text: Staff of medical aid organization Doctors without Borders carry the body of a person killed by viral haemorrhagic fever, at a center for victims of the Ebola virus in Guinea. 
   
   The deadliest Ebola outbreak in recorded history is happening right now. The outbreak is unprecedented both in the number of cases and in its geographic scope. And so far, it doesn't look like it's slowing down. 
   
   The outbreak has now hit three countries: Guinea, Sierra Leone, and Liberia. And the virus — which starts off with flu-like symptoms and often ends with horrific hemorrhaging — has infected about 600 people and killed an estimated 367 since this winter, according to the numbers on June 26 from the World Health Organization. 
   
   On June 23, the humanitarian group Doctors Without Borders sent out a distress call. As the only aid organization treating people with Ebola, the group said it was "overwhelmed," that the epidemic was out of control, and that it couldn't send workers to new outbreak sites without getting more resources. 
   
   Ebola is both rare and very deadly. Since the first outbreak in 1976, Ebola viruses have infected roughly 2,400 people and killed about one-third of them. Symptoms can come on very quickly and kill fast: 
   
   Journalist David Quammen put it well in a recent New York Times op-ed: "Ebola is more inimical to humans than perhaps any known virus on Earth, except rabies and HIV-1. And it does its damage much faster than either." 
   
   So why is Ebola doing so much damage right now? Here's a primer on what's going on. 
   
   Why is Ebola back in the news? 
   
   Ebola tends to come and go over time. 
   
   Every now and again, the disease spills over from animals to humAns 
   
   The viruses are constantly circulating in animals, most likely bats. Every once in a while, the disease spills over into humans, often when someone handles or eats undercooked or raw meat from a diseased ape, monkey, or bat. An outbreak can then happen for several months. And then it becomes quiet, again. 
   
   Ebola can completely disappear from humans for years at a time. For example, there were zero recorded cases of Ebola in 2005 or 2006. 
   
   Where is the current Ebola outbreak? 
   
   This outbreak started in Guinea sometime in late 2013 or early 2014. (The majority of cases have been in that country.) It has since spread to Sierra Leone and Liberia, including some major capital cities. It's the first time Ebola has ever reached a state capital. 
   
   Why is this particular outbreak so deadly? 
   
   First, this outbreak concerns the most deadly of the five Ebola viruses — Zaire ebolavirus, which has killed 79 percent of the people it has infected. (The virus is called that after the formerly named Zaire, which, along with Sudan, experienced the first Ebola outbreak back in 1976.) 
   
   
   
   There are also social and political factors contributing to the current disaster. Because this is the first major Ebola outbreak in West Africa, many of the region's health workers didn't have experience or training in how to protect themselves or care for patients with this disease. 
   
   What's more, an NPR story suggests that people in these countries tend to travel more than those in Central Africa (where outbreaks usually occur). That may have helped the virus disperse geographically, and it made it difficult to track down people who might be infected. 
   
   MANY OF WEST AFRICA'S HEALTH WORKERS DIDN'T HAVE TRAINING DEALING WITH EBOLA 
   
   Meanwhile, as an editorial in the medical journal Lancet noted, social stigmas and a lack of awareness may be preventing people from seeking medical care (or even actively avoiding it). Another often-cited problem is that some people have had direct contact with victims' dead bodies during funerals and preparations for burial, which can spread the disease. 
   
   In many ways, how well a country can deal with an Ebola outbreak comes down to basic health-care practices and public education. With enough resources poured into the effort, people should be able to contain this outbreak. So far, however, these countries are struggling. 
   
   Does Ebola really make people bleed from their eyes? 
   
   Yes. Bleeding from orifices is one of the more unusual and memorable symptoms of viral hemorrhagic fevers like Ebola. In later stages of the disease, some people bleed from the eyes, nose, ears, mouth, and rectum. They may also bleed from puncture sites if they've had an IV. 
   
   External bleeding can be one of the main symptoms that can help people realize they're dealing with a case of Ebola, since other signs — first fevers and headache, then vomiting and diarrhea — can be caused by any number of illnesses. Internal bleeding can happen, as well. 
   
   But it doesn't always happen. For example, this study of a 1995 outbreak found external bleeding in 41 percent of cases. And bleeding didn't correlate with who survived and who didn't. 
   
   What actually kills people is shock from multiple organ failure, including problems with the liver, kidneys, and central nervous system. 
   
   Symptoms come on abruptly after an incubation period of 2 to 21 days. And people generally die between day 6 and 16 of the illness. 
   
   Why is Ebola so deadly? 
   
   
   
   One of the main things that seems to make Ebola viruses especially deadly is that they seem to be able to evade much of the human immune system. Among other problems, white blood cells from the immune system are often seen to die off in patients. And if the body can't fight fully back, the virus can just keep taking over. 
   
