Micro Module 8 Activity

Republic of the Philippines
Cebu Normal University

Osmeña Blvd. Cebu City, 6000 Philippines
College of Nursing
Center of Excellence (COE) | Level IV Re-Accredited (AACCUP)
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph; secretary@cnunursing.org
Website: www.cnu.edu.ph
Degamo, Gwyneth Kim and Sarigumba, Sean October 3, 2020
Level 2A Microbiology
After watching the movie, answer the following questions based on the concepts
of epidemiology
1.1. What is the characteristic of the etiologic agent, including its pathogenicity
and virulence?
The causative agent mentioned in the movie was the Ebola virus, which is a member of
the Filoviridae family (genus Ebolavirus; order: Mononegavirales). These
microorganisms have filamentous and elongated structures with varying lengths and are
highly virulent pathogens that are capable of inducing frequently lethal hemorrhagic
fevers. The virus also actively subverts both the host's adaptive and innate immune
mechanisms and triggers harmful inflammatory responses as while it inflicts direct
tissue damage. Thus, the host's immune system is overwhelmed by the virus-induced
cell damage combined with a flurry of inflammatory factors, particularly within the
vasculature and liver, leading to septic shock and, ultimately, death.
1.2. How did the disease spread?
The Ebola Virus was primarily transmitted through the bite of infected fruit bats and
passed through people through direct contact. The first noted cases of the outbreak
were in the neighboring countries of Liberia and Sierra Leone, which was then evolved
into a public health emergency as it spread through the villages and the general
population of sub-Saharan Africa. In the movie, the first known case in Nigeria was the
Liberian-American Patrick Sawyer, who was a diplomat who flew from Liberia to the
county's most populated city Lagos. Upon arrival, he then became violently ill and was
admitted to a hospital to receive treatment. During hospital admission, the patient
repeatedly asserted that he wanted to be discharged, and when he was queried about
Ebola, he lied and said he had no exposure. He was then given treatment for presumed
malaria but based on the patient's failed response to the malaria treatment and his
travel from an Ebola-affected country in the region, the medical professionals in charge
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Telephone No.: (+63 32) 254 4837
suspected Ebola. The patient was then isolated and tested for Ebola virus infection,
while local public health authorities were alerted about a suspected Ebola case. A blood
specimen sent to Lagos University Teaching Hospital was confirmed positive for acute
Ebola virus infection. He died a few days later but not before he infected the medical
personnel, which then caused a cascade of subsequent infections that spread to a large
number of people.
1.3. Describe the stages of the pathogenesis of the disease.
The virus enters the host through the mucous membranes, through wounds, or any skin
damage. It can also be done parenterally and infects many cell types, including
monocytes, macrophages, dendritic cells, and epithelial cells. The infection route also
plays a part in the duration of the incubation period, which is six days via injection
compared to 10 days for direct contact. The Ebola virus then migrates from the initial
infection site to regional lymph nodes and subsequently to the liver, spleen, and adrenal
gland. Although not infected by the Ebola virus, lymphocytes undergo apoptosis, which
results in a decreased lymphocyte count. Afterward, hepatocellular necrosis will occur,
and it is associated with the dysregulation of clotting factors and subsequent
coagulopathy. Adrenocortical necrosis can also be found and is associated with
hypotension and impaired steroid synthesis. Ebola virus can also trigger a release of
pro-inflammatory cytokines with subsequent vascular leak and clotting impairment,
ultimately resulting in multiorgan failure and shock.
1.4. How was the period of illness depicted in the movie?
In the movie, patients who were infected with the Ebola Virus Disease generally had an
abrupt onset of fever and symptoms a few days after exposure. Their initial signs and
symptoms were non-specific and included elevated body temperature at 38 C, chills,
