Global cooperation needed to stop the spread of Ebola virus disease

The news and images out of West Africa, the center of an outbreak of deadly Ebola virus, are a bit scary. In the three countries affected by the outbreak —Liberia, Sierra Leone, and Guinea — more than 1,300 people have been sickened by the virus and more than 700 have died. Liberia closed its borders in an effort to prevent the infection from spreading. Images of health workers in protective gear ministering to patients and disinfecting the dead flash across screens. The Peace Corps has pulled all of its volunteers out of the three countries, and U.S. health officials have issued a warning not to travel to this area.

The Ebola virus (its name comes from the Ebola River in Zaire, site of the first known outbreak) causes an illness known as hemorrhagic fever. It is characterized by aches, fever, abdominal pain, organ failure, and uncontrolled bleeding. A person who has Ebola is contagious for up to 21 days. Spread of the infection occurs by direct contact with body fluids. There is no known cure, and half or more of those who develop Ebola virus disease die from it. Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, called the Ebola virus "a dreadful and merciless virus."

We live in an interconnected world in which air travel can spread contagious infection thousands of miles away in a few hours. As a physician, I am bracing myself for the possibility that Ebola may spread away from West Africa to other nations — like the United States. This morning, the director-general of the World Health Organization warned that "this outbreak is moving faster than our efforts to control it," and it comes with a "high risk of spread to other countries."

Preventing the spread of Ebola

This epidemic of Ebola virus disease has accelerated in the past couple of weeks. Experts from the World Health Organization and Centers for Disease Control continue to reassure us that its spread can be contained with appropriate care. This is true. But appropriate care is difficult—it requires a long stretch of quarantine for anyone who contracts Ebola virus disease and those who come into contact with them.

Work is being done to control the spread of the disease. There is a "level 3" travel advisory for the involved countries, which warns against nonessential travel to them. Surveillance methods are being put in place at airports to check individuals leaving the affected countries, so that no one travels while having symptoms that might turn out to be Ebola virus disease. A person without symptoms is not contagious, even if they have been exposed to the virus.

Here are some strategies that will help contain the disease:

• Identify new cases early. This means that health systems grappling with the epidemic need financial support so they can do appropriate lab testing, and they need the trust of their communities. Trust requires collaboration with local traditional healers.
• Isolate (quarantine) patients during the 21 days they are known to be potentially contagious.
• Identify people who have been in contact with individuals with Ebola virus disease and watch them carefully for the appearance of symptoms.
• Meticulous use of safe burial practices and protective clothing. Medical providers should use hoods, goggles, gloves, boots, and multiple layers of gowns when caring for Ebola virus disease patients.
• Research the non-human source ("reservoir") of Ebola virus. So far, experts aren't 100% sure how epidemics of Ebola begin. Spread from a mammal, possibly a fruit bat, is suspected but not proven.
• Develop a treatment and vaccine.

Looking ahead

The United States government has said it will work with other countries to try to end the Ebola epidemic. The CDC announced yesterday that it will send 50 more disease-control specialists into the three countries in the next 30 days. And President Obama's budget proposal for fiscal year 2015 asks for $45 million to fund a "Global Health Security Agenda." Work on Ebola would fall within this request.

I hope that Ebola can be contained before it spreads to other countries. But if it does spread, containing the epidemic will take a level of cooperation on the part of the global public that we've never before needed.