I hate to see people suffer.  That is one of the reasons I became a physician.  I have witnessed fear and paranoia since Thomas Duncan was diagnosed in Dallas, Texas with Ebola.   I’m sure you have too. That’s why I’m writing about Ebola.  In this blog post I’m going to address another media based fear that Ebola may become airborne. With three cases of Ebola diagnosed in the United States but more than 100 people being monitored in case they contract the disease, President Obama recently urged Americans not to give in to “hysteria” about the spread of the virus.

We have to keep this in perspective. He noted that 5 Americans who contracted the disease in West Africa were successfully treated in the US, and no new infections occurred, in comparison to the experience at the Dallas hospital where one patient’s treatment resulted in the infection of two nurses who treated him.

As I’ve previously discussed, there are so many more health issues that has been overshadowed by this issue.

Others have also raised the issue of over reporting when these “pandemics” are reported (think SARS, H1N1, MERS, Bird flu, etc.), especially in the context of generating fear and even hysteria. These concerns must be considered through the historical patterns that have remained overlooked.

False Alarm: A Culture of Fear

So let’s talk about fear. In 2005, I watched Dr. Marc Siegel during an interview on the Oprah Winfrey Show, discuss his book, False Alarm.  He discussed the media generated epidemic of fear that was sweeping across the United States.  While life for citizens of the developed world is safer, easier, and healthier than for any other people in history thanks to modern medicine, science, technology, and intelligence, he asked the question-why are we collectively so afraid?  He believes that we live in an artificially created culture of fear.  And he identified three major catalysts of the culture of fear—government, the media, and large drug companies.

With his analyses of the most sensational false alarms of the past few years, showed how these fearmongers manipulate our most basic instincts—often without our even realizing it. His book explains how to look behind the hype and hysteria, inoculate ourselves against fear tactics, and develop the emotional and intellectual skills needed to take back our lives.

Now that you know this—back to Ebola.

Can The Ebola Virus Become Airborne?

When I was in medical school, I learned that infections have a “vector of transmission,” meaning a certain pathway of infection—some like the flu virus is airborne, others are through contact with bodily fluids, etc.  So I was very surprised to hear mention of the virus becoming airborne in the media, and also recent conversations with colleagues and what they’d heard on television, about the possibility of Ebola becoming airborne. This week there were several media reports that the virus could become airborne.

One of my colleagues, in particular, was very upset and riled by the possibility. Wait a minute, I said, “Didn’t we learn about vectors of transmission, and how they don’t change?”

“Yes, but the infectious disease experts on tv  said it could happen.” That conversation led me to write this blog, based on the information I passed on to my colleague that calmed him down.

I do not know why respected doctors, both celebrity tv and infectious disease experts are on television suggesting that Ebola could become airborne.  It makes no sense to me, from a scientific perspective.  Have you ever heard of another infection changing its mode (also known as vector) of transmission? Probably not.

I haven’t  and neither has any other scientist in the natural world.  Experiments have been conducted, to see if it could be accomplished, and it was done with the H1N1 flu virus, but it became much less transmissible (it’s infectivity decline).

I did some research to prove to my colleagues that this “concern” is sensationalizing and not based in science, whatsoever. And here’s what I found-fears that Ebola will mutate and spread through the air are overblown, experts say are not based on the facts.

Recent Hypothetical/Unscientific News Reports

Yet in September, an op-ed by Michael Osterholm in The New York Times raised a disturbing possibility — what if the Ebola epidemic in West Africa goes on long enough and the virus keeps mutating? Could Ebola somehow become airborne then? And wouldn’t that allow the disease to spread even faster around the world? More recently, Dr. Oz raise possibility raised the specter of airborne Ebola on The Today Show.

A study published last week in the Los Angeles Times, raised the possibility that Ebola could be spread through the air via sneezing. Scientists certainly can’t rule that out, a CDC spokesman told the Times. Another scientist suggested that monkeys who came down with Ebola in Reston in 1989 may have spread it through sneezing. But this is not a true “airborne” contagion. A sneeze creates small droplets, not aerosol particles that can float through the air and perhaps move through a ventilation system, Jahrling said.

Vector of Transmission

First and foremost, despite the representation in the media, you need to know that Ebola is much less contagious than many other more common diseases. The virus, much like HIV or hepatitis, is spread through blood or bodily fluids and is not airborne.

