End of 21-day Quarantine for Family of Ebola Patient

USA Today News (20:10:2014)

People who had contact with Ebola patient Thomas Eric Duncan before he was hospitalized are breathing a sigh of relief today.

Those 48 contacts, including four family members who shared a small Dallas apartment with him, have completed the 21-day observation period without falling ill and are no longer at risk of the disease. About 10 of the 48 contacts were considered to be a higher risk because of their closer contact with Duncan.

Ebola has an incubation period of up to 21 days, according to the World Health Organization. People who are exposed to an Ebola patient who don't become sick during that time are considered to be out of the woods.

That's welcome news to Dallas and U.S. public health officials, who have struggled to contain Ebola since Duncan's diagnosis at Texas Health Presbyterian on Sept. 28. Duncan died Oct. 8.

Last week, two of Duncan's nurses were diagnosed with Ebola and have been moved to specialized hospitals. Other health workers who treated Duncan during his hospital stay continue to monitor themselves for fever and other symptoms.

In Spain, a nursing assistant appears to have recovered from the Ebola virus, the Associated Press reported Sunday.

The good news for Duncan's family should also reassure Americans about a fact that public health officials have been emphasizing for weeks -- that Ebola is not spread through casual contact -- said Robert Murphy, director of the Center for Global Health at Northwestern University Feinberg School of Medicine.

Dallas Health officials quarantined 4 members of Duncan's family after he was diagnose, ordering them not to leave the small apartment they shared with Duncan. Officials worried that the family was at risk

not just because they spent time with Duncan while he was sick but also because they stayed in an apartment with his soiled bed linens after he was hospitalized.

The fact that Duncan's family remained healthy even as two of his nurses became infected illustrates the peculiar nature of Ebola, said Peter Hotez, dean of the National School of Tropical Medicine and professor at Baylor College of Medicine in Houston.

Although the West Africa outbreak of Ebola has a 70% mortality rate, the virus is actually not very contagious in the early stages of disease when people are most likely to circulate in the community, Hotez said. Ebola doesn't spread through coughs and sneezes, only through direct contact with bodily fluids.

Even then, people aren't contagious at all until they begin showing symptoms such as a fever. Before symptoms appear, levels of the virus in their blood are too low to be measured, Hotez said.

Yet Ebola is frighteningly infectious at advanced stages of the disease, when the virus begins multiplying out of control and patients begin producing large amounts of diarrhea, vomit and blood. At that point, even a tiny amount of blood is teeming with Ebola, which puts nurses and caregivers at high risk, Hotez said.

Few people in the general community are exposed to Ebola patients who are that contagious, because patients at that stage are usually too sick to move around. Most are hospitalized if a bed is available. In West Africa, patients who can't get to a hospital are bedridden and typically attended by relatives.

Those aspects of Ebola help explain why, on average, people in West Africa spread the disease to only one or two other people, said Paul Offit, chief of infectious diseases at Children's Hospital of Philadelphia. In contrast, people with an airborne virus such as measles can spread the disease to 14 susceptible people.

Ebola has spread in West Africa because of burial rites that aren't practiced in the USA, in which relatives of the deceased touch the body and prepare it for the grave.

Only about 15% of Ebola cases in West Africa involve children, reflecting the fact that children are rarely home caregivers, Offit said.