Ebola - The New Swine Flu?
The increasing alarm surrounding the most recent outbreak of the Ebola virus disease (EVD) is a chilling reminder of the potential for the spread of viruses to rapidly reach epidemic proportions.
Since March 2014, the scale and spread of the current emergency in Guinea, Sierra Leone and Liberia has claimed more lives than any previous outbreak. Also striking is that the outbreak has occurred almost simultaneously in three previously unaffected countries.
The WHO has announced a $100 million response plan to tackle this new “unprecedented” Ebola outbreak, currently exhibiting a 56% mortality rate. Should underwriters also be on high alert?
Outbreaks of EVD occur primarily in remote areas in Central and West Africa following close contact with the wild animals that host the virus. It spreads easily between humans through direct contact: broken skin, damaged mucous membranes, during sex, in infected blood and bodily fluids including sweat, or indirectly through contact with virus contaminated environments.
The virus causes haemorrhagic fever marked by severe bleeding, organ failure and, often, death. People remain infectious as long as their blood and secretions contain the virus, typically up to seven weeks, and this risk persists even after death. Family members are often infected as they care for sick relatives or prepare the dead for burial.
The ease with which people travel worldwide implies infection could spread rapidly and without control, but there is no evidence of this yet. EVD makes people very sick very quickly - the time interval from infection to onset of symptoms is 2 to 21 days. It seems highly unlikely that a person with the advanced signs of EVD - the stage when onward transmission is most likely - would be physically well enough to undertake air travel.
The International Air Transport Association has stated that even in the rare event a person infected with the virus is unknowingly transported by air, the risk to other passengers is low.
It also seems doubtful that any infected person would slip through the underwriting net. Nevertheless, an applicant with unexplained or unusual illness and who has visited an affected area within the preceding month should be viewed with increased caution.
Groups at risk include:
- Medical personnel. In this new outbreak, several health workers have been infected whilst treating patients with suspected or confirmed EVD and not strictly practicing infection control techniques.
- Anyone treated in poorly equipped medical centres in the affected area, who may be exposed to re-used needles and syringes or contaminated equipment that has been improperly sterilized.
- Anyone butchering or eating infected animals or coming into contact with their faeces or urine.
- People involved in animal research or observation who also have an increased chance of contact.
There is currently no vaccine available for use in people or animals, yet it seems unlikely that EVD poses a threat beyond its immediate geographical location or the indigenous population and visitors working closely with them.
Deadly though it is, EVD is not airborne and so there is no credible risk of a swine flu-like epidemic such as that experienced in 2009.
For more information on EDV, read my full article in the latest issue of Risk Matters.