Will I get Ebola? Reporters and experts answer this and other questions.

Oct 08, 2014

More people have died in the current Ebola epidemic than all previous Ebola outbreaks combined. But how concerned should you be?

Two Post reporters and a doctor took your questions on Ebola: How it's been handled, what happens next and whether you need to worry.

Hi everyone. We're lucky to have a great group here to answer your questions on the Ebola epidemic.

Post reporter Lenny Bernstein just returned from a trip to Liberia where he saw firsthand the challenges to controlling the virus's spread (here's his latest), and reporter Lena Sun has been following the global reaction, including the news today that travelers from West Africa will face stronger screening at U.S. airports. We also have Dr. Amesh A. Adalja from the University of Pittsburgh School of Medicine to help with the medical side of things.

Lots of questions have been submitted already, so let's get started.

How does this differ from contracting AIDS. Ok. I understand how one gets AIDS: exchange of bodily fluids; what I don't understand how one gets Ebola. For example, the photographer, who had no contact with patients, gets it. How could he have gotten it, if it's not so easily gotten?

We still don't really know how the NBC cameraman, Ashoka Mukpo, got Ebola. He had to come in contact with the virus in bodily fluids. I got to know him over there and his work took him in contact with sick people every day. Someone might have sneezed, or coughed nearby. A single droplet of saliva is all it would take, if the virus contacted a break in his skin or a mucous membrane like his eye or his nose or his mouth. Also, the virus does live on surfaces for short periods of time, longer under the right conditions. He might have touched something in the wrong place and infected himself by rubbing his eye.

[Related: Ebola survivor Kent Brantly donates blood to help treat NBC cameraman Ashoka Mukpo]

Just so I can understand the news better: if Thomas Duncan had been recognized as having Ebola when he first went to the Dallas hospital, and treated at that time, is it more likely he would be alive today? Or does the timing of the onset of treatment not matter that much?

He clearly had a delayed onset of treatment and we know that early treatment for many infectious diseases is the best way to ensure survival.

Can ebola be transmitted through contact with aerosol particulate and how long can it exist outside a host?

There is no evidence that Ebola can be transmitted via aerosol outside of lab settings.

Considerable review of the case in Dallas, no doubt, is still underway. However, as a nurse interested in how informatics can improve health care, do you believe any EHR protections could have been in place that would have alerted staff to the gentleman's obvious risk factor(s)/symptoms earlier?

Travel history is something that has been part of medicine prior to the advent of EHRs. It's just as essential as asking a patient about his or her allergies. 

How long does the virus live on surfaces, for example, a train seat?

The virus is highly infectious but not very transmissable. My colleague Joel Achenbach explained this very well in a blog post a few days ago. What that means is that you only need a little virus to get a fatal infection. But it's not that easy for that virus to be transmitted. Remember, Ebola is MUCH less contagious than measles of influenza. (Get your flu shots!) It's not airborne. It's transmitted through bodily fluids. The overwhelming majority of people who have been infected with Ebola are people who have directly cared for a person who is sick with the disease or have handled the body of someone who has died from it. As one CDC expert has told us: "We’re talking about very sick people with vomit and stool on their skin and clothes in a house without running water or a toilet, not someone with a runny nose on a public bus. 

And this: "If it was on surfaces or as contagious as something like measles then we’d see a lot more sick kids."

If I'm walking down the escalator from the Metro, and the person ahead of me wipes his eyes or nose, then touches the railing of the escalator, then I touch the same spot, am I in danger of getting it.

Theoretically yes, if you then touch your eye, nose or mouth or the virus finds a break in your skin. This is why you have to be so careful in Liberia. But remember, that person ahead of you can only shed virus if he is showing symptoms of Ebola--high fever, vomiting, diarrhea, red eyes. During the early part of the incubation, he is no danger to anyone.

[Post Exclusive: How Ebola outpaced the world's response]

How long can the virus survive on contaminated surfaces such as doorknobs, ATM machines, shopping cart handles, etc.?

