, a hemorrhagic fever virus.
There are five strains of Ebola. The one grabbing headlines lately is called Zaire, and it is responsible for two current outbreaks — the large one affecting Guinea, Liberia and Sierra Leone as well as a smaller outbreak in an isolated village in the Congo.
The mortality rate for the large outbreak, through Oct. 26, is 49 percent. Of 10,207 people infected, 4,971 have died.
The virus is not a respiratory virus. It enters the body through the mucus membranes or a break in the skin. Cases of transmission have also been reported through needle sharing and through the ingestion of meat from bats, monkeys or primates that carried the disease.
The blood, feces and vomit of someone with Ebola are most infectious. Urine, semen and breast milk are less so. Saliva and tears may be infectious. Sweat is probably not.