12 Answers to Ebola’s Hard Questions

1) WHAT WENT WRONG AT THE CDC? Director of the Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden is the public face of the U.S. response to Ebola. And given the nationwide panic about the virus, it’s no surprise that one of the 4-by-6 cards is labeled “errors.” Frieden declared that U.S. hospitals were ready for Ebola, but the first hospital tested flunked badly.

Despite the panic and the miscalculations, however, the fight to contain Ebola in the U.S. has been largely successful. Of the people the CDC has been monitoring, no new cases have been detected. Experts say the danger to the broader public is extremely low.

But as parents pull kids out of schools, airline passengers show up in homemade hazmat suits, and self-published Ebola survival guides climb the Amazon charts, Frieden bears the brunt of the hysteria.

Frieden’s activist record may help explain why some Republicans are calling for his resignation, but the criticism transcends partisanship. After Amber Vinson became the second Dallas health care worker diagnosed with the virus, Obama seethed, according to an Administration official.

Frieden, it helps to remember, is a doctor, and his agency’s response to Ebola was grounded in years of science. “The protocols that were on the CDC website at least historically–maybe not in the last month, but historically–have worked well in the 24 African epidemics of Ebola,” says Dr. Anthony Fauci, director of the National Institute on Allergy and Infectious Diseases. “And as Frieden said publicly many times, we have dealt with Ebola since 1976 and put down every single epidemic.”

Frieden says that what keeps him up at night is the speed at which the virus is spreading in West Africa. On the home front, however, the CDC director is still making promises. “There’s really no scenario, other than a mutation, that we end up with a widespread outbreak in the U.S.,” Frieden says. “It’s just not in the cards.”

2) I KEEP HEARING THE VIRUS IS MUTATING. COULD EBOLA BECOME AIRBORNE.

No. Ebola, like most viruses, mutates often, but that doesn’t mean the way it spreads between people will change. To be very clear: In the history of all viruses, scientists have yet to see a virus mutate so that it goes from spreading via droplets–meaning it is carried by infected bodily fluids–to becoming airborne. Unlike influenza–where the dried viral particles can travel long distances in the air–Ebola can’t survive without a fluid vehicle, such as saliva, sweat, blood, feces or vomit. Ebola apparently needs that liquid to jump from one person to another, and liquid can’t travel as far as dry particles in the air. For the virus to find an entirely new way of moving around would be unprecedented.

3) WHO CAN ORDER AN EBOLA PATIENT TO QUARANTINE? WHAT ARE THE PATIENT’S LEGAL RIGHTS?

When it comes to containing deadly and contagious viruses that pose a potential public health threat, health officials have a lot of leeway. Local, state and federal agencies have significant powers to order quarantines of those who have been exposed to deadly viruses and to isolate individuals who are carrying diseases like Ebola. The burden rests with public health officials to show sufficient justification to issue those orders. While the orders can be challenged in court, judges often give the benefit of the doubt to health officials, especially during a public health emergency, experts say. Quarantines should not run for longer than the incubation period for a disease, however, which for Ebola is 21 days.

4) WHAT’S THE STATUS OF ALL THE EXPERIMENTAL DRUGS AND VACCINES?

There are no drugs or vaccines approved by the FDA to treat Ebola, but scientists have lots of leads. And the FDA can, in extraordinary circumstances, allow an experimental drug–meaning one that has not been proved safe or effective in people–to be used on human patients.

That’s what happened with ZMapp, the cocktail of antibodies received by Dr. Kent Brantly and Nancy Writebol, the first two American aid workers to get infected. ZMapp had been tested in primates and looked promising. It didn’t cause any serious side effects, and it was effective in protecting the animals from Ebola infection. And indeed, both Brantly and Writebol survived Ebola and have been declared free of the virus. Because the drug isn’t approved, it’s in short supply. Production of ZMapp is now being ramped up.

There are also two possible vaccine candidates that are currently being tested in healthy human volunteers in the U.S., Mali and Switzerland. Researchers should know by December if the vaccines are safe–and the World Health Organization (WHO) is ready to test them further in Africa if they are, with first priority going to health care workers.

In the meantime, the FDA is contacting companies that have drugs or vaccines in earlier stages of development and working with them to find quicker ways to make those options available if they prove safe.

5) CAN I GET SICK IF I TOUCH SURFACES THAT HAVE BEEN IN CONTACT WITH EBOLA?

It’s technically possible but highly unlikely, based on what scientists currently know. The vast majority of data on the transmission of Ebola shows it spreads when an infected person’s bodily fluids, like blood, sweat, vomit and diarrhea, come into direct contact with another person’s mucus membranes (as in the nose, mouth or eye) or broken skin. Although there hasn’t been a lot of research into whether Ebola spreads from surfaces, data available suggests the virus can survive on surfaces–remember, though, that the virus needs to be inside a liquid (in this case bodily fluids) to survive for long periods of time. The only confirmed case of a person getting Ebola from an object or material that can carry infection, was during a 2000–01 Ebola outbreak in Gulu, Uganda, when a patient who had never been directly exposed to someone with Ebola got the disease by sleeping with a blanket that had been used by an Ebola patient.

6) SHOULD THE U.S. BAN ALL TRAVEL TO AND FROM SIERRA LEONE, LIBERIA AND GUINEA?