This virus is not something that can survive in the environment very long. In ideal lab settings, we've seen survival up to 6 days but ideal situations don't really exist like that in the environment. It is estimated to be viable for about 24 hours in most ordinary settings.

Is it really true that Ebola is not transmissible during the incubation period? What exactly is a harmless incubation period? What if another person gets infected while the Ebola patient exhibits flu-like symptoms, through sneezing or sharing a bathroom?

During the incubation period, the levels of the virus of the blood are very low. Viremia--the amount of virus in the blood--is correlated with the development of symptoms. When virus levels are detectable that is when symptoms develop.

Does suffering ebola and recovering from it confer any immunity on the victim?

Yes. Roughly half of the people who have been infected with this strain of the virus have died. But the other half have survived, and they have immunity to this strain. So folks like Kent Brantly and Nancy Writebol, the two American missionaries who got sick in West Africa and were flown back to Atlanta for treatment survived and now have immunity. Brantly has also given his blood to another American doctor who was infected and the NBC freelance cameraman who is undergoing treatment now.

What is the fatality rate of Ebola who a person has been diagnosed with it? How does one have it they don't die?

The fatality rate can range from 50-90% and survival really depends on how quick someone gets supportive care as well as their own genetic makeup. 

We have vaccines for all sorts of viruses, but not others. What are the prospects for developing one for ebola? Ebola has previously been a threat primarily to undeveloped nations, and hence the market wouldn't be profitable. But now it's a threat to poor and wealthy nations alike. Does that speed up the likelihood of developing a vaccine?

The prospects for an Ebola vaccine are very good. There are several that are entering human testing and we expect that they will prove effective in humans. These vaccines are really the fruits of investments in biodefense that began after the anthrax attacks of 2001. 

[Related: Experimental drugs used for Ebola]

Where did Ebola originate?

In 1976, simultaneous outbreaks of Ebola occurred in both Sudan and Zaire. The ultimate origin is widely thought to be bats, but not definitely established.

Can mosquitoes transmit the disease?

There is no evidence that mosquitoes can transmit Ebola. 

It's so weird to compare the response to the Haitian earthquake in 2010 with a large outpouring of generosity while now it's a very "what about me, what about me" feel to the victims of this outbreak in West Africa. Wondering regular Joe or Jenny American can do to help people suffering right now?

Thanks for that question. There is a list of organizations that are involved in responding to the Ebola epidemic on the website of the U.S. Agency for International Development. The list is alphabetical, but one of the aid groups that has been working on the front lines the longest--and has been consistently sounding the alarm on the need for faster and more response--is Doctors Without Borders, known by its French name, Medicins Sans Frontieres or MSF.

The news says paramedics in Dallas have tested negative. The others who had contact are wait and see. How can they know for certain so quickly the paramedics are negative and not the others?

The paramedics, if they had direct exposure, will be observed like everyone else in the contact circle. There may have been an initial test that was performed that was negative, but they will have to wait the entire incubation period to be completely cleared if they had direct contact.

How do the names of the victims of ebola keep getting published in the press? Don't these individuals have a right to medical privacy under HIPAA?

Patients, or their surrogates, must consent to have their name published. Not all names have been published. There is a physician at Emory right now whose name has not been published.

Really, how hard and expensive can it be to either titer the dog's blood for antibodies or run a PCR for viral genome? If the test is negative, let the poor animal live.

There's no guarantee that the viral kinetics in canine species is similar to primate species. Also, is the incubation period the same? 

Is the virus being studied to track the potential evolution of the virus to one that may be more easily transmissible?

There are active efforts underway to study the genetics of the virus and determine the presence of mutations and understand how the effect the virus. Remember, not all mutations will necessarily increase the virulence of the pathogen--some may lessen it. 

