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Ebola Virus Disease:

What Do I Need to Know? How Can I Help?

Dr. Robert Fowler

The Ebola virus disease epidemic in West Africa has been a persistent topic of medical and public conversation over the past months. As the number of cases continues to rise, many of us undoubtedly wonder ‘What can be done?’ or possibly, ‘Is there any help that I can offer?’ We want to both provide an update on the current status of the outbreak and offer a number of engagement mechanisms for members to consider.

Where is Ebola?

This is first Ebola virus disease outbreak in West Africa and has become the largest the world has ever experienced. Although its origins lay in rural Guinea in late 2013, the outbreak was only recognized in March 2014. Since that time, it has spread throughout West Africa: Guinea, Sierra Leone, and Liberia have been the hardest hit, while Senegal and Nigeria have had small outbreaks due to imported cases and have had no further cases reported during the past 21 days. The United States has had an imported case, and two health workers have since tested positive for subsequent infections. There is an epidemiologically distinct outbreak in the Democratic Republic of the Congo. A number of countries have received repatriated healthcare workers, who have had either exposure or illness, in order to provide medical care.

Why does Ebola create so much apprehension and fear?

As with many prior outbreaks – SARS, MERS and pandemic influenza – the Ebola virus disease conjures fear in the general public, and often considerable apprehension for us as providers of healthcare. This is natural. There is a historically high mortality rate, no specific antiviral medication, and importantly, most of us have never treated a patient with Ebola.

How can I avoid getting Ebola?

A number of points deserve emphasis. First, the mechanism of transmission is person-to-person, through direct contact with the bodily fluids of someone who is symptomatic to another person’s mucus membranes – eyes, nose and mouth – or rarely, through percutaneous exposure with a sharps injury. Ebola is a febrile gastrointestinal illness. Symptoms can occur 2-21 days after exposure, with fever, fatigue, myalgias which progress to nausea, vomiting and diarrhea. If someone does not present with symptoms, they are not infectious to others. Because symptoms are non-specific, a travel history (to West Africa) and contact history (to those symptomatic, to funerals) are important to solicit.

 

Using standard (excellent hand hygiene) and contact precautions when providing medical care to symptomatic individuals (use of gloves, a mask, goggles or a face shield and a gown) and strict adherence to infection prevention and control practices including donning and doffing personal protective equipment, you can prevent person-to-person transmission. These are the same standard and contact precautions we should take everyday in caring for potentially infectious symptomatic patients. You cannot get Ebola from talking at a distance with someone who is infected – it is not “airborne” unless aerosol-generating medical procedures are performed.

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Will there be a case of Ebola in Canada?

It is possible that healthcare providers and hospitals in Canada will provide care for either a healthcare worker from West Africa or potentially, a traveler who subsequently develops symptoms after arrival. Health care providers and public health systems are preparing for this.

What can I do to help at home in Canada?

First, we should all be aware of the symptoms, seek contact and travel history for Ebola for individuals with fever and/or gastrointestinal illnesses and contact the right people – your hospital infection prevention and control officer or the public health authorities in your area – should you suspect a case (http://healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/ebola/professionals-professionnels-eng.php).

What can I do to help in West Africa?

West Africa cannot begin to cope with the overwhelming burden they are facing without help from the international community. Without our help, the outbreak there will not soon be controlled; and, will pose an ongoing threat for other regions. West Africa desperately needs more clinicians to help safely treat patients with Ebola. In Guinea, case counts remain high and there are active treatment centers in many locations. In Sierra Leone and Liberia, there continue to be more patients than beds in Ebola treatment centers. With excellent supportive care, patients with Ebola can survive. Due to an incredible humanitarian response over the past weeks, many treatment centres have been constructed. Now government and non-governmental organizations need clinicians to help local health workers provide care. Many groups are leading and assisting in the fight against Ebola – please consider applying to help through the following organizations.

The World Health Organization (WHO) is seeking physicians and nurses, infection prevention and control experts, epidemiologists and others to assist country WHO offices in the Ebola response. Click here to apply.

Médecins Sans Frontières (MSF) is an international medical relief organization, providing medical care in Ebola treatment centers in West Africa. Click here to apply.

Canadian Red Cross is currently seeking clinicians and others to work in Ebola treatment centres in West Africa. Click here to apply.

International Medical Corps is a global humanitarian alliance seeking Emergency Response Volunteers for the Ebola epidemic in West Africa. Click here to apply.

Dr. Robert Fowler is a critical care physician and Associate Professor of Medicine at the University of Toronto and director of research for the Department of Medicine at Sunnybrook Health Sciences Centre. He is a clinical lead for the World Health Organization in the West Africa Ebola virus disease outbreak, and has worked recently in Guinea, Sierra Leone and Liberia, providing primary care to hundreds of patients so far.