The most recent case of confirmed Ebola in Spain raises the possibility that the rules for Ebola transmission are not accurate.
According to the World Health Organization, Ebola is transmitted: “via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people.”
In other words, Ebola is like H.I.V. or Hepatitis B. You basically have to get a persons’ blood or other fluids on your own broken skin to be infected. The important thing is that you can’t get Ebola by having a person in the same room or airplane with you.
But anyone who has been following the Ebola outbreak must have wondered at the number of health care workers who have contracted the illness. The numbers just keep going up and up. Under guidelines, infection requires “close contact with patients when infection control precautions are not strictly practiced”. So we must assume that 348 health care workers, 186 of them who have died, simply didn’t understand that they shouldn’t let patients’ blood into open wounds in their own bodies?
The most recent Spanish case of Ebola makes this scenario impossible. The person infected had two brief contacts with the Ebola patient, a priest who had been in West Africa. She was a sanitary technician who changed his diaper once, and who later had contact with his belongings after he died.
Now, she wore full protection both times. Yes, there’s some question about using tape on the contact point between the wrists and the gloves. Yes, she lacked the ability to breathe different air. But remember, the current definition of contact requires direct contact of fluids through broken skin or mucous membranes. It is highly unlikely that occurred.
The worker finished treating the patient and went on vacation in Madrid. She clearly wasn’t worried about some kind of transfer. So we must assume that she was infected in some way not currently covered by the World Health Organization protocols.
What no one is saying openly is that the most likely source of infection was through the air. An aerosolized form of the blood could be inhaled and transmit the virus. In biological warfare circles, aerosolized Ebola does transmit the disease. (study here) We’ve known this for decades. (study here)
But another, less contagious route would be orally or conjunctivally (through the eye). Small studies on monkeys show that both oral and conjunctival infection from Ebola virus results in death. (study here) Another study confirmed that control monkeys, who had no direct contact with any fluids of infected monkeys, still became infected with Ebola virus. The only exposure was that the monkeys were held in the same room that had previously been occupied by the ill monkeys. The researchers again presumed that: ” (t)he most likely route of infection of the control monkeys was aerosol, oral or conjunctival exposure” (study here).
What is startling is not that these studies exist, it’s that no studies confirm the claims that the only route of transmission is through direct contact only. The monkey studies were done in 1996 and 1995, and can be accessed by simply by searching medline for keywords: “Ebola transmission aerosol.”
So workers using protective gear need to be aware that any speck of blood, picked up and stuck in a mouth or rubbed in an eye, is a potential infectious agent long after the patient has died and been buried. That requires a much greater level of quarantine and completely dedicated hospitals where sanitary measures are absolute. Think “boy in a bubble” absolute. No taped wrists, no common elevators. And full hazmat showers after any contact, because even a speck is contagious.
The other problem is that the most recent case went for vacation in Madrid. According to the World Health Organization: “People remain infectious as long as their blood and body fluids…contain the virus. Men who have recovered from the disease can still transmit the virus … up to 7 weeks after recovery from illness.” That means the Spanish nurse was infectious and wandering around Madrid. Her saliva, etc., was contagious. We can just hope that the person who washed her dishes didn’t wipe his or her eyes.