Here in northern Virginia, we had the original animal (not human) cases of Ebola Reston a few decades ago. (Thus the name.) As I recall the book The Hot Zone, this strain of Ebola caused great concern because for the first time ever, it was shown to use airborne transmission and not direct contact with bodily fluids. It spread between monkeys who were physically separated. Ebola Reston did not infect humans, of course, just monkeys. Why is everyone so sure that the current human Ebola virus will not mutate in this way, when it happened in Reston with the monkey version?

Dr. Adalja: I think the most important aspect of the Reston outbreak is the fact that it did not cause disease in humans despite infection. I would also add that maybe there's a tradeoff Ebola has to make between transmissibility and deadliness.

Government officials repeatedly state that Ebola is not easily transmitted. But healthcare workers must dress in such a way that suggests that it is actually impossible to remain alive in the presence of Ebola. Will you give all the scary facts about transmission, please?

Transmission is through exposure to the blood and bodily fluids of someone with Ebola symptoms. Healthcare worker personal protective equipment (PPE) varies depending on the setting. In Africa, where cross contaminated equipment is rampant more extensive PPE is required. 

[Related: The extensive process of donning PPE]

I have been discussing Ebola with the students in my high school science classes, including the reasons why antibiotics don't work for viral infections. They asked about why the few existing anti-viral drugs also don't work, and I didn't have a good answer. Is there a good succinct explanation I can give them?

Antivirals are often specific to the species of virus in question. For example, we have anti-HIV anti-virals, anti-influenza anti-virals, etc. Viruses come from disparate families and have different characteristics so not every anti-viral would be expected to work on every virus.

Watching images of the decontamination of the apartment the patient in Texas stayed in made me wonder what happened with the 'real waste' , the waste that was flushed down the toilet when he was already sick? Is there any danger from that?

Normal sanitation practices can deactivate the virus.

If the virus incubates for days before symptoms appear. What safeguards have been implemented to stop travelers who are infected with the virus in Africa, show no symptoms during screening, travel to the United States and develop symptoms after they get here?

Screening will not stop the spread of the virus. Why would this country allow travel from infected countries and hope our citizens and first responders will be able to protect themselves when this happens again. It is not logical for a traveler to buy a plane ticket, show up at an airport ,and admit that he/she has been exposed to the Ebola virus.

There really are none. This, in my opinion, is the weakest link in our protection scheme. But I'm not sure what else they can do. I believe they will soon start taking temperatures at airports, but as you say, if you don't have fever, you'll sail right through. The next line of defense is the emergency room, and hopefully patients will go there immediately upon developing symptoms like fever, and triage people will recognize the situation through symptoms, travel history and the like. The good news, of course, is that until you develop that first symptom--usually fever--you're no danger to anyone.

I lived in Toronto during the 2003 summer when SARS was a major issue. It was mostly an issue at hospitals as I remember. Also I remember that the municipal officials tried to downplay SARS at first since summer in when tourist dollars start showing up in greater numbers in Toronto which many blamed for either spreading SARS more or at least making it seems like a bigger deal when after a clam period, there was another big outbreak. Just wondering how SARS North American outbreak is different from Ebola?

SARS is a respiratory illness that makes transmission much more easier (because people cough, sneeze, etc more with it than with Ebola). There are a lot of lesson from SARS that are applicable to Ebola however. For example, economic impacts, role of travel, spread from an animal reservoir, etc.

Sweat soaked clothing from ebola victims is a frequent source of later infection among people who handle their bodies. Yet it is rarely mentioned ~ instead we get the same old same old "blood, urine, feces" litany more applicable to other diseases. I think this is misleading. What can be done to get WHO and the CDC to get their language into line with what we see in the news, particularly the videos?

Where's your evidence for that? It does stand to reason that sweat would transmit the virus. But in research, it has never been isolated in sweat. Corpses are leaking all kinds of things--including blood in many Ebola cases--and those are the right things to be concerned about.

[Related: How do you get Ebola]

If a person takes a fever-reducing medicine, then won't she or he have a "normal" temperature when checked at an airport?

Right, temperature screening can easily be subverted by acetaminophen or ibuprofen.

