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Sunday, January 18, 2015

Ten Key “Facts” About Ebola: True or False? By Kristi Koenig, MD, FACEP, FIFEM


"Ebola Represents A Trivial Threat To Americans' Health"

Alan: In the following list of true/false propositions I have left an inch and a half gap between each proposition (in red) and the corresponding answer. By scrolling slowly, you can easily "grade" yourself.

Ten Key “Facts” About Ebola: 
True or False? 


Kristi L. Koenig, MD, FACEP, FIFEM

Our public health preparedness expert cuts through the misinformation.
http://www.jwatch.org/content/2014/NA36218?query=etoc_jwem


1. Restricting travel from Ebola-outbreak countries to the United States is
the best way to prevent the spread of Ebola to our shores.











FALSE

There is no evidence that restricting travel will prevent spread of Ebola 
to the U.S. Exposed and infected persons might reach our country undetected
and thereby escape essential public health monitoring, which could worsen 
transmission risk. The key to controlling this epidemic is to stop Ebola at
its source in West Africa.

2. Ebola is not contagious until a person is symptomatic; the average 
incubation period for Ebola is 8 to 10 days.










TRUE

Symptoms may be very subtle in the early stages of disease when viral loads
are low. While nearly all patients will become symptomatic from 2 to 21 
days after exposure to Ebola, the average time from exposure to symptoms is
8 to 10 days. Ebola is not contagious prior to symptom onset.

3. A patient presenting with symptoms of Ebola and travel to Liberia within
the past 21 days can be safely removed from isolation after a negative 
serum test.











FALSE

Many hospitals send serum samples to regional laboratories for testing. 
Results must be confirmed by the CDC. An initially negative reverse 
transcription polymerase chain reaction (RT-PCR) test result for Ebola 
virus does not rule out Ebola virus infection. If an initial test is 
negative in a person under investigation for Ebola, repeat testing is 
indicated in 72 hours.

4. Quarantine is an essential public health measure to control the spread 
of Ebola.











FALSE

Quarantine is a strategy to prevent spread of diseases that may be 
transmissible prior to the onset of symptoms. Ebola is not transmissible 
before a person is symptomatic, so there is no scientific basis for 
restricting the movement of healthy, asymptomatic people who may have been 
exposed. Immediate isolation is indicated once symptoms develop.

5. Ebola is a highly contagious disease and can be spread via airborne 
transmission.










FALSE

Ebola is not easily spread; for example, it does not spread by casual 
contact — no household contacts of the first Ebola patient in Texas 
contracted the disease — and there is no evidence for airborne transmission
of Ebola. While some experts have suggested that Ebola could mutate to 
become airborne, scientific consensus is that this would be extremely 
unlikely. Ebola is spread via contact with blood and other bodily fluids, 
including saliva, mucous, vomit, feces, sweat, tears, breast milk, urine, 
and semen, and is highly infectious if the patient is critically ill with a
high viral load. This is the rationale for the high degree of precaution, 
including monitored donning and doffing of personal protective equipment 
(PPE), when caring for such a patient.

6. A patient presenting with fever and travel to West Africa within the 
past 21 days is more likely to have malaria than Ebola.









TRUE

In travelers from sub-Saharan Africa, diseases with short incubation 
periods, such as malaria and typhoid fever, also present with fever and 
must be considered in the differential diagnosis of Ebola. Malaria is much 
more common than Ebola. However, a positive malaria test does not rule out 
Ebola, as malaria is extremely prevalent in this population and the 
diseases could coexist.

7. The single most important step in Ebola preparedness is early screening 
for Ebola.









TRUE

Many patients will present with nonspecific flu-like symptoms who are not 
at risk for Ebola. The most important first step is to identify patients 
with epidemiological risk factors (travel to an Ebola outbreak region or 
direct contact with a known Ebola patient within the prior 21 days). For 
patients without these risk factors, triage can proceed as usual. For those
with risk factors and symptoms, immediate isolation and donning of PPE is 
indicated before any further contact or evaluation. Initial signs and 
symptoms of Ebola can be nonspecific and may include fever, myalgia, and 
malaise. Gastrointestinal symptoms develop later and manifest as severe 
watery diarrhea, nausea, vomiting, and abdominal pain. Up to 18% of 
patients in the current outbreak have developed hemorrhage, most often 
blood in the stool. Patients may develop a diffuse erythematous 
maculopapular rash that can desquamate. Multiorgan failure and septic shock
can ensue. Patients who survive can have a prolonged convalescence.

The algorithm Identify-Isolate-Inform is useful to remember preparedness 
priorities that include prompt notification to hospital infection control 
and public health authorities for suspected Ebola cases.

8. Ebola patients may present with profound hypovolemia and arrhythmias 
secondary to hypokalemia.









TRUE

Ebola patients are subject to large volume loss due to copious watery (and 
sometime bloody) diarrhea (such as that seen with cholera) and profuse 
vomiting. Profound dehydration and hypokalemia can result. Life-threatening
arrhythmias due to electrolyte abnormalities have been reported.

9. Cardiopulmonary resuscitation is indicated for Ebola patients in cardiac
arrest.








FALSE

Prevailing expert opinion is that if a patient has loss of cardiac output 
due to multisystem organ failure from septic shock in the setting of Ebola,
resuscitative efforts would be futile and also extremely risky for the 
clinicians performing the procedures. Some Ebola centers have requested 
that patients sign a do-not-resuscitate (DNR) order. The efficacy of other 
invasive procedures such as intubation and dialysis are still being 
debated, with anecdotal reports arising in the Western world of good 
outcomes after their application.

10. Doffing of personal protective equipment (PPE) is more difficult than 
donning.








TRUE

A buddy system involving a safety officer with a checklist is recommended 
for both donning and doffing of PPE. Clinicians must be sure that none of 
their skin is exposed. Doffing is more difficult than donning because the 
PPE may be contaminated with blood and bodily fluids from the Ebola patient
at that point, and even a small exposure can lead to transmission of the 
disease. There is no room for error when removing PPE.


      Dr. Koenig is the Director of the Center for Disaster Medical Sciences 
      at the University of California at Irvine and a member of the American 
      College of Emergency Physicians Ebola Expert Task Force. She also serves
      on the State of California EMS Commission and as guest editor for the 
      Disaster Medicine and Public Health Preparedness journal's special 
      edition on Ebola.

Editor Disclosures at Time of Publication

Disclosures for Kristi L. Koenig, MD, FACEP, FIFEM at time of publication 


  Editorial boards Koenig & Schultz's Disaster Medicine: Comprehensive
          Principles and Practices




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