Thursday, 7 August 2014

It is perfectly okay to be a bit freaked out by the Zaire ebolavirus...

The Zaire ebolavirus (abbreviated as EBOV) is one of 5 species of ebolavirus and a member of the same viral family as the species Marburg marburgvirus (yeah, I know). Three of the ebolaviruses, EBOV, Bundibugyo ebolavirus (BDBV) and Sudan ebolavirus (SUDV) are associated with Ebola virus disease (EVD) while Reston ebolavirus (RESTV) and Tai Forest ebolavirus (TAFV) are not.

Much has been written this week on why you are perfectly safe from an outbreak of EVD in your (judging by VDU's stats) probably non-West African home town, or while at the fruit shop or on your couch watching the trailer for Guardians of the Galaxy on endless loop while clutching your ticket for tomorrow night (it's reeeal). 

A plane may deliver an infected person to your country, but our healthcare system will catch it. It will be contained, kept in its box like a hyperactive yet frustrated boggart. Nothing to see here. Move along please. These assurances come after the preceding week in which we felt the aftermath of the first symptomatic "EVD on a plane" incident, 2 US healthcare workers becoming infected and the death of a very bright light in the treatment of EVD patients in Sierra Leone. Twitter's ebola hashtag has been afire like a stock exchange ticker ever since 2-weeks ago.

I'm here to say, it's okay to freak out as much as you like...just don't run into traffic, sell the kids or move to an isolated farm and stock up on tinned food. It's not that kinda bat-crazy. (apt)

So what is it about EVD that could warrant you feeling more fearful about it than about other fatal infections that are far more common? 

Don't forget >14,000 deaths due to Clostridium difficile infections per year (1), 200,000 people die of cholera each year (2), >600,000 died of malaria in 2012 (3) and >1,000,000 died from an AIDS-related illness in 2012 (4). Big numbers. How does our fear remain in the face of that tide of microbial mortality?

Could our unreasonable fears be due to any of these?:

  • Most diseases on that list are (still) treatable. HIV not so much, and antimicrobial resistance is of course on the rapid rise. Yet EVD kills more than 1 person in 2 and it does so quickly. That's scary. It isn't treatable; although that could be changing if the ZMapp "plantibody" and its pipeline comrades ever get to decent controlled trials.
  • Perhaps you just don't fee like you will get cholera or AIDS. They are "somebody else" problems but this jungle virus, well that's all over the TV, the papers, the web and on radio. It must be spreading fast.
  • This outbreak has spread widely in 3 countries, and cases are being added in numbers above 100 every few days. Now EVD seems to be spreading from that person who travelled on a plane while ill. Healthcare worker contacts seem to be bearing the brunt in this 4th country (Nigeria). OH, and he vomited on one of the planes he took on his multi-stop journey from Liberia to Nigeria.
  • EVD is a haemorrhagic fever. Haemorrhagic fever I said - arrggh!! No wonder they changed that name! It just sounds scary.
  • Around 40% of cases show obvious signs of bleeding. Not the movie level, leaking-like-a-sieve stuff though. But someone is bleeding. On the outside. For everyone to see. From a virus infection. 
  • EVD starts off like the flu, or the effects of a dodgy curry but it can end up with you laid out, alone and dying, with only your suited carers for close yet distant comfort.
  • Entire families get wiped out during these outbreaks. Perhaps not scary, but heart wrenchingly tragic and something we can feel in our own guts.
  • Even experienced healthcare workers get infected by this virus. Sure, this is likely attributable to the hot, overwhelming conditions, to the numbers of cases, under-resourced clinics (by big shiny HEPA-filter equipped hospital standards anyway), tiredness and accidents, but it's happening.
  • Just because! Humans watch in fascination the most exotic and scary things. Many like to be scared.

So I think it's okay and even perfectly normal to feel uncomfortable, worried, fearful, perhaps even a bit angry that your country is not doing more to help in West Africa, or is doing so a bit late.

Don't add guilt about having those feelings. 

But do make sure you reality check yourself and your friends.

Some of the concerns listed above just won't be a problem for you in your neck of the woods. Most of us were probably born into a very different situation to those being ravaged by the Zaire ebolavirus variant, a virus about which little was known by those who live in the region, until very recently. Perhaps that is partly our fault since we have lately been able to show that ebolaviruses are not new there after all (5). But this multi-country outbreak is likely to have started through practices that have been commonplace yet not ever resulted in this sort of death before. Most who will read this do so from a place of relative privilege. You are not likely to see an EVD case in your life. Do what you can to find out the facts. WHO and the CDC have many great webpages of resources that can help teach the realities. Read them. 

One reality is very clear, West Africa needs help to shut this down. It should have had it sooner.

Fear is fine, but remember your reality.

References..

  1. http://blogs.scientificamerican.com/molecules-to-medicine/2014/08/05/ebola-and-priorities-in-drug-development/ (from http://blogs.scientificamerican.com/molecules-to-medicine/2014/08/05/ebola-and-priorities-in-drug-development/
  2. http://www.who.int/mediacentre/factsheets/fs107/en/
  3. http://www.who.int/mediacentre/factsheets/fs094/en/
  4. http://www.who.int/gho/hiv/en/
  5. http://wwwnc.cdc.gov/eid/article/20/7/13-1265_article