What is the likelihood that the protective gear actually worked while the nurse was with the infected person but she exposed herself removing the gear? It seems to me that the infected sheets, etc (in Dallas) and the entire living area were not properly decontaminated. No one would even accept the waste. Who knows how her contaminated gear was removed from her and how it was disposed.

The latest report we have is that she may have touched her face with a gloved  hand after changing the patient's diaper. That shows you dangerous this virus is if it makes contact with a mucus membrane or a break in the skin. In my opinion, those sheets etc. should have been removed immediately after Mr. Duncan was hospitalized. If no one would take them, then take them someplace away from people and burn them. That's what they do with protective gear, blankets etc. in Liberia and it appears to work fine.

Should the CDC require PAPRS - Powered Air Purifying Respirator Systems - for medical personnel coming in contact with domestic Ebola cases in the U.S.? If not, why not? Would you walk into an infectious Ebola patient's room without a full face mask and a P100 filter system?

Ebola is not spread via the airborne route so a PAPR is not necessary. 

We have been told Ebola is only infectious when one is symptomatic, which can happen anywhere from 2-21 days after infection. However, if the virus is lurking in someone's body, and I kiss him on the lips, or drink from his cup (where his saliva is on the rim), it seems to me just as plausible that I could become infected even though he in not showing smptoms. So, is it true that one can only catch Ebola from somone who is symptomatic?

I think your only worry is if he spikes a fever or shows other symptoms soon thereafter. Then the question would be how long before it emerged was the virus beginning to replicate. Also, saliva is not a very good transmitter of the virus. Contact with blood, vomit and feces are the main ways the virus travels between people. Corpses are especially dangerous because the viral load is high and they can leak all kinds of fluids. Here's something I wrote just this morning on transmission vectors: Sex and Ebola.

 

If the Ebola virus is not spread easily, how did a healthcare worker in Spain who was wearing the appropriate protective gear catch the virus? Also, as far as transmission of the virus, can you name other viruses the public might be more familiar with that are spread the same way as the Ebola virus? For example, would you compare it to Aids or Hepatitis? How long does the Ebola virus live on objects?

The Spanish nurse may have contracted the virus when taking off her personal protective equipment. Contamination of oneself can occur if meticulous attention is not pain when both donning and doffing such equipment.

My Dad watches only Fox News and is convinced that tens of millions of Americans are going to die of Ebola in the coming months. Do you think some of the news coverage (not just Fox, others as well) has used sensationalism and panic to drum up ratings rather than give people accurate information about the disease?

Unfortunately, a lot of the news coverage, especially on television, has given people inaccurate information. Really, you are much more likely to get the flu. 

What is the current status of the U.S. military's efforts to field over 3000 troops and construct 18 Ebola treatment centers in West Africa?

President Obama said initially that up to 3,000 U.S. military personnel would be deployed as part of the U.S. response. Since then, U.S. military folks on the ground have done their assessments and recently, Pentagon folks said they could send more, up to total of 4,000 personnel. The United States has established a regional command in Monrovia, the Liberian capital. The military is building a 25-bed hospital in Monrovia that will treat sick health-care workers. That's aimed at assuring folks who volunteer that they will be cared for if they get sick.

    The U.S. military is also in the process of building 17 treatment centers, each with 100 beds, for sick patients. Yesterday, Gen. David Rodriguez, commander of U.S. Africa Command that has jurisdiction, said it will probably take until mid-November before those treatment centers are up and running. It's the rainy season over there, and there have been problems with equipment and other logistical issues. Remember, Liberia is one of the world's poorest countries, ravaged by years of civil war.

   Military personnel will NOT be involved in the direct care of patients. The U.S. is going to set up a regional training site and train up to 500 healthcare workers a week, and THEY will be among the folks staffing the treatment centers once they are built.

I was wondering how the United States' responses are different to other nations i.e. Australia, Canada, Japan, Italy, Sweden, etc... Are they more calm about it?

