Few words can strike fear into the heart of a person like Ebola. For some, it brings to mind when your country panicked about nothing, quite a few years ago. Others remember the hard battle to control the outbreak that left a death toll soaring into the thousands. Still, others look at it with anticipation of an unknown journey as they prepare to enter the Hot Zone of an Ebola Treatment Center. Below, I’ll provide some information I learned during my response, as well as things I wish I knew before getting there.
Responding to an Ebola outbreak will require both physical and mental strength. While you can never be fully prepared, knowing a few things before you go can ease the learning curve. I find it easier to deal with things I can anticipate so I can prepare in advance.
We’ll start with the history of Ebola and the disease process. Then we’ll follow up with some tips for the Ebola response.
History of Ebola
According to the CDC, the first Ebola outbreak was reported in 1976 near the Ebola River in the Democratic Republic of the Congo (DRC). As you might have figured out, the name for the virus comes from the river it was first discovered near.
Scientists believe bats or nonhuman primates (apes and monkeys) may be the original sources of the virus. Once the virus infects a human, it can pass from person to person through blood and body fluids.
The Ebola outbreak most are familiar with is the 2014 to 2016 outbreak in West Africa. Guinea, Sierra Leone, and Liberia were the epicenter for the outbreak with over 28,000 cases and over 11,000 deaths.
Disclaimer
Just a reminder we have a disclaimer that you can find here. Long story short, we’ll provide some tips we found handy, but use them at your own risk. Follow government health recommendations and those from your organization.
The Virus
When responding to Ebola, your primary concern needs to be preparing for the virus itself. If you plan to respond to a location with Ebola, you need to know the signs and symptoms and how to protect yourself.
Signs and Symptoms of Ebola
The early symptoms are unfortunately vague and very similar to many illnesses as well as heat exhaustion.
Early signs
- Fever
- Fatigue
- Muscle pain
- Headache
- Sore throat
Late signs
- Vomiting
- Diarrhea
- Rash
- Symptoms of impaired kidney and liver function
- Internal and external bleeding, in some cases
- Low white blood cell and platelet counts and elevated liver enzymes
The incubation period (time from first exposure to first symptoms) can be anywhere from 2 to 21 days. For more information on the Ebola disease process check out this article by WHO.
Infectivity
The risk of catching Ebola from an Ebola patient rises as they progress through the stages of the disease.
A patient just starting to show early signs of Ebola is the least infectious, but can still infect others. As they progressively become more sick, their infectivity rate increases. The “wet” symptoms (diarrhea, vomiting, bleeding) also make a person more infectious. This is why it is recommended to separate the suspect Ebola cases into suspect dry and suspect wet patient areas.
An Ebola patient is most infectious when they die. This is a critical time. It will require several resources to take care of the body, as well as care for the family. Death will be a very sensitive time and you’ll want to speak to your supervisor regarding how your organization is handling it.
We can release an individual with Ebola after their blood tests are negative for the virus, but the virus has survived for over a year in the eyes and in semen. Condoms are part of the discharge plan for patients. The Ebola survivors have to cope with the stigma of Ebola when they return home.
A Fighting Chance
Fragile
If there is only one other thing you can find encouraging about Ebola besides the vaccine, it’s this. The virus is relatively fragile compared to other viruses. That being said, just because something is easy to destroy does not mean it is easy to contain, nor can you let your guard down.
Several ways Ebola can be killed include…
- Bleach
- Alcohol
- Ammonia
- Peroxides
- Boiling water for 5 minutes
Image Source CDC
Washing your hands with soap and water or 0.05% Chlorine can reduce your risk of becoming infected. UV/sunlight also destroys the virus after a certain amount of time.
Ebola is still an extremely dangerous and deadly virus, but we can protect ourselves from it.
Ebola Vaccine
The Ebola vaccine changed the playing field for the Ebola response. Responders, for the first time, had additional protection besides layers of PPE. The known contacts of the patient now have a fighting chance if they get the vaccine quickly too.
