How Ebola started, spread and spiralled out of control

By Ian Mackay, The University of Queensland; Heather Lander, The Conversation, and Katherine Arden, The University of Queensland

Too slow. Too little, too late. Unprecedented. Out of control. These are just some of the descriptors for the biggest recorded epidemic of human infection by an ebolavirus.

The question by some is how this happened? As of this writing, 5,347 people are suspected or known to be infected (an undoubted underestimate) in Guinea, Sierra Leone, Liberia, Nigeria and Senegal. And 2,630 have died.

The previously stated death rate of 49% is also a serious underestimate. The World Health Organization has calculated the fatality rate among confirmed cases with known outcomes to be above 70% overall and 64% for those who were hospitalised.

Latest worst-case modelling predicts up to 1.4 million people might become infected in this outbreak; 70% of which is 980,000 souls.

How did it happen?

The outbreak was identified six months ago, three months after it is believed to have begun from a single animal-to-human transfer.

The world was soon after assured by those in senior roles that Ebola virus disease outbreaks were not hard to control and ebolaviruses were not easy to catch. This was meant to apply even to members of the Zaire ebolavirus species (an Ebola virus), one of which now ravages West Africa.

(Note, Ebola virus is the name of the Zaire species, while ebolavirus refers to all species).

Were assurances just hubris or simply a failure to recognise this outbreak for what it was?

Every infectious disease outbreak has a “personality”; this one includes the introduction of a terrifying disease into a completely susceptible population, in a part of the world with no chance of stopping it alone.

West Africa has very few health-care workers, poor roads and sizable distances between villages, towns and cities. These factors in combination with traditions, especially those for preparing loved ones for burial, have conspired to produce a perfect storm of opportunity for Ebola virus transmission and spread.

We often hear that ebolaviruses were not known to exist in Western Africa prior to this outbreak. But that is not strictly correct. Two scientific studies published in 1986, using samples collected in 1973 and 1981-2, had already reported finding haemorrhagic fever viruses, including Ebola virus, in the forests of Liberia.

Another study, co-authored by Dr Sheik Umar Khan who subsequently succumbed to an Ebola virus infection in Sierra Leone, was published after the outbreak began. It found signs of Ebola virus in samples collected from 2006 to 2008.

With 20:20 hindsight, one can speculate that this information could have been used by local governments to educate their citizens and better train and prepare their front-line health-care workers; a higher proportion of whom have, throughout history, been infected during Ebola virus outbreaks.

Experts repeatedly tell us this virus can be easily contained with early intervention. Had this population been prepared, perhaps more personal protective equipment and bleach would have been ready to go, and the rapid transmission of the West African Ebola virus outbreak might have been contained.

No airborne transmission

Transmission of ebolaviruses between humans is by direct contact in which the broken skin or exposed mucous membrane (mouth, eyelids, genital tract) of susceptible humans is exposed to an infectious dose of Ebola virus-laden fluid (blood, vomit, faeces, sweat, saliva and semen) from a patient showing signs of the disease.

Semen can remain infectious weeks into the convalescence period. Propelling wet droplets onto a mucous membrane is also a form of direct contact.

But regardless of what one might read in The Hot Zone (or the New York Times), there is no direct evidence that any ebolavirus species, strain or variant is transmitted via an airborne route.

The scientific evidence suggests that while aerosols can be used in the lab, it is the wet droplets in these rather than the dried down airborne fraction that are most likely involved in ferrying virus. Even the researchers involved in the events of the dramatised book version caution us to keep in mind that “aerosol and droplet transmission” is not the same as “airborne transmission.”

This does not sit well with some who see ebolavirus lab workers in lab containment “space-suits” and erroneously compare that to the personal protective equipment worn by diagnostic scientists, Médecins Sans Frontières workers, doctors, nurses and gravediggers, and draw the conclusion that more is always better.

What’s missing from their concern that only an airborne Ebola virus can explain current health-care worker infections, is that simply including a more advanced mask (respirator) or a battery-powered air pump and hood does not cover all the potential sources of infection in or out of an Ebola virus disease treatment centre.

Mounting a global response

West African health-care workers are in short supply. They’re overworked, exhausted, under-equipped, insufficiently trained or can be fallible.

In the early days of the outbreak, personal protective equipment use was rare and risk of infection was high. In some instances, protective equipment is still not used to the extent that it should be.

But an Ebola treatment centre is not the only source of Ebola virus infection when in the midst of a raging epidemic in crowded cities. Health-care workers have been infected in maternity wards. And when away from treating patients they have the same risk as the rest of the population of contracting an infection from others, such as in their hotels.

Another population taking a heavy toll are families. When an infected and sick member cannot get into an already full Ebola virus disease treatment centre, they return home, unrecorded, for care and another single case becomes many.