Well, I'm not sure I can characterize whether their response is calm or not. But the fact is, this epidemic requires an enormous effort by all countries. And that effort has lagged far behind the virus. ICYMI, we explored that in great detail in this story, about how the world's health organizations failed.

    The United States has committed up to 4,000 military personnel. But so far, we haven't seen that kind of manpower and resource commitment from other countries. President Obama criticized other countries on Monday and said they cannot sit on the sidelines. I would also point out that some small and considerably poorer countries have contributed far more. Take Cuba. It is sending 461 doctors.

Specifically regarding the three American doctors who contracted the disease, one would assume they were dressed in appropriate infectious disease attire. Do we know for sure if they were and if so, how could they become infected? I can understand how the masses can become easily infected, but if the doctors were following protocol, how did they become infected? Is it possible this disease is in fact airborne and no one will admit it?

No, in each case, there appears to have been a mistake. Rick Sacra, for example, was holding a baby he was told had been tested and was negative. Kent Brantly thinks he somehow became infected when he admitted two people during an overnight shift. The Spanish nurse who just became infected may have touched her face with her glove. There is no evidence of airborne transmission.

The CDC website states that the Ebola virus can remain in semen for up to three months after recovery. They recommend that the patient abstains from sex or uses condoms during that 3-month period. What is the recommendation for disposal of those condoms? Surely this type of biohazard should not be placed in household garbage.

A used condom would have to be treated as body fluid waste and be disposed of according to CDC guidance for other bodily fluids. When the patients are discharged, they receive extensive counseling from CDC about how to handle such trash in a safe manner.

Do you know when the Zmap drug will be available for distribution in the USA.

Zmapp is very scarce and it will probably on the order of a few months before a new batch is ready. 

If you were in Liberia and had Ebola symptoms and enough money for an airline ticket to a western country with hospitals that may be able to help you, what would you do? Would you take ibuprofen to reduce your temperature to pass the silly temperature test and get out to maybe get someone to save your life, or sit at home and die? I know what I would do.

Very tough choice. I thought about that a lot while I was in Liberia. I might have done that. Fortunately I had been assured that the Washington Post would get me out, even if it meant paying for a private air ambulance.

[Related: First rule of reporting in Liberia: Don't touch anyone]

Why wasn't Thomas Duncan immediately transferred to a level 4 bio-containment facility such as those where the other victims have been treated in the U.S.?

Ebola does not require treatment in a biocontainment facility--it can be treated in an ordinary hospital room so long as general infection control measures are followed.

I am with a local government of the Philippines. Can you tell us what are the types of acceptable protective or infection suit, mask, head cover, equipment that are appropriate for treating a patient with hemorrhagic fevers, including Ebola. I understand that WHO also outlines procedures for entering and exiting an infected patient's room, removing protective equipment and decontaminating surfaces inside and outside a patient's room. I plan to propose the acquisition of the same in the eventuality of a Filipino catching Ebola. Thank you.

Thanks for your question. If you go to the website of the U.S. Centers for Disease Control and Prevention, the American public health agency, www.cdc.gov, there is an extensive list of guidance and recommended protocols for hospitals and healthcare facilities. The CDC is also offering training on PPE and their syllabus has incorporated much of the specific protocols that the group Doctors Without Borders is using. They have also been conducting webinars for hospitals and other facilities.

I know for a fact that an emergency rooms in the DC/Baltimore area have, in the last several days, had patients who have travelled from African nations where ebola is present, come the the ED with ebola-like symptoms. Are you aware that emergency rooms do not have the ebola tests available and have to contact the CDC when a patient presents with these symptoms in order to get it? In at least one case, the CDC was contacted and, despite the fact that the physician who examined that patient was concerned that he may have ebola, the CDC refused to provide the test. In addition, they instructed the physicians to send the patient home. Can you please explain how this is not extremely dangerous and why the public is not aware of this?

We know that hospitals in the region and around the country have had cases of patients with Ebola-like symptoms. There was one at Howard University here in Washington, D.C. and another at Shady Grove Adventist Hospital in Rockville, Md. Both turned out NOT to be Ebola.