Vaccines for Ebola Responders
For the vaccine to work properly for Ebola responders it needs to be taken either at the same time as other vaccines or several weeks after. If you get a vaccine (like the Yellow Fever vaccine) before leaving for the Ebola site, your body will mount a large immune response to the Yellow Fever vaccine and then a much smaller one for the Ebola vaccine if it is taken shortly after. You would have all the benefits of the Yellow Fever vaccine, but only part of the benefits of the Ebola vaccine. The CDC recommends waiting up to 28 days to take another vaccine. Check in with your doctor and medical director for your mission.
Vaccines for Ebola Contacts
When an Ebola patient is admitted to the hospital or Ebola treatment center, a team will begin contact tracing. Since Covid, the world is a little more familiar with this concept. A sick person is admitted, and a caseworker finds out who that patient has come in contact with since symptoms started. They’ll go out and alert them they have been exposed and offer them the vaccine. This creates a ring of vaccinated people. A second ring may be included in case any of the ones in the first ring were infected and spreading it as well.
Tips for the Ebola Response
Now that you know some of the history and response efforts, it’s time to dive into the deep end, or in this case the hot zone. The hot zone refers to the area the suspected patients are located. The warm zone includes the donning station and the outside of the doffing station as well as your general hospital supply areas. The cold zone includes your living and dining quarters.
Each zone indicates the level of risk present. The hot zone is extremely risky and requires full PPE. The warm zone has the potential for contamination from the hot zone. The cold zone is another step away and hopefully completely safe. That said, extreme caution needs to be taken in all locations. The cold and warm zones will have a handwashing and shoe spraying station between them. A full decontamination area will be between the hot and warm zone.
PPE (Personal Protective Equipment)
Utilizing PPE properly and following all steps is critical. Your organization will provide you with training before you go in for the first time. Make sure you are comfortable with the process before going in.
Before going in, someone will write your name and the time you donned your PPE somewhere on your suit. For us we put the name on our forehead and the time on our sleeve. This lets others know who they are looking at as well as how long you have been in for. Another team suggested taping photo to our PPE so the suspected Ebola patients had some idea of what you looked like. As always check with your team lead first!
Doffing (removing) the PPE can take up to 10 minutes and there may be people in front of you. Do not push yourself so hard that you don’t have the strength to doff safely. Picking up a downed Ebola worker is extremely difficult and risky! When in doubt, get out early!
Temperatures soar during the day in Africa. The PPE acts as a greenhouse trapping the heat and sweat inside. It was not uncommon to come out of the hot zone and pour cups of sweat out of our boots as we changed into clean clothes. Sweat can pool in the arms and backside of the PPE and sloshes around into the gloves while working.
One of the more arduous tasks is removing the PPE. I personally had trouble holding my boot up for them to spray it off. Now may be a good time to practice your ability to balance on one foot.
Dish Soap
A constant battle we faced throughout the Ebola response was fogged-up goggles. We tried many ways to prevent them from steaming up with limited success on most options.
Previous teams had tried the anti-fog spray and didn’t find it very helpful. Rubbing a bit of saliva on the goggles also didn’t help and may have actually made it worse, (who wants to spread extra body fluids around with Ebola anyway). Liquid dish soap seemed to be the best solution. Your goggles will still fog up but it took about 4 times longer than the other methods.
Just dab a little drop and smear it around, lightly rinse it off so the soap doesn’t distort your vision and you’re good to go! Your goal is to leave some soap on there without having cloudy vision.
Dehydration
Ebola is not the only thing you have to watch out for. Dehydration is a very real concern.
Be prepared to sweat more than you ever have in your life. Ebola has been predominantly in warm climates. Add multiple layers of PPE to the warm environment and you will dump more cups of sweat out of your rubber boots than you realized you could sweat!
Your site will probably require you to walk out in the hot sun with no air conditioning doing demanding tasks. These may include carrying a stretcher in full gear or wearing a backpack sprayer to clean behind the suspect or confirmed patient.
Many of the symptoms of dehydration are the same as Ebola. The better hydrated you stay, the less you’ll have to worry about Ebola symptoms!
