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Please click this button to indicate that a screenreader is being used so we may better provide accessible content DEBUNKING TH

E MYTHS OF
DEBUNKING THE MYTHS OF EBOLA
MARK PHILLIPS
WESTERN GOVENERS UNIVERSITY
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Debunking The Myths Of Ebola Introduction a. Audience Hook: There seems to be a lot of hysteria about Ebola in the news media. Look at any news source and Ebola is probably on the front page. It makes it seem as though we should be frightened, but how much of a threat does Ebola pose? This presentation was put together to debunk the myths of Ebola and outline what is being done to combat its spread in the United States. b. Thesis Statement: Research suggest that the current Ebola outbreak will not be an epidemic in the United States because it has limited transmission vectors, limited survival on fomites (inanimate objects), and adequate containment measures are achievable to prevent its transmission. Additionally the U.S. community and government responses will be much different than they are in the countries where Ebola is escalating. c. Preview of Main Points: i. Research indicates Ebola is not transmittable through the air but only by direct contact with an infected source so it appears that contact precautions will be an adequate barrier to its spread. ii. Ebola has limited ability to live on fomites therefore research shows that fomites must contain large sources of body fluids in order for the disease to be transmitted. iii. Isolation standards currently employed at major hospitals with some modification appear adequate to contain Ebola. iv. Ebola’s spread in the U.S. will not mimic what has been seen abroad due to the fact we have an educated public and different cultural practices when it comes to dealing with the illness. 1. Many stories in the news media make it seem the current practices to contain Ebola’s spread are inadequate and that it is going to spread across the United States like a wildfire.

d. Ebola transmission v. Ebola is only transmitted through direct contact with infected body fluids from living or deceased victims. Ebola cannot be transmitted through water or air (Daniel G Bauschl, 2007). Despite the assertion that Ebola is not airborne, direct contact has been redefined to include droplets in the air (CDC, 2014). Droplets are large and can only travel a couple of feet. Unlike airborne diseases that contain small particles and can travel much farther in the air, droplets do not remain suspended in the air. For instance, if you cough in a room and leave, the airborne disease will remain suspended in the air similar to airborne dust. Droplets are large, fall to the ground, and dry up at which destroys the Ebola. The following illustration depicts the disparity between H1N1 (an airborne virus) verse Ebola (contact virus). The difference is dramatic as you can see. Ebola is not easily transmitted while H1N1 is easily transmitted as evidenced by the number of people infected in the first six months. 2. vi. There is a logical explanation for the nurses in Texas who contracted Ebola. Standard contact precautions have been in use for years in the U.S. healthcare setting. These precautions are designed to protect healthcare workers and the general public from bacteria vancomycin resistant enterococcus, methicillin resistant staphylococcus aureus, clostridium difficile, and others (“Bacterial Diseases”). Ebola differs from these Bacterial Diseases in its ability to make healthy people very sick. We contain Bacterial Diseases to prevent healthcare workers from carrying them to susceptible populations such as people with deep open wounds or those whose immune system are compromised. The CDC estimates 1% of the population is colonized and carrying MRSA around with them all the time with no ill effects (CDC, 2014). vii. The standard precautions for Bacterial Diseases are insufficient to protect healthcare workers exposed to Ebola because one minute drop can cause infection and death. Bacterial Diseases, on the other hand, can be washed off which renders the bacteria harmless. Even if a healthcare worker fails to wash, these Bacterial Disease generally will not cause harm unless that person is part of the susceptible population. Ebola often cannot be washed off quickly enough to prevent transmission and a droplet can harm even a healthy person. Standard precautions for Bacterial Diseases only minimize contact but they do not eliminate all contact which is crucial for preventing the spread of Ebola. 3. The new standard of precaution for Ebola patients at my hospital at the University of Utah is a full bodysuit and a powered air purifying respirator (PAPR). Using this new standard, no part of the body or clothing is exposed and there is no chance for droplet exposure. There is also an Ebola certified nurse at the University of Utah hospital seven days a week who is specifically trained to care for Ebola patients. The nurses who were infected in Texas attempted to modify standard precautions for Ebola but their methods were inadequate as they did not protect all of their skin and clothing from bodily fluids. Additionally the precautions they took made it almost impossible to remove the gear when they left the room without having some direct contact with fluids on the items they were trying to remove. If they properly used the new standard of care implemented by the University of Utah and many other hospitals, they would not have become infected. Unfortunately, the hospital in Texas simply was not adequately prepared to take care of an Ebola patient with an advanced case of the disease and protect its workers. This has sent an alarm out to all in the health care industry to plan ahead and be prepared. Clearly, this illistration depicts the increased safety afforded by Ebola precautions vs standard.

viii. The new system at hospitals who will be managing Ebola patients is complete isolation similar to the system in place at the University of Utah. Additionally these hospitals have require the presence of an employee who monitors and records all who enter or exit the room. This ensures contact isolation is maintained absolutely. Interestingly, the Atlanta hospital that cared for two Ebola victims followed standard contact precautions that are used for Bacterial Diseases (not complete isolation) and none of the twenty six people who interacted with the patients contracted Ebola. Using this example, it appears that even standard contact precautions can work if performed correctly (CDC, 2014).
Ebola’s ability to live on fomites (inanimate objects) is limited. Ebola has been studied in labs and in the field since 1967 when it was first isolated (Niaid.nih.gov,. 2014). Ebola can only survive in body fluid. If the body fluid is placed on an object, Ebola can survive several days as long as the fluid stays wet. When it dries out the Ebola is denatured in a matter of hours and is no longer a virus (Bausch et al., 2007). Clostridium difficile, on the other hand, can live on objects independent of body fluid. It can even survive many of our cleaning agents. Ebola is a virus and contains no organelles. It cannot grow or do anything on its own. Ebola takes over a person’s cells to make more copies of itself and has no other purpose. It is easily destroyed by light, drying out, and most cleaning agents. It cannot be spread around in the environment by itself. It can only maintain itself in a hosts fluids. 4. In Africa where Ebola has reached epidemic levels in some nations, cultural practices and lack of adequate healthcare facilities has contributed to the rapid spread of the disease. In Africa families often take care of the sick themselves due to a lack of medical services available. This can expose entire families to Ebola. Additionally, in these nations stricken with Ebola, it is common cultural practice for families to bathe and have extensive physical contact with the dead prior to burial. On the contrary, in the United States this mode of transmission will be of little consequence as these practices are relatively uncommon (Van Herp, 2014).

