What We Don't Know About Ebola - WebMD

Oct. 3, 2014 -- When Ebola arrived in the U.S. last week, it came with a steep learning curve.

Hospitals that thought they were prepared learned they had gaps in their communication. Public health officials soon learned about the problems of dealing with Ebola-contaminated waste and the difficulties of keeping exposed people at home. Parents of school-aged children struggled to understand the risks of sending kids back to their classrooms. We learned about flaws in the system that screens travelers.

That made us wonder: What else don’t we know about Ebola?

To find out, we reached out to Ebola experts to get their thoughts.

Elke Muhlberger, PhD, is a microbiologist at the Boston University School of Medicine, who specializes in the study of filoviruses, the virus family to which Ebola belongs. Amesh Adalja, MD, is an infectious disease specialist at the University of Pittsburgh Medical Center. And Thomas Geisbert, PhD, is a microbiologist and immunologist who specializes in Ebola at the University of Texas Medical Branch in Galveston.

Here’s their list of big questions that remain to be answered about the virus.

1. Why are humans so vulnerable to Ebola?

Muhlberger: Ebola virus causes a very severe disease in humans, and that’s also the case in monkeys and great apes. In great apes it’s a really big, big issue, because they’re very close to extinction.

But other animals, say mice and guinea pigs and bats, don’t have any problems controlling Ebola virus infection. They don’t get sick, and they are quite happy if they’re infected with Ebola in the wild.

If we are, in a very bad sense, the exception in terms of Ebola, the question is why are we so vulnerable? What are the differences in the immune response in mice and bats that keep them safe compared to humans?

2. Which patients may be likelier to spread the virus?

Adalja: We know how people catch Ebola. It’s only passed through close contact with the bodily fluids of infected individuals.

But what we don’t really know is whether some people may spread the disease at different rates than others.

With smallpox, for example, people who bleed from their mouths and noses, a rare form of the disease called hemorrhagic smallpox, are more contagious than people who have the disease, but don’t bleed.

Sicker patients may be more apt to spread the virus. Or maybe they are less risky because they’re more likely to be bedridden and thus not able to interact much with others.

We know that 50% of [people with] Ebola cases bleed internally, or hemorrhage, and 50% don’t. Does that make them more likely to spread virus or not? There are people who may be vomiting more than others, or having more diarrhea. All those factors may be things that determine how likely a person is to spread the disease.

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