   Scientists are still figuring out exactly how this happens, and they have several promising leads. One is that the virus is making proteins that act as decoys, interfering with the body's ability to fight back. 
   
   How hard is it to catch Ebola? 
   
   Ebola is relatively hard to catch. Unlike measles or the flu, it's not spreadable over the air through casual contact. 
   
   In order to get Ebola, someone must touch the blood or bodily fluids (including sweat, urine, and semen) of a person or animal who's infected (alive or dead). People can also catch it through indirect contact with victims' fluids, such as via bedding or medical equipment. 
   
   People generally aren't infectious until they get sick. 
   
   This limited transmission ability is one of the main reasons why Ebola outbreaks can often be stopped within weeks or months. What it takes is public education and good health-care hygiene like patient isolation, sterilization procedures, and the use of gloves and masks. 
   
   What are the chances of Ebola spreading to the US? 
   
   The ebola viruses known today don't spread from person-to-person well enough to have much risk of causing a wide pandemic across several continents. The risk of Ebola coming to the US is very low. 
   
   How do you treat Ebola? 
   
   Patients are treated for symptoms, including IV fluids for dehydration. It's important to remember that some people do survive an Ebola infection. 
   
   Hopefully, in the future there will be more options. For example, researchers are working to find drugs, including a recent $50 million push at the National Institutes of Health. And scientists are working on vaccines, including looking into ones that might be able to help wild chimpanzees, which are also susceptible to the disease. 
   
   Update: Incorporated the newest case counts from the WHO on June 26. ||||| Public Health 
   
   Could The Ebola Outbreak Spread To Europe Or The U.S.? 
   
   i itoggle caption Nir Elias/Reuters/Landov Nir Elias/Reuters/Landov 
   
   Ebola headlines this past week make the hair stand up on the back of your neck. 
   
   "Ebola Epidemic In West Africa 'Out Of Control,' " CNN said Monday. "Doctors Aren't Sure How To Stop Africa's Deadliest Ebola Outbreak," Shots reported. 
   
   And it's true: The outbreak in West Africa is the largest in history. Nearly 500 people have caught the hemorrhagic virus in Guinea, Liberia and Sierra Leone. The death toll so far is 338, the World Health Organization said Tuesday. 
   
   So should Europe and the U.S. begin worrying about the virus? 
   
   "The chance of Ebola spreading out of West Africa is very, very low," says infectious disease specialist Kamran Khan, with St. Michael's Hospital in Toronto. "But if it did spread, Paris is probably the first city on the list." 
   
   Paris? Why single out that city? 
   
   To answer that, let's back up a bit. 
   
   Khan and his team have spent years figuring out how viruses and bacteria move around the globe. "We look at many outbreaks and decide what paths they're going take," he tells Shots. "The big question is whether sick people are going to get on a plane and spread the disease." 
   
   That answer, he has found, depends largely on two factors: How many people are infected, and the degree of travel from the outbreak area. 
   
   Take SARS, for example, the respiratory virus that can spread through water droplets when a person coughs or sneezes. When SARS first appeared in 2002, it was isolated to rural China. So it spread slowly. 
   
   After about four months, a doctor brought SARS to Hong Kong. The outbreak quickly worsened. 
   
   "The airport in Hong Kong is a major, major international hub," Khan says. "You could see SARS start spreading rapidly around the world from there." 
   
   The virus jumped from Hong Kong to Vietnam and Thailand. It crossed the Pacific Ocean to Canada and the U.S. Eventually, it reached several countries in Europe. More than 8,000 people caught the virus. 
   
   But critical differences between SARS and Ebola make the Ebola virus much less threatening, Khan says. 
   
   The major city affected by the Ebola outbreak is Conakry, Guinea, home to about a million people and an international airport. But it's not a central hub, like Hong Kong International Airport or Chicago O'Hare. 
   
   "The volume of travel in the Conakry airport is low," Khan says. "Most of the flights are local. But 10 percent of the traffic goes to Paris." That would make Paris the likeliest place for Ebola to arrive. 
   
   And it is a possibility. After a person is infected with Ebola, symptoms could appear within two days — or take up to 21 days, Khan says. So a person infected in Guinea could hop on a plane and bring Ebola to, say, France or another international destination. 
   
   Even if that happens, the odds of fellow passengers catching the virus are extremely low, says Dr. Mark Gendreau, who specializes in aviation medicine at Lahey Medical Center in Peabody, Mass. 
   
   Several cases support this claim. 
   
   In 1996, a Gabon man with clear symptoms of Ebola boarded a plane to Johannesburg to seek medical treatment. He had a fever above 105 degrees Fahrenheit and signs of internal bleeding. 
   
   The man eventually made it to a hospital in South Africa. He did not infect anyone during his flight or other travels, the European Centre for Disease Prevention and Control reported. 
   