muscle pains (myalgia), and generalized weakness and discomfort (malaise). Because
of these nonspecific symptoms, in the early stages of the disease, the Ebola Virus
Disease was often confused with more common infectious diseases in the African
region such as malaria. Patients then progress from the initial non-specific symptoms
after a few days to develop gastrointestinal symptoms such as vomiting and abdominal
pain. Other symptoms such as bleeding inside and outside of the body, shortness of
breath, headache, or confusion were also observed to have developed. Patients with
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the fatal disease usually develop more severe clinical signs early during infection. They
die typically due to complications such as multiorgan failure and septic shock. In
nonfatal cases, patients may have a fever for several days and improve, and those who
survive can have prolonged convalescence.
1.5. What were the signs and symptoms of the disease?
The signs and symptoms of the disease were reported to appear anywhere between 2
to 21 days after contact with the virus. The course of the illness progressed from "dry"
and non-specific symptoms such as fever, aches and pains, and fatigue, which can be
mistaken for malaria or typhoid fever. Afterward, the virus then progresses to "wet"
symptoms such as diarrhea and vomiting as the patient's condition deteriorates.
The signs and symptoms of the Ebola Virus Disease include the following:
· Weakness and fatigue
· Abdominal (stomach) pain
· Body aches and pains, such as severe headache, muscle, and joint pain, and
abdominal (stomach) pain
· Unexplained hemorrhaging, bleeding or bruising.
· Gastrointestinal symptoms including diarrhea and vomiting
· Fever
1.6. How was the diagnosis of the disease confirmed?
In the movie, the medical professionals of Nigeria ruled out the Ebola Virus Disease
diagnosis with their patient through a combination of symptoms that suggested EVD
(Ebola Virus Disease) and possible exposure to the virus within 21 days before the
onset of symptoms. Exposure may be identified as contact with blood or bodily fluids
from an individual who was infected with or who died from EVD, objects contaminated
with blood or body fluids of a person sick with or who died from EVD. Upon showing
signs and having ruled out a possible exposure, the patient was then isolated, public
health authorities were notified, and blood samples from the patient were collected and
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tested in order to confirm the infection. Ebola virus can be detected in blood after the
onset of symptoms. It may take up to three days after symptoms start for the virus to
reach detectable levels.
Although not shown in the movie, Polymerase chain reaction (PCR) is one of the most
commonly used diagnostic methods because of its ability to detect low Ebola virus
levels. PCR methods can identify the presence of a few virus particles in small amounts
of blood, but the ability to detect the virus increases as the amount of virus increases
during an active infection. However, when the virus is no longer present in significant
enough numbers in a patient's blood, PCR methods will no longer be effective.
7. Describe the pathologic changes by the infected individuals in the movie?
Often an acute infection will cause pathologic changes in a short time after
contact with the virus, and ebola hemorrhagic fever is an acute viral infection that the
course of disease is unusually severe. Pathologic changes occur in infected individuals
5-21 days after contact with the virus. Patients first manifest high fever and soon
express difficulty in breathing as cough, stomach pain and muscle pain is experienced.
Then patients suffer from acute diarrhea and vomiting that gradually increases daily as
the virus worsens. Period of illness occurs 8 to 10 days after contracting the virus, and
some patients do not survive this period while others experience decline after 14 days.
8. What were the interventions that were employed to manage the disease?
· The country did a speedy action against Ebola by instinctively doing contact
tracing and taking extra fast measures to monitor suspected individuals.
· Individuals showing primary symptoms like fever were immediately tested