We are all part of a shrinking global village, and right now some of its homes are ablaze. We can and should expect each of our governments to do more than pay someone else to buy, fill and carry a few buckets to throw on the inferno, as the Australian government has done.

Instead we should follow and build upon the example set by the United States. Every neighbour in this village has a duty to mount an equally robust response. And from the ashes we must build a stronger, more communicative and sustainable alliance to watch for and respond to global health emergencies.

Heather Lander previously received a US DOD T32 Training grant.

Ian Mackay and Katherine Arden do not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article. They also have no relevant affiliations.

This article was originally published on The Conversation.
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Health Check: what you should know about varicose veins

By Caroline Robinson

Veins are part of the body’s extensive network of blood vessels, returning blood back to the heart to maintain a continuous circulation. And when things go wrong with them, you can end up with varicose veins.

The heart and blood vessels are known collectively as the circulatory system. With each heartbeat, oxygen-rich blood is pumped through arteries to all parts of the body. Tiny capillaries in body tissues allow the oxygen to be released, for use by cells.

Veins transport de-oxygenated blood back to the heart, ready to be pumped to the lungs to receive more oxygen. As they transport blood against the force of gravity, veins require special mechanisms to ensure that blood doesn’t flow backwards.

Deep and not so deep

There are two types of veins. Superficial veins are the ones you see as blue or purple vessels just under the skin. They have one-way valves to keep blood moving in the correct direction – towards the heart.

Deep veins lie between large muscles in the legs and arms. These veins don’t have valves and rely on the pumping action of the surrounding muscles to keep the blood moving. When you’re walking, for instance, muscle activity compresses the veins in your feet and legs.

These important mechanisms to assist blood flow through the veins are referred to as the “calf muscle pump” and the “foot pump”.

If the valves in the superficial veins don’t function efficiently, blood can flow backwards (this is known as venous reflux). This causes the pressure inside the vein to increase, leading to venous hypertension.

The thin walls of veins are not capable of withstanding much increase in pressure and they get pushed outwards. It’s these distended and visible veins that are known as varicose veins – “swollen, twisted, lengthened” veins.

Increased pressure inside varicose veins can also dilate much smaller veins, commonly around the ankles. These are known as spider veins (telangiectasias), but they are not, in fact, veins at all. They’re actually dilated capillaries that are less than one millimetre in diameter.

Causes and prevalence

Varicose veins occur most commonly in the legs and thighs. Someone with varicose veins may become very self conscious about the appearance of their legs, but these distended veins can also cause pain, itching, aching and tired legs, muscle cramps and swollen ankles.

Indeed, they may have a negative effect on a person’s quality of life and have been associated with depression.

Visible varicose veins in the legs affect at least one third of the population and become more common with age. Women are more likely than men to develop them and all people with a family history of venous disease are at increased risk.

There’s also a strong link between obesity and varicose veins, especially for women.

Varicose veins often develop during pregnancy, due to a combination of factors including increased hormone levels, increased elasticity of the tissues, and increased blood volume.

In later pregnancy, compression of veins in the groin by the growing baby has an impact. And women who have more than two pregnancies are at greater risk.

Other risk factors

Standing or sitting for long periods of time increases gravitational force on the legs and is another risk factor. And people who’ve had a deep vein thrombosis (blood clot in the deep leg veins) are very likely to develop varicose veins as part of what is knows as “post-thrombotic syndrome”.

High-heeled shoes are known to change muscle function in the leg and have been incorrectly proposed as a cause of varicose veins. Calf muscle activity is actually increased when walking in high-heeled shoes and this decreases pressure in the leg veins.

Varicose veins can lead to more serious problems and it’s important to seek advice from a general practitioner or hospital doctor in the event of bleeding varicose veins, skin changes in the leg, a suspected blood clot (thrombosis), or a break in the skin that will not heal (ulceration).

Still, they’re not always problematic but if you’re at risk of developing varicose veins, here are some suggestions to reduce that chance.

Preventing varicose veins

• Walk regularly to improve circulation of blood in your legs and reduce pressure inside the veins.

• Do foot and leg exercises if sitting for long periods of time. Raise your heels to shift pressure on to your toes for instance, or rotate your feet and ankles to aid circulation in the legs.

• Avoid standing without moving, as the leg muscles aid circulation of blood in the legs.

• Put your feet up when sitting to reduce pressure inside leg veins and minimise ankle swelling.

• Consider wearing light compression full-length socks or tights, as these reduce the pressure inside veins and can improve aching legs. A nurse specialist or a general practitioner can prescribe graduated compression stockings for more severe varicose veins.

