Hey there. Welcome to Paging Dr. Gupta. Thanks so much for joining us. We have another outbreak to talk about. First, we talked about Hantavirus back in April. That struck a small cruise ship in the South Atlantic. It does appear to be winding down. But now, you've certainly heard about Ebola. So today, we're going to be pivoting to Ebola and the developing situation in Central Africa. This is a place in the world where I've spent a lot of time, specifically the Democratic Republic of Congo and neighboring Uganda. Here's the headline: the World Health Organization has declared this a public health emergency of international concern, but importantly at the same time, the global risk remains low. The risk is high in that region, and for now the outbreak appears to be spreading quickly. My producer Andrea is back with me. So what are people asking about?

Yeah, listeners have many questions and concerns about Ebola. What it is, how it's spread, and just how deadly is it?

Alright, we'll have those answers. I'm also going to explain why global health experts are concerned about this, even though, again, the global risk remains low. We'll have all that when we come back from a short break.

'Welcome back to Paging Dr. Gupta. Today we decided to unpack the Ebola outbreak that is now unfolding in Central Africa. So first things first, what is Ebola and how is it spread? So Ebola disease, sometimes called Ebola hemorrhagic fever, is a disease caused by one of a small handful of different Ebola viruses. It is primarily transmitted to humans when they interact with animals. When they're hunting, when they're handling, when they are eating infected bushmeat, for example. And keep in mind, in this part of Central Africa, wildlife can be a resident's main source of protein. And that vital source of nutrition is a gateway for animal-to-human transmission. Now, we've been reporting on Ebola for a long time. The first human outbreaks are thought to have occurred in 1976, relatively near to where today's outbreak is centered. Three virus types are believed to be behind most of the largest human outbreaks. One of these three, the Bundibugyo virus, is driving the current epidemic. Now, part of the reason Ebola gets so much attention, why it's so frightening for people, is the high fatality rate. Global average, around 50%. The disease itself, if people do get sick, usually starts with what are known as dry symptoms: fever, fatigue, muscle pain, headache, sore throat. And then it progresses to so-called wet symptoms: vomiting, diarrhea, and sometimes internal and external bleeding can occur as the disease progresses. That's where it gets its name, the hemorrhagic fever. Now the time between exposure and the onset of symptoms, this is called the incubation period, something we talked about with hantavirus as well. That incubation period ranges from 2 to 21 days. So just think about that. You could be exposed and then not develop symptoms for three weeks and therein lies part of the problem. Someone may not know that they are carrying the Ebola virus. They're not sick. They could travel around the world within that time. Now people are not believed to be contagious until they show symptoms of the disease. Very important. We'll come back to that point. But until you're sick, you're probably not going to be spreading this to other people. There is no specific treatment or vaccine for this particular Ebola type. Now I do want to explain a couple of terms. This is a very infectious virus, but not very contagious. Highly infectious, not very contagious. Let me explain. Infectious basically means that just a little bit of the virus can make you sick, versus contagious, which describes how transmissible it is. In the case of Ebola, it's not that contagious. It's not airborne, for example. You really have to be in direct contact with bodily fluids of an infected person such as vomit or blood, or come in contact with contaminated materials on a person who has died of the disease. That is why you see healthcare workers and others dressed head to toe in what essentially look like space suits. Now one thing to point out is that, let's say you even have a little tiny cut on your hand or your fingernail or something like that, and you are exposed to even a small amount of infected fluid, you could potentially become infected. That is what they mean when they say something has a high infectiousness. Ebola's high infectiousness is one aspect that might be compounding the crisis. For example, some local funeral customs involve mourners touching a deceased person's body, and that's where they might come into direct contact with bodily fluids. So even after someone has died, they could still be potentially spreading the disease. Complicating the matter, this past week, there have been at least three attacks on healthcare facilities treating patients suspected of having Ebola. In two incidents, the Associated Press reported that attackers demanded the bodies of relatives be released, which could then further spread disease. In the third incident, 18 patients with suspected Ebola left the facility during the attack. OK, what other questions do we have?

Do we know how big the outbreak is so far?

'That is a great question and honestly a very difficult one to answer, a troubling one in some ways because health officials really don't know. As of this recording on Monday, the WHO says there are more than 900 suspected cases and more than 220 deaths believed to be linked to Ebola. There have been more than 100 cases confirmed primarily in the DRC and a few more in Uganda. These are all clues when people are trying to figure out the size and scope of an outbreak. There are some Americans among the cases. Dr. Peter Stafford, an American missionary working in DRC, he developed symptoms. He tested positive. He's now at a hospital in Germany receiving treatment. In fact, he was treated with an experimental monoclonal antibody and is now said to be doing better. Six high-risk contacts of Stafford may have also been exposed. This includes his wife, also a doctor, and a third doctor. Five were sent to Germany. And the sixth was sent to the Czech Republic. But keep in mind, this is probably a significant undercount. There's a lot of uncertainty about the number of infections and how far the virus has spread. The World Health Organization has said that the agency is worried for a few reasons. First of all, the outbreak was slow to be identified. There were already a lot cases before the World Health organization really got involved. There are healthcare workers among those who died. Another issue, there is significant population movement within the outbreak area. These are pretty populated areas. And finally, this is a rare type of Ebola which has no specific treatment or vaccine. That is, in a nutshell, why global health experts are so worried about this. When we come back, I'm going to tell you how this outbreak compares to the one in 2014. I was on the ground then, in Africa. What are countries doing to protect themselves? I'll explain it, right after this short break.