and isolated, then the surfaces they touched were thoroughly disinfected.
· The patients were provided fluids that should be taken to stay hydrated
against the constant vomiting and diarrhea.
· Daily observation of the patients’ status, whether their fever was still
abnormally high or if there is a decrease in the vomiting and diarrhea.
· Deceased patients were immediately cremated to avoid further

contamination.
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9. What were the patient outcomes?
Few of the infected individuals failed to fight against the disease and were cremated
immediately, but the other patients slowly regained normal status of health as their level
of symptoms decreased day by day.
2. Research
2.1 What is the incidence and prevalence of the disease?
In outbreaks caused by the Zaire species of Ebola virus in Central Africa, case fatality
rates have reached 80 to 90 percent. The ebola disease virus prevalence reports an
estimated 670 confirmed cases in every 1,000 individuals in the year 2014-2016 in
affected places in Guinea, Liberia and Sierra Leone. The EDV has an incidence rate of
death of 5,655 in every 100 person-years, this calculation was based on WHO reports
of confirmed cases from 2014-2016.
2.2. Describe the patterns of incidence of the disease.
EVD has the pattern compatible with an epidemic disease. The scope of this outbreak,
both in terms of cases and geography, can be attributed to the unprecedented
circulation of EVD into crowded urban areas, increased mobilization across borders,
and conflicts between key infection control practices and prevailing cultural and
traditional practices in West Africa. Engaging local leaders in prevention programs and
messaging, along with careful policy implementation at the national and global level,
helped to eventually contain the spread of the virus and put an end to this outbreak.
2.3. Describe the type of infection that the disease will cause.
Ebola virus is a class A bioterrorism agent, known to cause highly lethal hemorrhagic
fever. It is spread through contact with infected blood or bodily fluids. The mortality rate
can be as high as 90 percent. Because the Ebola virus is so hazardous, it is classified
as a biosafety level 4 agent - the level assigned to the most dangerous agents known.
3. You will describe in brief the sharing that you and your partner have done in
compliance to this requirement. Cite verbatim exchanges in developing the
collaboration.
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Telephone No.: (+63 32) 254 4837
Upon having finished the movie and the learning content pertaining to the modules at
hand, we promptly began to discuss our observations, learnings and the important life
lessons that we gleaned over this learning experience. Throughout the movie, we
observed how medical professionals play an important role in disease control and
prevention and although the plot, music and cinematography does a good job of
portraying how medical experts would respond to a public health emergency, it also
highlights the emotional, mental and social challenges that doctors and nurses face in
the likely event of an epidemic. Even my partner Kim expressed her annoyance on the
Liberian diplomat who refused to cooperate and even lied to the nursing and medical
staff thus endangering everyone in the process. She said, “Samoka sad ana niya uy
pwede raman gud mucooperate”. I also expressed my praise towards Nigeria’s medical
experts particularly in the scene where they all came together in solidarity, putting all
their expertise on the table, as they prayed and persevered for the common good of the
Nigerian people. I said, “Nindota sad ana nila uy ngana sad unta diri sa Pinas”. I was
amazed at how fast they were able to respond to the epidemic despite their lacking
healthcare infrastructure and the manner by which they were able to elicit the
cooperation of the city’s various stakeholders who played an important part in the swift
delivery of vital health services. The movie also did a good job of portraying the general
population’s initial reaction of fear and panic which swept upon the city upon hearing
that this deadly disease was at their doorstep. It was most evident in the scene where
the taxi driver helped transport a man and his spouse who was infected with the virus
and was in a critical condition. The taxi driver was very distraught upon hearing this and
kept berating the couple to leave as he panicked about being infected and for having
potentially lost his only livelihood. My partner and I also grew to admire the medical
expert who was in charge of the infectious diseases ward as he was this warm and
supportive presence who encouraged his patients to keep on fighting thus reigniting
their desire to live another day. My partner Kim also expressed our regrets towards the
medical professionals who gave their lives in fighting the epidemic which she
verbalized, “Luoya sad nila oy hinaot dili sad na mahitabo nato or sa atong mga kauban
puhon”. Although I shared her regrets, I told her that instead of commemorating their
deaths, we should remember how they lived, a life full of meaning and purpose, an
existence worth celebrating for it was a life lived to serve others. Yes, we should mourn
their deaths, but must also be thankful that these noble men and women had lived.
College of Nursing
Telephone No.: (+63 32) 254 4837
References:
Kaner J, Schaak S. (2016). Understanding Ebola: the 2014 Epidemic. Accessed

October 2, 2020 from
https://globalizationandhealth.biomedcentral.com/track/pdf/10.1186/s12992-016-0194-
4?site=globalizationandhealth.biomedcentral.com
Ebola Virus Disease Outbreak — Nigeria, July–September 2014. (n.d.). Retrieved from
www.cdc.gov website: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm‌
Diagnosis. (2019). Retrieved from https://www.cdc.gov/vhf/ebola/diagnosis/index.html
Signs and Symptoms. (2019). Retrieved from

https://www.cdc.gov/vhf/ebola/symptoms/index.html
Team, H. J. (2020, September 7). Filoviridae virus, filoviridae marburg and ebola
viruses. Retrieved October 2, 2020, from Health Jade website:
https://healthjade.net/filoviridae/
Ebola virus disease Information for Clinicians in U.S. Healthcare Settings. (2019).
Retrieved from https://www.cdc.gov/vhf/ebola/clinicians/evd/clinicians.html

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Republic of the Philippines

Cebu Normal University

Degamo, Gwyneth Kim and Sarigumba, Sean October 3, 2020

1.2. How did the disease spread?

1.3. Describe the stages of the pathogenesis of the disease.

1.4. How was the period of illness depicted in the movie?

1.5. What were the signs and symptoms of the disease?

· Weakness and fatigue

· Abdominal (stomach) pain

· Unexplained hemorrhaging, bleeding or bruising.

· Gastrointestinal symptoms including diarrhea and vomiting

1.6. How was the diagnosis of the disease confirmed?

7. Describe the pathologic changes by the infected individuals in the movie?

· Individuals showing primary symptoms like fever were immediately tested

· Deceased patients were immediately cremated to avoid further

9. What were the patient outcomes?

2.1 What is the incidence and prevalence of the disease?

2.2. Describe the patterns of incidence of the disease.

Kaner J, Schaak S. (2016). Understanding Ebola: the 2014 Epidemic. Accessed

Diagnosis. (2019). Retrieved from https://www.cdc.gov/vhf/ebola/diagnosis/index.html

Signs and Symptoms. (2019). Retrieved from

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