• Maintain a healthy weight as obesity increases pressure inside the leg veins.

• Eat a healthy diet including high-fibre foods because constipation and straining during bowel movements can worsen varicose veins.

Caroline Robinson does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
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Health Check: does alcohol have medicinal properties?

By Merlin Thomas, Baker IDI Heart & Diabetes Institute

Since the late Stone Age, people have been drinking alcohol to help them feel better. For the most part, this has been in order to “remember their misery no more” (Proverbs 31:6-7). But it’s widely believed alcohol also has a range of medical virtues.

Many studies have found that people who regularly consume a small amount of alcohol have a lower incidence of heart disease, stroke, diabetes and some cancers when compared to those who don’t drink at all or drink only occasionally.

By a small amount – we’re talking about having no more than one or two drinks most days for men and half this for women, whose blood-alcohol levels tend to be higher after drinking the same amount.

Of course, moderate drinking takes discipline and self awareness. So it’s hardly surprising these are also the kind of people who have fewer health problems.

How might it work?

Nonetheless, researchers have repeatedly attempted to establish the direct actions of drinking on health and well-being.

For example, alcohol has favourable effects on HDL cholesterol. This is also known as “good cholesterol” because people with high levels of HDL cholesterol have lower risks of heart disease and stroke.

But if this was how alcohol works, why would more selective strategies to increase HDL cholesterol be universally unsuccessful in preventing heart disease?

A glass before or during an evening meal is often said to be the most beneficial. This may be partly because this social pattern of drinking is easier to regulate and habituate. Alcohol is also less intoxicating with food in the stomach.

However, drinking with food also slows down stomach emptying. This may have health benefits by slowing the flux of sugars and fats into the bloodstream and their subsequent burden on the body.

Many alcoholic drinks also contain antioxidants, not just red wine. In fact, some beers and ciders also have quite high levels of antioxidants, some of which may better absorbed or more potent than those in wine.

But again, the medicinal effects of regularly taking the amounts of antioxidants found in a single glass every day are unclear. Even when taken in high doses as supplements, there is little evidence of health benefits.

Is wine better than beer or spirits?

In some head-to-head trials red wine seems to outperform beer or spirits with respect to surrogate markers of health, such as vascular stiffness and oxidative stress.

However, when you look at overall health outcomes in moderate wine drinkers, they appear to be much the same as those in moderate beer drinkers or those who have a glass of scotch or gin every night.

But this does not mean they are equally healthy, overall. In fact, one reason wine gets all the kudos is that the lifestyle factors that permit a regular but limited intake are more common with wine drinkers.

Certainly, beer has some advantages because there is less alcohol in a can, which you can finish while the bottle of wine remains temptingly open. Light beers also have expediency as the potential for intoxication and abuse is reduced, along with the alcohol content. Many also contain fewer calories, while retaining both flavour and flavanoids.

The downward slide

Before you start thinking a having a drink or two may be good for you, it is literally sobering to remember that excessive drinking is a leading cause of preventable death, particularly in young adults and men, but also increasingly, in women. Excess alcohol contributes to the global burden of disease to a greater extent than smoking.

Alcohol inhibits the functions of the brain, especially at the front end where we think through what we are doing. When this area is intoxicated, we lose some of our inhibitions. This is why alcohol seems relaxing and takes away (thoughts of) our worries. But this can also lead to bad choices, such as dancing on tables, violence or driver error.

Consume more alcohol and other areas of the brain are also affected, leading to disturbed balance, slurred speech, blurred vision and other symptoms recognisable as being drunk.

Heavy drinkers have more heart disease, hypertension, dementia and some cancers. Even episodic binge drinking is associated with an increased risk of chronic disease.

Rather than alcohol being toxic, these associations are more likely due to the characteristics of people who drink more (their mood, their stress, their lifestyle, their self control, and so on) when compared to those who drink in moderation or don’t drink at all.

Alcohol, like food, should be one of life’s shared pleasures. But both need restraint. A little glass can easily become more, especially if the bottle is already open. And sometimes, its far healthier to not drink at all than go down this slippery slope.

Merlin Thomas does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
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Health Check: why do my gums bleed and should I be worried?

By Mike Morgan, University of Melbourne and Stuart Dashper, University of Melbourne

Bleeding gums are very common but that doesn’t mean you should ignore them. They’re usually a sign of gum (periodontal) disease.

If treated in its early stages, periodontal disease can be easily reversed. But more advanced and severe forms of the disease can result in tooth loss, require complex long-term treatment and are associated with a higher risk of diabetes and other chronic diseases.

Most people will experience some degree of periodontal disease in their lives. Australian oral health surveys indicate that, at any one time, one in four adults have moderate to severe periodontal disease. The prevalence of periodontal disease increases with age, with more than half of Australians over the age of 65 having moderate to severe forms.