Welcome back to Paging Dr. Gupta. We are talking about the Ebola outbreak in the Democratic Republic of Congo in Central Africa, the DRC. I covered an Ebola outbreak is Guinea, which is a bit west of the DRC back in 2014. And on Wednesday night, I joined my colleague Anderson Cooper for a CNN event where I was asked about how this Ebola outbreak compares to that one in 2014. I'm going to play part of this for you because I think it really underscores the conditions in DRC that make public health so challenging.

Hey, welcome to this CNN subscriber series Q&A with Dr. Sanjay Gupta focusing on health and wellness. And there's certainly a lot of stuff in the headlines to talk about. So let's get started. Sanjay, how are you doing?

Doing well. Thanks for having me.

All right, good. Well, we're going to talk about health and wellness. A question about Ebola. You were on the ground, it says in West Africa during the Ebola outbreak in 2014 that killed over 11,000 people. How does this outbreak compare to what you experienced back then? And how do you think this outbreak might develop?

Yeah, well, you know, first thing I'll say, and Anderson, you and I can probably both speak to this because we've been on the ground in these places in Africa, Central Africa, DRC, the Ugandan border, and you get a sense sort of from a public health infrastructure, how challenging it is.

Some of these areas are incredibly remote, I mean, the area where this outbreak is is in the northeast, it's closer to Rwanda, so that has some benefit in terms of travel, but the road system throughout DRC Congo is legendarily, the number of paved roads is very small.

Yeah, it's really tough to even simply, like imagine this, you have to take these coolers full of reagents to be able to go to a location where you think there's an outbreak to be be able start doing testing. I mean, and if the reagents, they warm up, you get there and the test comes back negative, you're asking yourself, well, is it truly a negative test or did the reagent go bad somewhere along the way? I'm just trying to paint a picture of how challenging it is. I mean, we're so used to having tremendous resources in the United States. They don't have that. There's a few things that concern me about this outbreak. And to give context, in 2014, I was primarily in Guinea. That ended up being an outbreak that lasted around two years. I think 27,000 people were confirmed to have been infected, but it was probably much higher because a lot of people, again, never get tested. And about 11,000 people died. So when they talk about mortality rates around Ebola, a lot of times it comes from these other huge outbreaks. So you know, big outbreaks, lots of data to sort of get an idea of just how the morbidity and mortality around this. What concerns me about this is a couple things. One is that, you know we didn't really hear about this until there was already a lot cases. A lot of suspected cases and then a lot confirmed cases and I think there were close to 80 deaths by the time the alarm bells really started ringing. April 24th, a healthcare worker got sick in Congo, but didn't know what it was. And it wasn't until May 15th that these cases really started to get confirmed. That means there's a lot of cases that get out there before you can start to really get a handle on it. And as you know, Anderson, incubation period, typically eight to 10 days, but can be as long as three weeks. So people who are in that area, for the next three weeks, some of them, if they're going to get sick, they can travel around the world, you know, during that time. And I think that's always the concern with outbreaks. I think when you and I were there with doing Planet in Peril years ago, I remember this phrase that kept coming up, which is an outbreak somewhere is an outbreak everywhere.

All right, time for one more question.

What steps is the U.S. Government taking to protect all of us?

'Well, the U.S. State Department last week started requiring that U. S. Bound flights carrying passengers who had recently been in an Ebola affected area, such as DRC, South Sudan, Uganda, that they needed to land at Dulles International Airport. That's the one outside Washington, D.C. or Atlanta's Hartsfield-Jackson Airport. There, they will undergo health screenings. Houston's George Bush Intercontinental Airport will also start receiving passengers departing affected areas late Tuesday night. Now, the rule does apply to all passengers, including US citizens and green card holders, if they were in one of these areas within the previous three weeks. The US Centers for Disease Control and Prevention has also invoked what is known as Title 42 for at least 30 days. Title 42 is a public health law that restricts entry of certain people into the United States during outbreaks of communicable diseases. And of course this does raise concerns about how Ebola will affect the World Cup, which is being held in a handful of cities across the United States, as well as Canada and Mexico starting June 11th and running through July 19th. Here's what we know. The DRC players, they've all been living and training away from their home country for the past several weeks, mostly in Europe. That team is expected to be based in Houston, Texas for the group phase of the World Cup. The White House Task Force for the World Cup has said that the DRC team needs to isolate for 21 days or risk being denied entry into the United States. The DRC team spokesperson said that as of late last week, there was no change to their schedule. Some planning to travel to the United States for the matches may also be blocked from coming into the U.S. Under Title 42 if they've been in infected areas in the previous three weeks. One public health expert, Dr. Peter Hotez, said he doesn't think that Houston, where the DRC team will be based, is at particular risk. In fact, we asked him if he would go to a game and he said he wouldn't be afraid to be at a game with DRC fans because Ebola is really only contagious when people are sick. They're showing symptoms and that means they likely wouldn't be well enough to actually be attending a game. Public health officials and FIFA are on high alert and will be following the situation closely and coordinating with local authorities. According to CNN reporting, host cities have already started to ramp up their surveillance tools for all sorts of infectious diseases, a new group called the Health Security Operations Center, HSOC, has been created by experts at Georgetown University and MedStar Health to monitor health data during the World Cup, and they're going to put out daily updates starting June 1st. This is a quickly moving story. Again, the global risk is low, but the last Ebola outbreak back in 2014 was a big one. Nearly 30,000 people infected, 11,000 died, and you've heard why there is so much concern. We'll stay on top of it. But that's all the time we have for today's episode. Thanks to everyone who sent in questions. We got a lot of questions about Ebola. Keep them coming. Record a voice memo. Email it to pagingdrgupta@cnn.com. That's pagingdrgupta@cnn.com, or give us a call, 470-396-0832, and leave a message. Thanks so much for listening. I'll be back on Friday.