BY Richard Dawood

Advisory: Covering the Ebola outbreak

This is the largest known outbreak of the disease and the first in West Africa.

The affected countries are Guinea, Liberia, Nigeria and Sierra Leone where there have been more than 3,000 suspected cases and more than 1,500 deaths, though there is also a serious problem with under-reporting.

Small numbers of cases have also been reported recently from the Democratic Republic of Congo (DRC), but these do not appear to be directly related to the West African cases.

The West African outbreak is currently out of control and likely to continue for many months as there are no local laboratory resources or hospitals capable of providing the intensive care needed to give severely affected victims any prospect of recovery. Because of the way infection spreads, healthcare workers are at very high risk, and the death toll has already included some of the most skilled local doctors and nurses. Bringing the outbreak under control will require much external help, including case finding, contact tracing and infection control. In the words of one expert from the US Centers for Disease Control (CDC), it will be necessary to “stamp out every ember” of infection.

MEDIA TRAVEL TO THE AFFECTED REGIONS

The CDC and the World Health Organisation (WHO) have refrained from issuing health advice specifically directed at media personnel travelling to affected regions, since avoidance of possible exposure lies at the heart of the preventive warnings they currently offer.

However, some organisations such as Public Health England have provided advice for humanitarian aid healthcare workers that may be relevant to travelling media personnel.

Key issues for journalists covering the Ebola outbreak:

Insurance/evacuation

Make sure that any travel health insurance you or your employer have in place will cover you for every aspect of your intended assignment and will not be invalidated by any travel restrictions or government warnings. Ensure that this also covers the cost of medical evacuation.

Careful travel health preparation

Ensure all recommended vaccines are up to date (including flu vaccination), take careful precautions against malaria and travel with a full medical kit. The risk of common travel-related illnesses is very much greater than the risk of Ebola infection. In the context of the current outbreak, however, any illness that causes a fever – even flu – may result in unnecessary alarm and incorrect treatment, so the emphasis should be firmly on prevention.

Have a plan in place

What would you do if you became unwell? Where would you go? Think carefully about worst-case scenarios, and plan for them on the basis that there are unlikely to be any reliable local resources available. This might be a particular issue for international broadcasters employing freelance crews from more than one country and needs to be considered carefully and in advance.

Personal protective supplies

If high-risk exposure is deemed essential, personal protective measures need to be tailored and adapted to the task in hand, including the extent of exposure likely. Examples of the type of equipment that might be considered can be found on the Fleet Street Clinic website. Different types of products are available to cope with a range of risk including:

  • FFP3 respirators (facemasks)
  • Goggles
  • Eye care
  • Protective coveralls (Tyvek or Tychem)
  • Overboots
  • Antiviral disinfectant (Virkon sachets or tablets)
  • Sponge or spray bottles
  • Nitrile gloves
  • Clinical waste bags
  • Alcohol gel hand wash
  • Hard surface wipes
  • Transparent plastic pouch

Training

An introduction to the use of personal protective equipment against biohazards can be found here. There is no point taking along personal protective equipment of any kind unless you know how to use it correctly, so training and a clear understanding of the principles involved is a vital part of preparing for any assignment in a high-risk environment.

Restriction on travel

According to International SOS, many countries have restricted travel from Ebola-affected countries including:

  • Côte d’Ivoire, which announced on 23 August that it had closed its land borders with Guinea and Liberia. It has also banned all passenger flights from Guinea, Liberia and Sierra Leone.
  • Gabon stated on 22 August that it is restricting entry visas to travellers from Guinea, Liberia, Sierra Leone and Nigeria on a case-by-case basis. It has also banned the entry of flights and ships from countries affected by Ebola.
  • Cape Verde on 19 August banned nationals from Guinea, Sierra Leone, Nigeria and Liberia from entering the country for the next three months.
  • Rwanda has reportedly banned entry to travellers who have visited Guinea, Liberia or Sierra Leone in the 22 days prior to travel.
  • Senegal on 21 August closed its land border with Guinea, while the country's sea and air borders will also be closed to vessels and aircraft from Guinea, Liberia and Sierra Leone.
  • Chad on 21 August closed its land border with Nigeria at Lake Chad. The country earlier banned the entry of any travellers originating or transiting through Guinea, Liberia, Nigeria or Sierra Leone. Airlines serving the country have rerouted flights accordingly.
  • South Africa on 21 August banned the entry of all non-citizens travelling from Guinea, Liberia and Sierra Leone.
  • Botswana on 19 August banned entry of travellers who have been in Guinea, Liberia, Nigeria and Sierra Leone in the 30 days prior to travel.
  • Kenya on 19 August suspended entry of passengers travelling from and through Guinea, Liberia and Sierra Leone, excluding health professionals supporting efforts to contain the outbreak and Kenyan citizens.
  • Namibia has banned all travellers from countries affected by Ebola, with the exception of Namibian citizens.

