How Ebola Could Kill You, and Why It Probably Won’t

Stay calm. If you have a fever, a headache, and vomiting, it’s probably not Ebola. It might be strep, or flu (get your shot), but it’s probably not Ebola. Despite what the news channels want you to believe, we are going to survive. West Africa is in the middle of the largest Ebola epidemic in recorded history. And while “recorded history” doesn’t go back that far when you’re talking about isolating and identifying viruses, this is certainly not Africa’s first rodeo with the disease. The first known outbreak was in 1976, and there have been several since then. They all ended. Between outbreaks, the virus probably lives in monkeys or other animals until some unlucky bush-hunter kills his dinner and gets blood in his eye.

[I’ll stop here and insert a disclaimer: I am about to oversimplify the pathogenesis of Ebola hemorrhagic fever, to which several brilliant scientists have devoted their careers. Sorry.]

[Disclaimer #2: My intent is not to make light of this disease or its victims. The losses in West Africa are real and tragic. My goal is to reassure those of us living in a developed country with proper sanitation and a very capable healthcare system that Ebola here is not the same as Ebola there.]

So how is Ebola spread, and what does it do? Well, first you need to have direct contact with bodily fluids from a symptomatic person (more on this later). Pick your bodily fluid (blood, feces, vomit, urine, breast milk, semen…), but direct contact is definitely the way to go. The virus may live for a few hours on solid surfaces, but certainly not as long as most of the viruses that plague our schools and daycares. And it’s not particularly resistant to standard disinfection practices. The Ebola virus infects you through mucous membranes or open wounds—so you can pick your exposure method Clue-style (Ms. Ebola in the laceration with the feces, etc.). The virus then spreads to various cells in your body over the next 2-21 days, depending on where it entered and how much got in, and starts knocking off your organs. That’s not good, because you really need most of them. Your liver stops making some pretty important stuff, your blood vessels get leaky, and you go into shock. About half the people who have gotten it die.

But stay calm. You probably won’t get Ebola, and even if you did, you probably wouldn’t die.

Why not?

  1. It’s not a very good virus. Viruses don’t have a lot to live for. They don’t care about money or careers or fame. Their only concern is making another copy of themselves. It’s all about survival. The best viruses (based on their ability to complete this singular task) have a lot of features that Ebola doesn’t:
    • A virus that knows how to survive will be transmissible prior to the onset of symptoms. It will pick off targets when they don’t suspect it. This is why mono does so well in colleges across the country—it takes a few weeks from exposure to symptoms, and you’re contagious in meantime. But nobody wants to make out with “the Ebola guy.”
    • A good virus can infiltrate, go dark, hide out for years, and then attack at any time. Think HIV, herpes, hepatitis C…these are gifts that keep on giving. If you evoke a strong and lasting immune response, you die. Killing your host quickly is not only poor form, it’s also bad for your survival.
    • Good viruses have wings. Varicella (the virus that causes chickenpox) nailed this one. You don’t need anybody to puke in your face to get chickenpox—all you have to do is be in the same building. The most infectious viruses spread through the air. Ebola doesn’t, or everybody in Africa would have been dead years ago.
  2. We’re not in Africa. Sure, Texas Health Presbyterian Hospital could have done better. But, serious faux pas aside, we are still in a developed nation with proper sanitation, sterilization equipment, and protective gear. 55% of infected individuals in West Africa die. In West Africa. The Wall Street Journal published a great article about the situation there, entitled “Ebola Virus: For Want of Gloves, Doctors Die.” The author described the poor conditions there this way: “Rubber gloves were nearly as scarce as doctors in this part of rural Liberia.” But we have gloves. And gowns. And masks with face shields. We have isolation rooms. The CDC has issued very detailed recommendations for protective equipment and isolation procedures. We have the ability to transfuse, perfuse, hydrate, ventilate, and otherwise support the heck out of sick patients until they recover. We’ve got this.
  3. We don’t “wash our dead.” I’m not exactly sure what all this entails, but apparently bodily fluids are involved. Touching bodies of Ebola victims is just not a good idea. Incidentally, the CDC has also issued detailed guidance for funeral homes about the handling the remains of those that die from Ebola.

No, it isn’t over. There will be more cases in the news. But there have been a lot of other scary diseases in the news in the past (SARS, MERS, H1N1, EV-D68), and we’re not all dead yet. And we won’t be—at least not from Ebola.

So wash your hands, not your dead. Avoid bodily fluids like–well, the plague. And don’t go to West Africa unless you plan to help out. Sorry, there are no vaccines for Ebola (yet). But in reality, your best bet to avoid an Ebola scare is to get your flu shot, because you’re still far more likely to get—and die from—that.