|Hospital Carlos III|
The first human Ebola contagion outside of Africa, detected in the nurse Teresa Romero in the Carlos III Hospital in Madrid, led to a scare concerning a possible outbreak un Spain. But the first cases of the epidemic occurred in Guinea earlier this year. Since then, the virus rapidly expanded, becoming the most lethal Ebola outbreak in history, with more than 3,800 dead and 8,000 infected, according to World Health Organization (WHO) data.
So far, the confirmed cases of infection had occurred only in Guinea, Liberia, Sierra Leone and Nigeria. Both Spanish missionaries, Miguel Pajares and Manuel García, were infected in Liberia and Sierra Leone, respectively. Both were taken to Spain to be treated at the Carlos III Hospital in Madrid on 7 August and 21 September, where they died within a few days due to the severity of the infection. It was during the latter case that one of the nurses in the team assisting the patient was infected.
In Mètode we talked to two professors of the University of Valencia about the main questions that arise in the case of Ebola in Spain. Santiago Mas-Coma is Full Professor of Parasitology and expert of the WHO, as well as president of the International Federation for Tropical Medicine (IFTM). Fernando González-Candelas is Full Professor of Genetics and researcher in molecular and evolutionary virus epidemiology.
THE CAUSES OF CONTAGION
Although the exact causes have not yet been determined, according to the latest information in the media, the spread would have been accidental, when the nurse was taking off her biohazard suit used by all the staff working with the patient. In this regard, Professor Mas-Coma points out that it seems «it wasn’t a protocol failure, but a understandable human error given the stressful situation».
In a recent interview for Mètode, José María Martín Moreno, Full Professor of Preventive Medicine at the University of Valencia, claimed that maximum-security suits were not necessary to treat Ebola patients, and that they could even be counter-productive, making movement and the access to the patients more difficult. The professor said it was enough with «adequate gloves, waterproof coat, a simple face mask and goggles». However, many healthcare workers who participated both in the care of the two missionaries and the infected nurse have reported a lack of coordination between health authorities. They indicate that they received insufficient training to deal with the disease and the use of inadequate suits when they assisted the patients.
In this regard, Professor Mas-Coma says we need to «understand that medical personnel who are not used to these situations may make mistake».
«We talked to two professors of the University of Valencia about the main questions that arise in the case of Ebola in Spain»
«Health personnel is very vulnerable to infection and represent about 5% of the total infected in the current outbreak»
THE RISK TO HEALTHCARE WORKERS
Santiago Mas-Coma sees some parallels between the case of contagion in Spain and contagion of health workers in affected African countries like Nigeria. In fact, according to WHO, health personnel that deals with victims of Ebola is very vulnerable to infection and represent about 5% of the total infected in the current outbreak.
The European Centre for Disease Prevention and Control claimed this week in its twitter account that «infection control protocols in Europe are of high standard but risk to healthcare staff cannot be completely eliminated». Of the total dead registered by WHO before 5 October, 232 are be medical personnel.
THE POSSIBILITY OF AN OUTBREAK IN SPAIN
«The virus does not spread easily if not in contact with the patient’s bodily fluids: blood, vomit, etc.», explains professor Fernando González-Candelas, who reminds us that «a very direct contact with an infected person who shows symptoms» is needed to get infected. «The virus is not easily transmissible, as occurs with the flu», says the researcher in the Cavanilles Institute of Biodiversity and Evolutionary Biology.
In this sense, both professors from the University of Valencia say it is difficult for a serious outbreak to happen in Spain, since the moment the Ebola case is confirmed, a protocol is activated to track anyone who has been in contact with her, especially her husband. «Everyone who had any suspicious contact with the nurse is already under monitoring», expert Mas-Coma explains.
MUTATION OF THE VIRUS
In an article published on 11 September in the American newspaper The New York Times, the virologist Michael T. Osterholm suggested the possibility that the virus mutates and becomes airborne.
«A virus can not change its transmission mode so drastically», says Fernando González-Candelas, who calls the letter «pseudo-scientific terrorism». The Genetics professor uses the AIDS or hepatitis C viruses, which are not airborne, as examples. «Each virus is adapted to a cellular receptor, so a bloodborne virus, for example, can not be transmitted through the air.»
THE CONTROVERSY OVER THE DOG
n recent days, one of the controversies has revolved around the need – or not – to sacrifice the nurse’s dog. Animal groups and scientists claim that studying the animal would have been beneficial for disease research, and asked for alternative options to sacrificing the dog. However, it was put down last Wednesday.
In an article published in Emerging Infectious Diseases, a journal of the CDC (USA Center for Disease Control), in 2005, researchers found that some dogs exposed to an Ebola outbreak in Gabon presented antibodies against the Ebola virus. Professor Mas-Coma explains «This means that we could consider it possible to transmit the disease from dog to human. And a dog is not easy to control».
In the opinion of the Parasitology professor, sacrificing the dog was the correct option in this case. «It is obviously hard for everyone, especially for the owners, but the danger of an infected dog can’t be overlooked», the WHO expert concludes.
Anna Mateu. Assistant-editor of Mètode.
Fernando González-Candelas: «A virus can not change its transmission mode so drastically»
Santiago Mas-Coma: «It is obviously hard for everyone, especially for the owners, but the danger of an infected dog can’t be overlooked»