    Hospitals don't have the ability to do the Ebola tests on their own premises. There are about a dozen state labs that can do the blood test, which must also be confirmed by the CDC (Centers for Disease Control and Prevention.) In the Washington area, for example, the DC Health Department does NOT have that capability but the Maryland state lab does. 

    Here are some useful links that show/explain what's supposed to happen in suspected cases:

Algorithm for evaluating a returning traveler.

Checklist for patients being evaluated for Ebola in US.

Is it just blood or any bloodily fluid i.e. sweat, tears, urine, feces, semen, etc..? What does "contact" with bloodily fluids mean? I just touch blood of Ebola sufferer and BOOM, that's it? Ebola sufferer uses public restroom, doesn't wash hand, uses doorknob, I touch same doorknob with urine on it and BOOM, that's it?

As we've said in answering other questions, it doesn't last long on surfaces under normal conditions. But yes, theoretically that could happen--if the person you describe was symptomatic and shedding virus. It would also have to find a break in your skin, or a mucous membrane--your eyes, nose or mouth. So just as you should normally, wash your hands thoroughly and frequently. Try not to touch your face (which is very difficult). Alcohol-based hand sanitizer does a reasonably good job on the virus, though it's not as good as chlorine.

The nurse in the Washington Post article contracted Ebola after helping her patient only two times, while wearing full protective gear. Are they thinking she violated protocol in decontamination or that the virus penetrated her gear? I know this strain of Ebola is not Ebola Reston but is Ebola Zaire, but didn't Ebola Reston spread from monkey to monkey that were in cages in separate rooms? Lastly, how do we know that this virus has not mutated?

The latest info we have is that she may have touched her face with her glove after tending to the patient. That's a mistake. I'm not a scientist so I can't say how we know that the virust hasn't mutated. But it appears to be behaving the same way as it has throughout the epidemic. Only now there are so many infections, which means more chances of transmission and more chances for a health worker to make a mistake while providing care.

If Ebola is so difficult to transmit, why is it necessary to have people donning hazmat suits disinfecting Duncan's apartment long after he left? Shouldn't all of the virus at this point be noninfectious? Doesn't this send a conflicted message?

Within short periods of time, it could still be alive in any body fluids that might be on his sheets etc. Within longer periods, I believe it's just a sound precaution. The research on how long the virus lives outside the body is not that great. So no one wants to gamble with a cleanup worker's health that there isn't virus in that apartment somewhere.

What practical advice can pediatricians and other PCPs provide to their worried patients about Ebola in the US? Thank you.

Calm them down! There has been one (1) case in the United States, population 300 million. There probably will be a few more. But unless you're coming in contact with an infected person's body fluids while he or she is symptomatic, you won't get the virus. In Liberia, population 4.2 million, there have been thousands of infections. Schools are closed. Workplaces are closed. Gatherings are discouraged. And yet people get up in the morning, go to the market, do some of their normal activities. They're in a lot more danger than we are.

If you are exposed to the virus just once, what are the chances that you will actually get Ebola?

It really depends. The sicker the person, the more virus they are going to have in their body. In West Africa, many people  have become infected because of burial customs where relatives are bathing and touching the body. In our recent story about how the virus outran the world health organizations, we explain that in some places, the final farewell can include sharing a favorite beverage by putting a cup to the lips of the deceased before taking a drink.

     Also, it is important to remember that you have to be showing symptoms to be infectious.

How many batches of Zmapp can be produced in a year? And from that, how many people can be treated with that much produced in one year? Finally, why is it so rare?

We don't know exactly. Only Mapp pharmaceuticals and Kentucky Bioprocessing (which has the tobacco plants where the antibodies are produced) know exactly how it's made. (Maybe a few others who have been involved along the way.) And they tell us it's difficult and time-consuming. The US govt is trying to speed things up by expanding the number of facilites that can create it.