Other countries that have implemented Ebola-related travel restrictions include:

  • Cameroon, which has banned flights from Guinea, Liberia, Nigeria and Sierra Leone.
  • Gambia has banned all passenger flights from Guinea, Liberia and Sierra Leone.
  • Nigeria has suspended flights to the country operated by Gambian national carrier Gambia Bird.

Airlines that have restricted flights to Ebola-affected countries include:

  • Air France, which has suspended flights to Sierra Leone from 28 August.
  • The Togo-based carrier Asky Airlines has suspended flights to and from Guinea, Liberia and Sierra Leone.
  • Arik Air (Nigeria), Gambia Bird and Kenya Airways have suspended services to Liberia and Sierra Leone.
  • British Airways has extended its suspension of flights to Liberia and Sierra Leone until 31 December.
  • Ceiba Intercontinental, the national airline of Equatorial Guinea, has reportedly suspended flights to West African countries.
  • Emirates Airlines has suspended flights to Guinea.
  • Korean Air suspended flights to and from Kenya from 20 August.
  • Senegal Airlines has suspended flights to and from Conakry (Guinea) until further notice.

BACKGROUND

Ebola Virus Disease (EBD) belongs to a class of diseases called Viral Haemorrhagic Fevers (VHFs). Other diseases in this category include Lassa Fever, Marburg and Crimean-Congo Haemorrhagic Fever.

  • VHFs are infections of animals that only rarely go on to infect humans and are caused by viruses that are naturally carried by rodents, ticks, bats or mosquitoes. In the case of Ebola, the natural hosts are certain types of bat.
  • VHFs are found mostly in the remotest parts of the developing world. Previous outbreaks have occurred on a small scale and have rapidly burned themselves out.
  • Infections in visitors to endemic areas are extremely rare.
  • Most fevers in short-term visitors to endemic areas are caused by more common diseases, such as typhoid or malaria.

Key features of Ebola infection

Like other VHFs, Ebola infection constitutes an all-out attack on cells throughout the body, involving all body systems and with a correspondingly high fatality rate – up to 90 percent. Symptoms include:

  • Fever (greater than 38.6°C or 101.5°F)
  • Severe headache
  • Muscle pain
  • Weakness, debility
  • Diarrhea (often with blood)
  • Vomiting (often with blood)
  • Abdominal (stomach) pain
  • Bleeding (e.g., from the nose and mouth) leading ultimately to multi-organ failure and death. The onset of symptoms (incubation period) is typically 8-10 days following exposure – with a range from two to 21 days. So an illness occurring more than 21 days after the last possible exposure is not likely to be Ebola.

How it is spread and how to avoid infection

Inevitably, isolated instances of spread to other countries via international travel may occur. In countries with a well-developed health infrastructure, the possibility of incoming infection taking root and becoming established is remote. In a clinical update dated 20 August 2014, the UK’s travel health network NATHNAC said that “the risk of a traveller becoming infected with the Ebola virus during a visit to the affected countries and developing disease after returning is very low, even if the visit includes travel to areas in which cases have been reported”.

Transmission generally requires direct contact with an unwell, symptomatic, infected person and/or their body fluids or the dead bodies of victims of the disease. Avoid infection by:

  • Staying away from sick people and hospitals, funerals, dead bodies, homes of victims and their families
  • Frequent hand washing and/or use of alcohol-based sanitisers
  • Not handling animals of any kind but notably bats
  • Not eating bush meat and ensuring any meat products are thoroughly cooked

Vaccines/curative treatment

There is a vaccine in development, and an experimental drug, ZMapp, is being tested with promising results. The current outbreak has given considerable urgency and impetus to these developments. For the time being, however, the treatment options are limited and prevention is based upon avoidance of exposure and personal protective measures.

RESOURCES

Up-to-date case counts and information about the extent of the outbreak can be found at:

CDC

WHO

ECDC

Other resources on Ebola include:

NATHNAC

Public Health England

European Center for Disease Prevention and Control (ECDC) 

International SOS

Secure Bio

Fleet Street Clinic

Richard Dawood is the medical director of the Fleet Street Clinic in London.

This advisory is meant to assist journalists in making their own decisions following a rigorous risk assessment. INSI cannot accept responsibility for any problems that occur.

AP Photo