   Why? Unlike SARS, Ebola doesn't pass easily from person to person. "Transmission requires very close contact with bodily fluids, like blood or mucus," Gendreau says. "You need prolonged contact with somebody." 
   
   There's another case that argues against Ebola spreading because of airline travel. 
   
   In 2004, a businessman visiting Sierra Leone flew to London and then the U.S. He had a fever, diarrhea and back pain. When he reached his hometown in New Jersey, he went straight to a hospital. 
   
   The diagnosis was Lassa fever — another hemorrhagic virus that, like Ebola, is transmitted through bodily contact. The Centers for Disease Control and Prevention tracked down 188 people who had close contact with the man during his travels, including 19 passengers on the flight from London to Newark. The CDC reported that none of them caught the virus. ||||| Health authorities struggling to control the worst outbreak of Ebola on record said drastic action is needed to prevent more deaths. 
   
   More than 390 people have died in the outbreak in Guinea, Sierra Leone and Liberia, the World Health Organization said in a statement today. That toll is greater than the 280 people killed in 1976, when the virus was first identified near the Ebola River in what is now the Democratic Republic of Congo. 
   
   The WHO plans to meet with health ministers from 11 countries July 2-3 in Accra, Ghana, to agree on a plan to bring the outbreak under control. Health workers will have to tackle resistance from local people who are hiding infected family members, destroying medicines intended to help and adhering to rituals that fuel the spread of the virus. 
   
   “This is no longer a country-specific outbreak but a sub-regional crisis that requires firm action by governments and partners,” said Luis Sambo, the WHO’s regional director for Africa. “WHO is gravely concerned of the ongoing cross-border transmission into neighboring countries as well as the potential for further international spread.” 
   
   The outbreak is expected to last another three to four months, focused around the “hot spot” in the rural border areas where the three countries meet, said Francis Kasolo, the WHO’s director of disease prevention and control for Africa. 
   
   Crossing Borders 
   
   “What we are seeing is a lot of cross-border movement,” Kasolo said in a telephone interview. “When somebody comes in contact with a sick person in Guinea and crosses into Sierra Leone, as long as they don’t report having come into contact with an Ebola patient, there is a grave possibility that that person will transmit the disease.” 
   
   At next week’s meeting, the WHO will discuss forming a multi-country team that will share information daily on Ebola cases and people who have come into contact with those infected, Kasolo said. The Geneva-based organization has deployed more than 150 people to fight the epidemic, with tasks including surveillance, communication, infection control, logistics and data management. 
   
   The virus is also spreading because some hospitals are allowing infected patients to leave. Unsafe burial practices are also contributing. 
   
   Effective communication of safe measures to local communities is a major challenge that will be discussed in Accra, said WHO spokesman Daniel Epstein. 
   
   Educational Effort 
   
   “If there isn’t a strong public-health information and education component to the control activities, then people don’t understand and end up infecting themselves and doing things they shouldn’t be doing,” said David Heymann, a professor at the London School of Hygiene and Tropical Medicine who has studied Ebola since the first outbreak in 1976. 
   
   Guinea has pockets of resistance, mainly in the town of Gueckedou, the epicenter of the disease, said Remy Lamah, the country’s health minister. 
   
   “There are always citizens who remain attached to their rites, their traditions and others do not even believe that Ebola exists,” he said by phone today from Conakry, Guinea’s capital. “We want to use teachers and students during the holidays for awareness caravans in their communities.” 
   
   The WHO is also recruiting Ebola survivors to speak at next week’s meeting and share their experience with their own communities to try to end resistance to control efforts. 
   
   ‘Denial Barrier’ 
   
   “That’s one of the ways of trying to break the denial barrier of saying Ebola is just another disease,” Kasolo said. “We want them to be advocates within the communities where they come from on this particular disease.” 
   
   Suspicion of health workers’ motives has thwarted initiatives in some places. In Sierra Leone, youths in Kailahun burned drugs and other supplies, claiming the medicines were meant to kill Ebola patients, the country’s ministry of health and sanitation said this week. 
   
   Some households in Sierra Leone’s Kenema district are also hiding infected family members until they become very ill, health minister Miatta Kargbo said in an interview. Bogus vaccination programs are also causing undue confusion. 
   
   “The ministry wishes the general public to know that there is no vaccine for Ebola and it has not instituted any Ebola vaccine immunization in schools,” the ministry said in a statement. “The act of spreading this misleading and scaring information is a criminal offense and people involved in this act are warned to desist forthwith.” 
   
   In Liberia, traditions of waiting to bury bodies for months and touching the dead have made controlling the spread harder, Tolbert Nyesuah, assistant minister for health said. Denial that that disease exists has also complicated containment, he said. 
   