ix. Another problem in Africa, unlike in the United States, is lack of education and a belief system that undermines efforts to control the spread of the disease. Michel Van Herp from Doctors Without Borders stated, “[d]ue to limited education, many Africans still place the blame of sickness on spirits and do not trust doctors. They believe that to say "Ebola" aloud is to make it appear, but the reverse also believed to be true - denying that Ebola exists would mean that it won’t be able to affect you. This fear and superstition is understandable if you think about how patients with cancer in western societies sometimes cope. For example, sometimes cancer patients refuse to accept their diagnosis in order to try to avoid the consequences of what that diagnosis means (Van Herp, 2014). x. In conclusion, the United States has advantages over Africa in terms of containing the spread of Ebola in terms of differing cultural practices, better education, better access to healthcare and better contact precautions among those who are exposed. As a result, it seems likely that the spread of Ebola in the U.S. will be much more limited than in Africa.

5. Conclusion e. Restatement of Thesis: Ebola will not reach epidemic proportions in the United States the way it has in Africa because unlike in Africa, in the U.S. (i) patients are treated in hospitals, not by families at home, (ii) people will not be handling the remains of Ebola patients after they have passed away, (iii) the total isolation precaution for healthcare workers should entirely limit the spread of Ebola, (iv) the population is not as susceptible to superstitions that undermine efforts to contain the spread of the disease, and (v) the population as a whole is more educated with respect to taking exposure precautions. f. Summary of Main Points: xi. Ebola is only transmittable by direct contact with body fluids. xii. In the U.S., isolation standards have been elevated to the highest level to stop its spread in hospitals. xiii. Communities in the U.S. are educated and will seek medical attention if infection occurs. g. Closing comments: xiv. Given the nature of the disease and the myriad of precautions being taken in the United States, it is highly unlikely that Ebola will become an epidemic the way it has in Africa. xv. There may be some minor outbreaks in some areas where containment protocols were not followed correctly but these should be controlled when the proper protocols are followed.
Scripted Audience Questions
Question: What if Ebola evolves and becomes airborne?
Answer: Many people were also very concerned about this with HIV. An article in Scientific America entitled “Fact or Fiction?: The Ebola Virus Will Go Airborne” states,
“- interviews with several infectious diseases experts reveal that whereas such a mutation—or more likely series of mutations—might physically be possible, it’s highly unlikely. In fact, there’s almost no historical precedent for any virus to change its basic mode of transmission so radically(Maron, 2014).”
Question: Our healthcare system is so advanced, how did the nurses in Texas get Ebola with only one patient?
Answer: The nurses were not prepared adequately and did not have specific training for this level of contact precaution. At another hospital in Atlanta several patients were cared for with standard precautions used for Bacterial Diseases without anyone being infected. The difference may lie in the fact that the Atlanta hospital had time to prepare as their patients who were being flown from Africa. The Texas hospital with the infected nurses had no forewarning and had to immediately take care of the patient. With all this attention, hospitals across the country are designating teams, areas and are training personnel for this task.
Question: Why is Ebola getting so much media attention.
Answer: Probable because this is a very deadly disease which carries a high mortality rate. In the US 80% survival has been seen so far while in africa survival is a mere 30% (CDC, 2014). This makes it very scarey. The odds of survival are pretty poor, but fortunately it doesn’t spread easily.

References
Bausch, D., Towner, J., Dowell, S., Kaducu, F., Lukwiya, M., & Sanchez, A. et al. (2007). Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids and Fomites. The Journal Of Infectious Diseases, 196(s2), S142-S147. doi:10.1086/520545
Cdc.gov,. (2014). CDC - MRSA and the Workplace - NIOSH Workplace Safety and Health Topic. Retrieved 3 December 2014, from http://www.cdc.gov/niosh/topics/mrsa/
Cdc.gov,. (2014). Infection Prevention and Control Recommendations for Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals | Ebola Hemorrhagic Fever | CDC. Cdc.gov. Retrieved 3 December 2014, from http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
Cdc.gov,. (2014). Transmission| Ebola Hemorrhagic Fever | CDC. Cdc.gov. Retrieved 3 December 2014, from http://www.cdc.gov/vhf/ebola/transmission/index.html
Maron, D. (2014). Fact or Fiction?: The Ebola Virus Will Go Airborne. Scientificamerican.com. Retrieved 3 December 2014, from http://www.scientificamerican.com/article/fact-or-fiction-the-ebola-virus-will-go-airborne/
Niaid.nih.gov,. (2014). Ebola/Marburg. Retrieved 3 December 2014, from http://www.niaid.nih.gov/topics/ebolaMarburg/understanding/Pages/overview.aspx
Van Herp, M. (2014). News & Stories RSS Feed | MSF USA. Doctorswithoutborders.org. Retrieved 3 December 2014, from http://www.doctorswithoutborders.org/news-stories/voice-field/struggling-contain-ebola-epidemic-west-africa. (n.d.).

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