I am a doctor & infectious diseases specialist who treated Ebola patients with the WHO and CDC in West Africa. Ask me anything.

Are we all fucked?

Edit: Guilded at 4 upvotes? Thanks stranger!

To answer your question: http://www.reddit.com/r/IAmA/comments/2i6t4g/i_am_a_doctor_infectious_diseases_specialist_who/ckzekla

Nancy Writebol stated that she has no idea how she got Ebola and is positive that she adhered to all MSF protocols. She emphasizes that "We just don't even have a clue what happened"

It means one thing: something is being overlooked or underestimated. It could really only be two things: transmission by asymptomatic carriers and/or virus stays viable on surfaces much longer than it is currently believed. Apart of course from another terrifying possibility of a strain mutating and going truly airborne. By the way, what strain they both were infected with, the same one?

Another interview is out today with Nigerian doctor who survived Ebola, she also states emphatically "After all, my contact with Sawyer was minimal. I only touched his I.V. fluid bag just that once without gloves. The only time I actually touched him was when I checked his pulse and confirmed him dead, and I wore double gloves and felt adequately protected.

Could you comment on that?

Could you also cite any studies showing that asymptomatic Ebola patients are not infectious and studies that shows the exact moment the patient becomes infectious?

The amount of time that Ebola virus survives on surfaces has been studied. An excellent article on this is available in the Journal of Applied Microbiology 2010; 109: 1531–1539. The decay constants and survival times for Ebola (and other Filoviruses) on surfaces vary depending on humidity and temperature as well as pH, type of surface, UV light exposure, or exposure to certain chemicals. Under ideal conditions Ebola has remained viable on biological material on surfaces for as long as 3 weeks – however those are not conditions that are found in normal, non-laboratory environments. There is one species of Ebola, Ebola Zaire that is circulating currently in West Africa; there is one strain of that one species that is being identified in the current West African outbreak.

As for the interview, yes, she told us at the time that the only contact she had without gloves involved her touching the IV fluid bag from the index case. It is difficult to know if her recollection is accurate but even if it is, we do not know if the index case had recently contaminated the IV bag with bodily fluids in one manner or another. Remember that the IV bag was located well within the 3 foot distance that we remind people is necessary to avoid contamination with Filovirus. Thus, this event, in and of itself does not allow us to make any serious and certain determinations regarding what actions constitute risks for Ebola transmission.

1) How worried should be be about ebola in the US and elsewhere in the world?

2) If you had all the power and resources in the world, what diseases would you choose to eradicate and how would you go about it?

1. The only people who should be worried are the ones that were in close contact with the Ebola patient in Texas while he was symptomatic. It's a public health emergency of international concern, we have to have a mechanism to rapidly recognize individuals that may have this disease, unfortunately the system right now is just voluntary.

2. HIV

What is the biggest misconception about Ebola?

The biggest misconception is its fatality rate. Whether a person survives or doesn't is greatly dependent on when they present for treatment, having appropriate treatment and where they get it.

What are the chances of people surviving it in a western country, where they have access to tiptop medical care?

How well a patient does is largely dependent on how soon after they become symptomatic do they receive appropriate treatment, regardless of where they are. As long as US health care workers are acutely aware that another patient may present, as the Dallas case did, and do not allow that patient to go home while they are symptomatic, and begin treatment immediately, then the chances for survival for that individual are very good and the chances that that individual can spread the disease are reduced dramatically.

Is a North American Ebola outbreak being blown out of proportion by the media? My friend is a hypochondriac and is thinking about quitting his job and cutting out the outside world because of this. I would really appreciate your answer so I can show this to him and put his mind to rest.

There is no North American outbreak; there is one single case. There may be 1, 2, 3 or 4 more individuals amongst the almost 100 who were in contact with the index case in Dallas when he was symptomatic. However, because they are under isolation and being monitored, they cannot transmit the infection and lead to an actual outbreak in the United States.

How long does Ebola survive on a surface outside of the body?

How long it survives depends on what biological fluid it's in, what the pH is, what the temperature is, what the humidity is, and exposure to UV light, and toxins, such as chlorine.

[deleted]

At minimum:

Soap, Chlorine, Bottled Water, Gloves, Buckets, Water hose, Mask & Goggles (For close encounters), Condoms, Tylenol, Pepto Bismol, Sedative, Oral Rehydration Fluid.

Hi Doctor! Current FIU student here (Panther proud!). My question is why do you think this virus has been so difficult to contain? Do you think its worth trying to help infected patients at this point?

Also, if I come down with ebola, will I be excused from my midterms next week?