   Neighboring Countries 
   
   There is low risk at present that the outbreak will spread to other nations, Kasolo said. Still, officials from neighboring countries such as Mali, Guinea-Bissau, Senegal, Ghana, Ivory Coast and Gambia have been invited to attend the Accra meeting in case the disease spreads, he said. The Democratic Republic of Congo and Uganda will share their experiences dealing with past outbreaks. 
   
   “We still think we have another three to four months to go with the epidemic, but the duration will be influenced by how national governments and affected communities respond,” Kasolo said. 
   
   For Related News and Information: Sierra Leone Youths Burn Drugs Claiming to Prevent Ebola Deaths 
   
   To contact the reporter on this story: Makiko Kitamura in London at mkitamura1@bloomberg.net 
   
   To contact the editors responsible for this story: Phil Serafino at pserafino@bloomberg.net David Risser, Kristen Hallam ||||| MSF warns that doctors are struggling to contain second wave of disease in region amid poor monitoring and communication 
   
   The Ebola epidemic in west Africa is "out of control" and will be contained only if politicians, religious leaders and aid agencies urgently improve their response to the unprecedented outbreak, Médecins Sans Frontières (MSF) has warned. 
   
   The disease, which is continuing to spread through Guinea, Sierra Leone and Liberia, has so far claimed 350 lives, according to the World Health Organisation (WHO). The total number of confirmed, probable or suspected cases stands at 567, with the disease identified in more than 60 locations across the three countries. The disease, which can kill up to 90% of those who become infected, was first reported in Guinea in March. 
   
   Dr Bart Janssens, MSF's director of operations, said the charity had already treated 470 patients and was struggling to cope. "The epidemic is out of control," he said. "We have reached our limits. Despite the human resources and equipment deployed by MSF in the three affected countries, we are no longer able to send teams to the new outbreak sites." 
   
   MSF said that civil society and political and religious authorities were failing to recognise the scale of the epidemic, adding that prominent figures had to do more to promote the fight against the disease. Amid the panic, it said, key messages were not getting through and people were continuing to attend funerals where there were no infection-control measures in place. 
   
   Janssens said Ebola now had to be viewed as a public health issue throughout west Africa. 
   
   "The WHO, the affected countries and their neighbouring countries must deploy the resources necessary for an epidemic of this scale," he said. "In particular, qualified medical staff need to be made available, training in how to treat Ebola needs to be organised and, contact tracing and awareness-raising activities among the population need to be stepped up." 
   
   On Saturday, the WHO said a failure to gauge the severity of the initial outbreak and a subsequent relaxation of counter-measures had helped give rise to a "second wave" of the disease. 
   
   "When the epidemic started, it was a little underestimated, so that the states took a while to really prepare themselves," said Pierre Formenty, a WHO specialist. 
   
   "At the end of April, we started to see a decrease in the number of cases and we maybe saw a relaxation by the teams in the three countries, and this relaxation allowed things to restart. In addition, there were some problems with the affected populations which were sometimes not fully listened to." 
   
   In an interview with AFP, Formenty said that the WHO, MSF and others had mobilised dozens of experts but doctors alone would not be able to contain the epidemic. 
   
   "The most important things are monitoring and communication," he said. "States are getting better but the problems of communication continue. The medical corps on their own cannot stop this epidemic. It is only with the help of the population that we can fight this epidemic and stop it." 
   
   Formenty admitted that more needed to be done to explain the dangers of infection to those attending funerals or caring for the sick. 
   
   "One case can restart an entire epidemic," he said. "In an area where the quality of health services is not optimal, the populations have struggled to understand why we were asking them to make such an effort and probably we have not been able to explain both the disease and the means of control to the populations."
target: – The World Health Organization is calling an emergency meeting of health ministers from 11 countries next week in hopes of coming up with a plan to combat the worst outbreak of Ebola the world has ever seen. So far more than 390 people have died in the outbreak, which is stretching across Guinea, Sierra Leone, and Liberia, Bloomberg reports. That far exceeds the 280 killed when the disease debuted in 1976. "This epidemic is out of control," a Doctors Without Borders official said this week, according to the Guardian. This outbreak is proving especially deadly because it involves the most devastating of the five Ebola viruses; Zaire ebolavirus kills 79% of those infected, Vox explains. It's also the first major outbreak to hit West Africa, and workers there aren't sure how to deal with it—many hospitals, for example, are releasing infected patients. Among the general populace, education is even worse. In Sierra Leone, for instance, young people have burned drugs and supplies, believing that it was the medicine killing the patients. At its meeting next week, the WHO will seek to form a multi-country team to close that information gap. On the bright side, "the chance of Ebola spreading out of West Africa is very, very low," one specialist tells NPR—although if it did it would likely hit Paris next, because 10% of Guinea's air traffic out of its Conakry airport heads there.