According to the history of human virology-according to virologist, they DO NOT CHANGE their vector of transmission.  Meaning a virus that spreads through bodily fluids, has never become airborne.

Ebola is not an airborne. You can’t catch Ebola by sitting across the room (or an airplane) from someone who has it. You can only get infected by direct contact with the bodily fluids of someone who has the disease and is showing symptoms.

Ebola Experiments

There’s a study reported aross the internet that reported in the International Journal of Experimental Pathology, titled “Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus.” The abstract concludes:

Demonstration of fatal aerosol transmission of this virus in monkeys reinforces the importance of taking appropriate precautions to prevent its potential aerosol transmission to humans.

This, however, is a laboratory experiment that does not in any way mimic (or portray) what the virus does in the natural world. So says one of the co-authors, Peter Jahrling, a scientist who works with Ebola in a laboratory in Frederick, Md., that’s part of NIH’s National Institute of Allergy and Infectious Diseases.

“The aerosol studies were done to inform the community about the threat of a truly weaponized threat delivered by a competent adversary. Those conditions should not be extrapolated to a natural disease setting,” Jahrling told me.

There’s absolutely no evidence this has happened with this virus, it doesn’t mutate (change its genetic structure) very quickly, such a change in transmission has never happened before in recorded history.

The World Health Organization is not aware of any studies that actually document this mode of transmission. On the contrary, good quality studies from previous Ebola outbreaks show that all cases were infected by direct close contact with symptomatic patients.

This is a scary scenario. But fortunately for the world, most infectious disease experts remain very skeptical that Ebola will ever become airborne. “This is way down on the list of possible futures for Ebola and in all probability will never happen,” explained Ian Jones, a virologist with the University of Reading,  in September.

‘We’ve never seen a human virus change the way it is transmitted’

But why are experts so confident Ebola won’t become airborne? It’s worth reading this long post by Vincent Racaniello, a virologist at the College of Physicians and Surgeons at Columbia University.

He goes into detail about how viruses mutate, but here’s his bottom line: “We have been studying viruses for over 100 years, and we’ve never seen a human virus change the way it is transmitted”

“When it comes to viruses, it is always difficult to predict what they can or cannot do. It is instructive, however, to see what viruses have done in the past, and use that information to guide our thinking. Therefore we can ask: has any human virus ever changed its mode of transmission?

“HIV-1 has infected millions of humans since the early 1900s. It is still transmitted among humans by introduction of the virus into the body by sex, contaminated needles, or during childbirth.

“Hepatitis C virus has infected millions of humans since its discovery in the 1980s. It is still transmitted among humans by introduction of the virus into the body by contaminated needles, blood, and during birth.

“There is no reason to believe that Ebola virus is any different from any of the viruses that infect humans and have not changed the way that they are spread. The likelihood that Ebola virus will go airborne is so remote that we should not use it to frighten people. We need to focus on stopping the epidemic, which in itself is a huge job.”

Also, Anthony Fauci, MD the director of the National Institute of Allergy and Infectious Diseases, told the Senate in mid-September: “Very, very rarely does [a virus] completely change the way it’s transmitted.”

Dr. Fauci noted that viruses do mutate a lot, in ways that might make the disease more virulent or a little bit more efficient at spreading. That’s why researchers are currently trying to monitor the mutations. But with all the dire things to worry about with Ebola, he said, the prospect of the disease going airborne is not “something I would put at the very top of the radar screen.”

Many factors play into how contagious a disease is thought to be, say Jeff Duchin, MD, an infectious disease expert at the University of Washington, Seattle, and Amesh Adalja, MD, an infectious disease expert at the University of Pittsburgh.

“I would anticipate the reproductive rate for Ebola in the U.S. to be zero,” Adalja says.

By comparison, measles, diphtheria, and whooping cough (pertussis) are all airborne, and they can be transmitted by “just being in face-to-face contact with an infected patient, without touching them,” Duchin says. When that person coughs or sneezes, others may become infected after breathing in the organisms.

Ranciello goes on to say, “I am fully aware that we can never rule out what a virus might or might not do. But the likelihood that Ebola virus will go airborne is so remote that we should not use it to frighten people. We need to focus on stopping the epidemic, which in itself is a huge job.”


Take Away:

Remember you have a far greater chance of dying from a car accident or developing a chronic disease—and you can do something about decreasing your risk of developing these illnesses and primary causes of death.