The reason it is difficult to contain is because it was not recognized for many months after it had started affecting people, killing people and traveling from one country to another. By the time the outbreak was recognized and that an international response was mounted, it was already in 3 countries and had spread to urban areas. Never before in the history of Ebola outbreaks has there been an outbreak that has involved major metropolitan areas and capital cities. The culture and habits of the affected population has also facilitated the spread and continuation of this infection. For example, burial practices, superstitions, etc.

It is absolutely critical to treat infected patients, not only for their sake but in order to end the outbreak and do our best to keep Ebola zaire (the current strain) from becoming endemic in West Africa (if at all possible), a place it had never been before.

The patients with Ebola who were college students in Nigeria were given laptops to take their exams from the isolation ward. So not to worry - you will be able to take your midterms.

Can you please shut down the conspiracy theories about "airborne" Ebola?

Here's the problem with that one. The current strain and species that is highly lethal and problematic, thank goodness, is not airborne. People do get confused because if somebody is very sick and have a high virus load, then they're "spittal" (someone who spits a lot).

Airborne is something like measles and it's carried in the air.

What about reports of doctors saying they're concerned it will mutate into an airborne virus?

Most mutations are bad for viruses, very rarely does it benefit the virus. While Ebola is a negative strand RNA virus and therefore likely to make mistakes (have mutations). The chance that the mutation for this Ebola strain to become airborne is very small.

Can you please make clear what the risks of contracting/coming down with ebola once and for all and the specifics of how it spreads? I'm sick of buzzfeed and facebook telling everyone we're on the edge of a pandemic.

thanks for the ama.

Thanks for having me!

Symptoms are non-specific. Some people present themselves with fever, a sense of feeling sick, muscle pains, sometimes joint pains and discomfort of the throat.

Later on (2 days): they may vomit or have diarrhea and often there's a rash. First rash resembles measles, and has a similar distribution in the body. The rash is easier to see in light-skinned individuals. As it progresses, some patients begin to have hemorrhage which can affect them internally and externally. Sometimes we see blood in the vomit or urine. Sometimes they develop a new rash that amounts to tiny and large bruises.

In Africa, we were describing Ebola to people as being a stupid virus. It doesn't jump easily from one person to the next. So you have to be up close and personal.

When you don't have symptoms, you don't have enough virus to share with others. Once you are symptomatic, the amount of virus you can share, increases the sicker you are. This gives the rest of us a clue to not get very close to someone who looks very sick.

To prevent this from becoming a pandemic, people need to realize if they have been in close contact with someone who has Ebola, they need to present themselves for monitoring to the public health service. So that if unfortunately they come down with symptoms they receive treatment immediately.

One sad side to staying away from people who are ill is that there are many more people who will have sicknesses that will have nothing to do with Ebola and probably not contagious. And we don't want that to happen.

First, as a veteran myself, I would like to thank you for your service in the Navy. What is the screening process entering the United States consist of for individuals who spent time in "hot zones"? Since it seems the man in Dallas lied on a form about having contact with an infected individual do you recommend a higher level of screening? If so, what would it involve?

Thank you! The form being referred to in the media is an exit form filled out in Liberia. It asks if they've been to a funeral, if they've had contact with someone who was sick, have had contact with Ebola...When I was combating Ebola in Nigeria, we anticipated lying on forms, so the entrance and exit screening in Nigeria is particularly rigorous. It includes "subtle screening"--we have observers throughout the airport looking for people showing symptoms. However, bc individual could lie or be ignorant of exposure to Ebola are reasons why the country they are coming to needs to have some procedures in place for individuals that have arrived from at-risk countries. Currently the US has a recommendation that individuals present themselves to physicians if they think they may be at-risk, but there is no specific screening in place. That needs to change ASAP

What do you think needs to be done to stop this outbreak? Also what's something we should know or do?

The only way to stop this outbreak is to have enough people with training and experience, and enough facilities and resources (Personal Protective Equipment, oral rehydration fluid, etc.). And an awareness campaign that the effected population can understand and agrees with to encourage them to get prompt treatment. And we need extensive contact tracing.

Hi I am from India.

1. I heard doctors were forced to serve there. Is that true?

2. What can be done AFTER ebola spreads to high population density areas such as SA/SEA?

1. Doctors are not forced to serve in West Africa. Not even local physicians are forced to serve in Ebola wards. Only voluntarily and after appropriate training.

2. You've put the cart before the horse. The truth is, what we need to do is stop and then extinguish the outbreak where it is. And do appropriate entrance screenings of individuals in other countries to avoid the nightmare scenario you're talking about.

As an epidemic, in your honest opinion, do you think ebola will spread more rapidly in the U.S. now that more cases of it have been confirmed?

