Identifying patients at risk for Ebola

Ebola is knocking at our door…will you open it?

How to identify patients at risk

Knock knock.

Whose there?

Ebola.

Ebola who?

No, I’ve got Ebola you idiot, let me in.

Is it just too soon for joking about this topic? The headlines are horrifying, telling us things like “Ebola is here”, “Burn the bodies” and of course “Fear of Ebola breeds a terror in physicians”.   This is what we are talking about at the water cooler right now. People are afraid of Ebola.   People need answers. Let’s find answers…

What to look for (Symptoms)

The incubation period for this virus is from 2 to 21 days, with humans becoming infectious during the onset of the first symptoms. These first symptoms include:

  • Sudden onset fever
  • Fatigue
  • Muscle pain
  • Headache and sore throat
  • Vomiting
  • Diarrhea
  • Rash

As this virus continues:

  • Kidney and Liver function
  • Both internal and external bleeding (oozing from gums, stools)

Other things to look at include laboratory findings such as a low white blood cell count and elevated liver enzymes.

It can be difficult to differentiate Ebola from other viruses even with all of these symptoms present, so the following test are also completed before a diagnosis can be made:

  • * antibody-capture enzyme-linked immunosorbent assay (ELISA)
  • * antigen-capture detection tests
  • * serum neutralization test
  • * reverse transcriptase polymerase chain reaction (RT-PCR) assay
  • * electron microscopy

* virus isolation by cell culture.

Again, most of the early symptoms are very ambiguous, and they will present very much like any other virus such as the flu. The key is really going to be two fold: 1.) ask questions. 2.) remain calm.

When we triage patients; that’s where the questions need to be very direct. Try questions such as:

  1. When did your symptoms begin?
  2. How high has your temperature been?
  3. Did you have a Flu shot this year?
  4. Have you been outside of the country in the last month?
  5. If so, where did you go?
  6. Have any of your friends and family been out of the country in the last thirty days? Where did they go?

Be careful with these questions, we know that people tend to be less than forthcoming when they feel threatened. Our patient’s are not on trial here, we simply want to protect them as well everyone else.

Ebola is extremely frightening for any patient to even consider, especially since it is still thought of as a death sentence. It’s for that reason that the healthcare professionals, although completely “freaked out” themselves, must remain calm and offer hope to the patient.

So, they have the diagnosis…what now?

First of all, the patient will be placed on droplet isolation as per the CDC recommendations (2). Then supportive care will be the key. Although there are two potential vaccines on the horizon, neither one has been approved as of yet (3). So, we will focus on rehydration and treatment of specific symptoms as they arise.

Yes, Ebola is a scary virus. Yes, it will most likely make its way to the U.S. Yes, we will open the door to these patients just like we have for every other patient group.

For more information:

  1. http://www.cdc.gov/vhf/ebola/pdf/ems-checklist-ebola-preparedness.pdf
  1. http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
  1. http://www.who.int/mediacentre/factsheets/fs103/en/
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