In its milder form, periodontal disease is known as gingivitis. Gingivitis occurs when plaque builds up along the gum line where the gum attaches to the tooth. If not removed, the bacteria that make up the plaque provoke an inflammatory reaction in the gum tissue.

The first sign of unhealthy gums is bleeding during or after brushing your teeth. Gingivitis typically results in reddened gums that appear swollen, shiny and smooth. Healthy gums, on the other hand, are coral pink and slightly stippled like orange peel.

In cases of gingivitis, gum health can be restored by removing plaque with thorough daily brushing and regular flossing. Toothpaste acts as a gentle abrasive, assisting in plaque removal. It is important to use a fluoride toothpaste to help prevent that other common form of oral disease, tooth decay.

While some people promote the use of salt water on a toothbrush to help remove plaque, the evidence firmly shows toothpaste is effective at removing plaque and, when it contains fluoride, at reducing tooth decay.

When brushing your teeth, be sure to brush gently along the gum line where the tooth meets the gum tissue. If bleeding persists, a dentist or hygienist may need to remove plaque that home cleaning can’t reach.

Gingivitis can progress to chronic periodontitis, particularly if you’re not brushing and flossing regularly. Chronic periodontitis occurs when persistent inflammation causes the alveolar bone (which forms the tooth socket that supports the tooth) to break down.

This also causes gums to recede. This is where the term “long in the tooth” comes from – as more of the tooth becomes visible, it appears as though it is lengthening. Without an adequate supporting bone, teeth become loose. At this point the condition often becomes painful.

Chronic periodontitis is currently treated with an intensive cleaning regime and, in some cases, gum surgery.

Unfortunately, once the pathogenic bacteria become established they are very difficult to remove. People with chronic periodontitis often require regular and ongoing professional dental treatment to prevent the disease from progressing.

Our colleagues at the University of Melbourne Oral Health CRC are developing a treatment for periodontitis by targeting one of its key pathogens, Porphyromonas gingivalis. Progress has already been made, with the latest findings looking very promising.

While inflammation arising from the presence of plaque is by far the most common cause of bleeding gums, it can be symptomatic of other conditions including diabetes, some blood disorders and – although now uncommon – scurvy.

Some misconceptions about bleeding gums and tooth loss do persist. For instance, it is still occasionally said that “a tooth is lost for every baby”.

This certainly need not be true. While the hormonal changes caused by pregnancy will make gums more susceptible to the effects of plaque (and therefore be more likely to bleed), pregnancy per se will not cause periodontal disease or tooth loss arising from it.

There is also a commonly held view that bleeding gums are a part of everyday life and to be expected. This is also not the case. Bleeding gums are usually a sign of disease.

The good news is that most periodontal disease is preventable through sound oral hygiene measures, coupled with regular dental check-ups. Your dental health professional can give you advice on how to brush and floss most effectively.

Mike Morgan receives funding from NHMRC. He is Program Leader of the Oral Health Cooperative Research Centre, which brings together scientists, clinicians and industry to advance the prevention, diagnosis, treatment and management of oral diseases. It is funded through the Australian Government’s Cooperative Research Centres program and the contributions of its research partners. He is Director of the Australian Dental Council, Board member of VicHealth, Principal Oral Health Advisor, Dental Health Services Victoria and a member of the Australian Dental Association.

Stuart Dashper receives funding from the National Health and Medical Research Council and the Cooperative Research Centre scheme

This article was originally published on The Conversation.
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Need an Ophtalmologist in Kigali?

Ophtalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophtalmologist is a specialist in medical and surgical eye problems. Since Ophtalmologists perform operations on eyes, they are both surgical and medical specialists.

In Kigali ophtalmologists are distributed in both public hospitals and private clinics. Blurry vision especially at night, spots, eye strain, trouble with reading at night, tearing of the eyes, and headaches are all common and annoying eye complaints that could be early warning signs of eye disease. Common eye conditions treated in Kigali include nearsightedness (myopia) sightedness, color blindness, conjunctivitis, dry eyes, cataracts, glaucoma, and pterygium. Public hospitals catering to eye care needs include CHUK, King Faisal Hospital, Rwanda Military Hospital, Kibagabaga and Masaka District Hospitals. Some of the private specialised eye care centers where you can find an Ophthalmologist most of the time include Dr Agarwal’s Eye Hospital, Kigali Eye Center, Eye Clinic, DK Optical, Eye Care Optical, Kigali Optic, New Vision Optic. Other clinics that have visiting Ophthalmologists on appointment include Plateau Polyclinic and Le Carrefour Polyclinic.

Kigalihe.com