Posted by: Chris Maloney | October 7, 2014

Is Ebola Virus Transmitted Through the Air?

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.



  1. Health officials say Ebola is not airborne.

  2. I appreciate the comment, but I’m wondering if you read the post.
    Actually, health officials are adamant that Ebola requires direct contact, preferably extensive direct contact with the infected person’s fluids. They also acknowledge that contact with the corpse may be a factor. But what I’m pointing out in this post is that the Spanish nurse does not meet those criteria. I also believe that if 168 U.S. or European doctors had died from Ebola no one would be thinking they all simply used very sloppy containment protocols. Surely medical personnel in West Africa are currently familiar with universal precautions. But universal precautions may not be adequate, as shown by the monkey studies.

  3. I did read the post. Health officials say that because the virus is sloppy it’s very hard to be transmitted through the air. Lack of health infrastructure is a major factor in the spread of the virus in Western Africa. If the disease is airborne how come no one else is getting sick in Lagos, Dallas, and Madrid?

  4. The thought of so many medical workers getting it has not set very well with me either. Thanks for writing about what doesn’t make sense to many of us.

  5. Oh good. It wasn’t clear from your first response, so thank you. I think it’s more likely that Ebola is passed via mucus membranes, but I don’t think it requires direct contact. The tiniest speck of blood could conceivably infect an individual,and that blood could get airborne from a cough and stay infectious well after the death of an infected individual. I don’t think it’s spread via saliva, which would be why we’re not seeing the sort of nightmare pandemic that would result from that.

    We’re also not clear if individuals can get sick but not display symptoms. The infectious rate after recovery for semen stretches for weeks. Which brings up the concept of someone as a carrier for Ebola without having the whole symptom cascade.

    If you’ve been following the history of HIV transmission in Africa, it feels a little like we ignore the infectious rate of these illnesses as long as they are contained to the continent. Only when they break out into Europe and the U.S. do we really get the sense that even with good containment measures it’s possible to get infected.

    My underlying reason to post was that I still don’t hear universal protections being required: separate air supplies, full impermeable suits, disinfectant showers post-exposure, and absolute isolation of all material in contact with the infected. If we’re quarantining family members and medical personnel in contact with each other without those precautions, we’re just betting that the virus won’t make the leap. I hope we’re right.

  6. Thanks for the reply. I’m very concerned that medical personnel are not being given the simple information that the tiniest speck of dried blood could infect them if it’s brought in contact with their mouth or eyes. If they know, it’s one thing, but being told it’s got to be direct contact with fresh fluids is just wrong.

  7. I agree. I’m not a health professional, but a journalist. My biggest concern is to educate and not create panic through misleading posts.

    I think what needs to be done is better education and understand why the disease is an epidemic in West Africa. Many Americans, just like those in Africa don’t have a clear understanding of the disease and its risks.

    The international community needs to come together to get this under control. Having people turned away and dying in the streets is not a way to get this deadly virus under control. As you stated, betting this won’t mutate shouldn’t be on the table.

    We must turn our fear into leadable action. This disease, even when the outbreak is over, will still linger. Education is critical.

  8. Oh, absolutely. You notice that I ask the question, I don’t state it as a fact. I’ve found when I ask the question, I get more traffic from people who are also asking the question. Right now, here in Maine, I have a patient who is convinced she has Ebola even though she’s never been in contact with anyone.

    I guess my underlying feeling is that there is a level of arrogance from U.S. and European doctors that Ebola would not exist if standard universal precautions (basically don’t get their blood on you) were met. I’d like it to be clear that the resources and equipment to keep those medical personnel in West Africa safe simply do not exist. Acknowledging that the infection is spread through dried blood, even days after the patient passes, and simply by being in the same, unsterilized room (as with the second monkey trial) means that we can have people care for Ebola and stay safe.

    But right now, we’re still pretending this is an Africa-only problem. We can’t let Sierra Leone go down and pretend we’re going to be safe if we take temperatures in the airport. If it can be spread weeks later by semen, we could be looking at the next AIDs epidemic, one that we can see coming and can take action now to prevent. It’s a healthcare Tsunami and we’re just standing and watching:

  9. […] is easier to get than we’ve been told. It isn’t airborne (see previous post) but it is passed by any contact to the eyes or mouth from dried blood. That means if you are […]

  10. […] Remember Ebola? It was thought to be only transmitted with difficulty, from direct blood contact. Then we realized, too late, that bloody droplets were infectious as well. Caregivers went from surgical masks to separate breathing systems and the spread finally […]

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