Disease experts say, resolutely, that stopping flights from West Africa or denying visas to people from Guinea, Liberia and Sierra Leone will only increase the risk that an infected and unknown traveler makes his way to the U.S.

It’s a devil-you-know rationale: by carefully screening and tracking travelers from West Africa before departure and after they arrive in the U.S., public-health officials are in a better position to respond to any Ebola cases that develop.

“To block people from coming into the U.S. from West Africa is not thinking about the loopholes,” says Koya C. Allen, an epidemiologist who studies disease transmission related to travel. If flights are halted, people will leak out through other means.

That’s why the Department of Homeland Security has ordered that all passengers arriving from or through Ebola-hit countries land at just one of five designated airports. And travelers entering the U.S. from Liberia, Guinea and Sierra Leone will now be actively monitored for Ebola-like symptoms by state and local health officials for 21 days upon arrival, the CDC announced on Oct. 22.

7) IF YOU SURVIVE EBOLA, DOES IT MEAN YOU CAN NEVER GET IT AGAIN?

Possibly. Scientists currently do not know of any case in which a person got Ebola more than once. But that’s because doctors still don’t know much about how the human immune system responds, since so few survivors have been studied from the beginning of infection to the end. Researchers do know that even several years after being infected, monkeys that survive can still fight off another Ebola infection.

8) HOW LIKELY IS A MAJOR OUTBREAK OUTSIDE WEST AFRICA?

Slim. Aside from a few isolated cases outside Africa, Ebola outbreaks have been located on that continent, where the virus was first discovered, starting with Zaire in 1976.

There’s no reason to think that will change anytime soon. Weak health care systems in that part of the world stymie efforts to stop the spread quickly, which can result in more cases–and more people leaving outbreak areas to seek medical care or safety elsewhere. Countries bordering Liberia, Sierra Leone and Guinea and those with strong trade and ties to the affected regions are at increased risk, according to the WHO.

9) HOW DO HOSPITALS SAFELY DISPOSE OF THE BODILY FLUIDS OF AN EBOLA PATIENT?

You can’t just toss ebola-infected materials into the trash. Critical to containing the virus is safe disposal of the fluid-soaked waste used in the treatment of an Ebola-infected patient, which is classified as a hazardous material by the Department of Transportation and subject to all kinds of requirements.

CDC guidelines state that medical waste–things like garments, sheets, gowns, cleaning supplies or anything that comes into contact with the patient or their bodily fluids–must be sterilized before they are removed from the hospital. Hospitals can do this in an autoclave, a pressure chamber that uses steam sterilization or by incineration. Both kill the virus. Most hospitals have at least one of these capabilities on-site.

Fecal waste can be flushed down the toilet, since U.S. sewer systems are designed to deactivate infectious agents through disinfection with chlorine and bleach and bacterial breakdown of sludge–though medical-waste laws vary by state.

10) WHAT’S THE NEXT EBOLA?

Ebola is by no means the only infectious disease that has the ability to spread on a mass scale, nor is it the only one for which we don’t have an approved drug or vaccine.

One of the more worrisome diseases among the public-health community is bird flu, a respiratory virus that has the ability to cause pandemics. Many viruses that originate in animals eventually make their way to humans–and once they do, some are transmissible from human to human. That hasn’t happened with bird flu yet, but if it did, it would likely be a disaster much greater than the current Ebola outbreak.

Another infectious disease that concerns experts is the Middle East Respiratory Syndrome (MERS), which was first reported in Saudi Arabia in 2012 and made its way west in May 2014, when two people brought the disease to the U.S.

11) THERE HAVE BEEN ONLY A FEW CASES OUTSIDE WEST AFRICA. WHY ARE PEOPLE FREAKING OUT?

The almost-zero probability of acquiring something like Ebola often doesn’t register at a time of mass paranoia–and that may just be human nature. “There are documented cases of people misunderstanding and fearing infectious diseases going back through history,” says Andrew Noymer, an associate professor of public health at the University of California at Irvine. “Stigmatization is an old game.”

Like the first cases of HIV/AIDS, Ebola is something novel in the U.S. It is largely unknown to Americans, and its foreign origins may help spark fearful reactions. The fatality rate for those who do contract it is also high, and the often gruesome symptoms provoke strong, instinctual responses.

12) IS THERE ANYTHING I CAN DO TO HELP?

There is. Aid groups and organizations with programs already in place in Sierra Leone, Guinea and Liberia need money to make sure they have a consistent flow of resources to treat patients and protect health care workers. Doctors Without Borders/Médecins Sans Frontières (MSF) and the International Red Cross have been active in the region, and both accept monetary donations, through doctorswithoutborders.org and ifrc.org/en/get-involved/donate, respectively.

The nonprofit CDC Foundation, to which Facebook founder Mark Zuckerberg recently donated $25 million, accepts monetary donations on its site, cdcfoundation.org.

“There is definitely a need for more well-trained, well-managed medical and support staff to safely and efficiently care for patients,” said an MSF spokesperson.

Health care workers with experience dealing with infectious diseases can volunteer through USAID (usaid.gov/ebola/volunteers). Finally, $10 donations can be made to WHO by texting EBOLA to 27722, which will support relief efforts in West Africa.

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