It is possible that some of the individuals that were in close contact with the Dallas case may prove positive for Ebola, but because those individuals are being closely monitored, any disease they show won't result in further spread. I am totally confident that our public healthcare workers will prevent that Dallas case from spreading to outbreak proportions in the US despite the fact that other persons he'd be in contact with are positive. That's not an outbreak.

Presuming that you would have been scared of the threat of ebola to you personally.How did you deal with the fear of working in such a volatile infectious environment?

I wasn't afraid. I have a lot of respect for the virus, and take many precautions when dealing with it. Having been in the service I was trained in the use of PPE (personal protective equipment), so fear was not a factor. Interesting note: Ebola was not the only threat. There are many other infectious diseases that people have to protect themselves from ranging from malaria to rabies. There are also social dangers (high crime, kidnappings, Islamic terrorist organizations) and traffic dangers (traffic is horrible!)

Good Morning Dr. Marty,

What can the average person do to fight the spread of Ebola world wide?

Educate yourself. Be aware, be knowledgable and encourage your government to be vigilant. Donate to your favorite NGO that is working in the area, such as Médecins Sans Frontières.

Médecins Sans Frontières

Many might be familiar with that organization by its translated name, Doctors Without Borders.

Thank you Dr. Marty

Thanks!

Hello Dr. Marty! Fellow panther here; thanks for the AMA. With the first Ebola case in Texas now, realistically how likely is is that it can make it's way down here? I'd also like to know if you think it's more of a threat than the chikungunya outbreak going on in the Caribbean right now which is growing in Florida. I'm from Jamaica so that has been on my radar more so than Ebola.

Extremely likely, the incident in Dallas will be contained in Dallas. The only issue for South Florida would be a second passenger with a similar scenario.

There have already been documented cases in chikungunya that have been transmitted by infected mosquitos in South Florida. Chikungunya is a realistic problem for South Floridians that exists, compared to Ebola, which we hope to never see in South Florida.

Hello Dr. Marty!

First and foremost, thank you for all your work in the progression of medicine, global healthcare, and in serving our country through the Navy. I have a few questions,

What is one of the most difficult aspects of Ebola research?

What was your favorite medical school experience?

What words of wisdom would you like to share to those aspiring to become physicians?

Thank you once again, and have a great day!

Difficult aspects of Ebola research: the fact that its such a dangerous disease. Since there is no licensed vaccine with no specific treatment, it has to be handled under Bio Safety Level 4 condition (Google that one) Fave Med school experience: LOL! Words of Wisdom: Have passion for your work. It requires humanity, passion, dedication and a love of science.

Would you say that Americans fear of contracting it are irrational?

I hate to call somebody irrational, so no. It is so unlikely that most Americans would be exposed that it is not a time for people to have a fear of Ebola in their backyard.

Can you give us insight on "Garcinia Kola" that all the conspiracy theorists are blowing up about?

I have not been following the conspiracy theories.

How do these people with the disease feel like? In other words, do they basically think/react like they're going to die or do they remain optimistic?

It's very individual. Some were determined to survive, some weren't. As in any disease the attitude someone has greatly influences how well they respond to treatment.

What do you think of the efficacy of Lamivudine on treating Ebola?

While that drug might have some promise, it has not been experimentally proven to be safe or efficacious for Ebola. Therefore, at this time, we continue with the use of symptomatic treatment for these patients.

Do you think there's any possibility Ebola could mutate and become airborne?

I answered this above: http://www.reddit.com/r/IAmA/comments/2i6t4g/i_am_a_doctor_infectious_diseases_specialist_who/ckzdwj3

What's your favorite book?

Whichever one I'm reading at the time is usually my favorite one. I'm currently reading the Century Trilogy books (on the last installment) by: Ken Follet

How come the Dr. treating the Dallas patient did not know of his travel if he was asked, and answered he was from West Africa?

Answer: http://www.nytimes.com/roomfordebate/2014/10/02/how-to-stop-the-spread-of-ebola/recognizing-ebola-is-the-key-to-prevention

Check out the "debaters" opinions as well.

What would you say is the greatest obstacle to containing and fighting the outbreak?

The greatest obstacle right now is the size, distribution of this outbreak and the fact that multiple different governmental systems are involved in attempting to contain it, as well as the enormous need for skilled professionals, resources and facilities in order to treat these patients. Another big obstacle is that of fear and misunderstanding amongst people affected and even amongst those of us who are not affected.

Is Ebola more likely to mutate to a more infectious strain than, say, hepatitis C or HIV?

Answered above: http://www.reddit.com/r/IAmA/comments/2i6t4g/i_am_a_doctor_infectious_diseases_specialist_who/ckze4ng