Rehydration
My personal estimate was that I lost 3 liters of fluid for every hour time slot I went in during the hottest part of the day. In the Democratic Republic of Congo that was from about 1100 to 1600.
I would come out, change, and immediately down 2 liters of water. I attempted to drink the oral rehydration solution (ORS) but couldn’t stomach it! The most fitting description I could find for ORS is fuzzy sea water! It’s salt and has a bit of grit to it! Yuck!
If you have extra room in your luggage bring electrolyte replacement options. You can buy it in powder form or in concentrated bottles.
Bike shops are a great spot to find additional electrolyte replacement options. Talk to the shop and ask them what they recommend. There are a lot of options out there! You can buy electrolyte drink mixes, gummies, or little individually packaged tubes of gel or paste. Each is designed to keep bikers’ electrolytes balanced and stamina up, something very similar to what you’ll be needing.
Our cook was able to source a lot of natural vegetables. I have never eaten or enjoyed pineapple more than I did in DRC. It was the perfect snack! Also, now may be the time to add some extra salt to your diet! Chances are you’ll need it.
Mind games
The early symptoms of Ebola are frustratingly generic. Headaches, general weakness, fatigue, and general aches are a few of the symptoms. Unfortunately, the symptoms of heatstroke, dehydration, and even just an exhausting day of heavy labor are also very similar.
The vaccine may offer a little extra peace of mind, but it can also cause some of the same side effects. Play it safe, keep track of your temperature. Run any of your symptoms by your supervisor.
One of the most frustrating things I dealt with was learning that hiccups are a symptom of Ebola. You don’t realize how many times you hiccup in a month until you’re working around Ebola. Thankfully they are a late sign of Ebola, so don’t be too alarmed!
Violence
There have been multiple attacks on Ebola treatment centers over the years. The region we worked in was pretty stable, but you need to keep an ear out for trouble. Listen to your security team’s advice.
Some locals would rather trust their alternative healers. Others believe white people brought Ebola to their country. These are all stigmas you may have to deal with. It is our job to be fair to all.
Quarantine
Covid, in 2020, introduced public health’s role to the general population. With Ebola, the local health department will work with your organization to prepare for your return home. Their requirements can vary greatly and may include paperwork, a phone call, home inspection, a list of close contacts, and pets… Some may have you sign a statement saying you agree to their conditions.
They informed us to limit our contact with family when we arrived home. Most family members slept in a different room or in the basement as they waited out their quarantine time.
Unfortunately, Ebola isn’t the only thing you have to avoid. Anything will be flagged as Ebola until proven otherwise. The flu, a cold, and food poisoning all have some symptoms in common with Ebola. Eat your vegetables, take your vitamins, and use lots of alcohol (hand sanitizer that is). Play it safe, and hopefully, you won’t end up reenacting a scene from E.T.
Businesses have adapted to the quarantine lifestyle so hopefully getting a well-deserved pizza and some ice cream will be a little easier this year! Just have them ring the doorbell and walk away. No need to fill out extra exposure contacts.
Final Thoughts
Spend a little extra on a fast-read thermometer. Sure you can get the basic thermometer that takes 30 seconds to read your temp or you could save yourself 28 seconds twice a day for the next two months by getting the fast read thermometer. A fast-read thermometer was the best purchase I made for my Ebola response!
Buy disposable everything. I bought several cheap items with the intent to just leave them in the country when I finished.
Downloading some music, books, movies, or other offline apps is a nice way to relax on long trips.
Did we mention electrolyte mixes? Yup, but seriously, bring more than you think you’ll need. Someone will appreciate it! Salty snacks will be handy too!
Finally, the Ebola response is doable. It will tax you in every way possible. You may have to make difficult decisions, and you’ll demand more from your body than you ever thought possible. You’ll have puddles of sweat in places you never knew could have puddles! You’ll miss being able to interact physically with a hug or a high five becoming distant memories. In the end, though, you’ll become an Ebola responder, someone that answered the call to one of the most challenging diseases on the planet in our time.
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Additional resources
Ebola Treatment Centres: design and construction (PDF)
Interactive map
Ebola Site map (PDF)
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