I'm just disgusted by all the "Ebola theater" measures that political demagogues are now advocating regarding travelers entering the U.S. from West Africa. Not one of these steps would have identified Thomas Eric Duncan as an Ebola carrier, because he was still asymptomatic when he arrived in Dallas, let alone when he left Africa or passed through Brussels.

Exactly.

There has been much discussion about containment: one of the best defenses against the disease spreading is early containment in a specific area. Is there any discussion on a global level e.g. U.N., etc. to close borders in any country to incoming travelers from West Africa?

A number of countries in Africa already have closed their borders to people from Liberia, Sierra Leone and Guinea and have suspended air travel. No one believes this will work entirely. Those borders are fairly porous, from what experts have said, and I think a determined person could find his way in.

How are journalists in Liberia protecting themselves since they need to get so close for a story?

I always tried to stay 4-6 away from sick people in case they sneezed, coughed or vomited. You don't touch anyone. You try not to touch anything you're not certain about. You try not to touch your face. You (and everyone else with access) wash your hands with a chlorine solution about 25 times a day. You use the same stuff to wash off your boots. I never brought my boots into my hotel room. I never got in a taxi because I never had any idea who was in it before me. I tried really hard not to go into a sick person's house.  Here's a story I wrote about it.

Can urine on a toilet seat cause the virus to spread? Should we spray with a disinfect before using a public bathroom?

I sure as hell wouldn't come in contact with it.

I understand that public health experts have come to a consensus that it's worse for public health - both in the US and in West Africa - for there to be a travel ban between the U.S. and those countries. My question is: why can't there be a limited travel ban to only allow aid workers to fly to/from West Africa, with extensive testing/screening done before they may enter the U.S.? I understand that an "epidemic" is not likely in the U.S. But I don't really care about that. I just don't want anyone getting sick from this in the U.S.

A travel ban, even a limited one, would deal a huge blow to those countries and make everything worse, experts have said. It's not just aid workers they need, but many other kinds of resources. In addition, this kind of travel ban would throw their economies--already reeling--into the toilet and have a ripple effect on neighboring countries. 

    The World Bank just came out with a new economic assessment that said if the epidemic was to significantly infect people in neighboring countries, the two-year regional financial impact could reach $32.6 billion by the end of 2015.

How can I best protect myself and my family from Ebola if another case arises in my area like the one in Dallas?

I think, as with all things, use common sense. And the kinds of precautions basic public health precautions that we should all be taking are going to be your best bet unless you or a loved one is getting assigned to fly into one of the affected countries. I would start by making sure you and your family wash their hands frequently.

Can you comment on the negative consequences the overdone , sensationalist media coverage is having on the attempt to inform and educate the American public about this one virus? Does the absurdly irresponsible (CNN: “Is Ebola the ISIS of Biological Agents”) make it more difficult for public health professionals to communicate clear, accurate information and avoid generating unfounded fear and panic? The relative probability of adverse impact to the vast majority of Americans by Ebola near zero. (Commuting to their workplace is, on average, 5 times MORE lethal.) Yet the media has promoted an imminent threat condition. Comments?

We have tried to put everything in perspective and help people understand how this outbreak happened and what the response has been.

That's all we've got time for. Thanks for joining us, and thanks to Lenny, Lena and Amesh for their helpful answers. 

For more on how Ebola spreads, check out:

- How do you get Ebola?

- Sex in a time of Ebola

And for a look at why this epidemic has been so deadly, read:

- How Ebola sped out of control

In This Chat
Lena Sun
Lena H. Sun is a national reporter for The Washington Post, focusing on health.
Lenny Bernstein
Lenny Bernstein writes the To Your Health blog.
Dr. Amesh A. Adalja
Dr. Amesh Adalja is an adjunct instructor in the Department of Medicine’s Division of Infectious Diseases at the University of Pittsburgh School of Medicine and senior associate at UPMC Center for Health Security. He also serves as a medical branch director for UPMC’s Corporate Emergency Coordination Center and is appointed to the City of Pittsburgh's HIV Commission.
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