Even experienced international disaster responders are shocked at how bad it’s gotten.
Photo by Reuters
It’s nine months into the biggest
Ebola outbreak in history, and the situation is only going from bad to
worse. The outbreak simmered slowly in West Africa from December 2013, when the first case was retrospectively documented,
through March, when it was first recognized by international
authorities. It began gaining momentum in June and throughout July. Now,
terms like “exponential spread” are being thrown around as the epidemic continues to expand more and more rapidly. Just last week, an increase of 700 new cases was reported, and the case count is now doubling in size approximately every three weeks.
Already, the number of cases (approximately 5,300 as of Sept. 18)
and deaths (2,630) has dwarfed the total number of cases and deaths
from every reported Ebola outbreak in history—and those are only the
cases that we know about. Here’s where we stand with Ebola right now.
The situation on the ground
By all accounts, it’s understandably miserable everywhere Ebola has
hit, but even experienced international disaster responders have been
shocked at how bad it has gotten. A Doctors Without Borders worker in
Monrovia, Liberia, named Jackson Naimah describes the situation in his home country,
noting that patients are literally dying at the front door of his
treatment center because it lacks patient beds and assistance; the
sufferers are left to die a “horrible, undignified death” and
potentially infect others as they do so:
One day this week, I sat outside the treatment center eating my lunch. I saw a boy approach the gate. A week ago his father died from Ebola. I could see that his mouth was red with blood. We had no space for him. When he turned away to walk into town, I thought to myself that this boy is going to take a taxi, and he is going to go home to his family, and he will infect them.
When health care workers aren’t available, or when patients are too
fearful to take loved ones to a clinic, it falls to those closest to the
ill to nurse them. This has wiped out entire families, “prey[ing] on care and love, piggybacking on the deepest, most distinctly human virtues,” turning caregivers into victims as the virus passes among siblings and parents, from one generation to the next.
Health care workers who are treating the sick are dying because they also lack basic protective equipment,
or because they have been so overwhelmed by taking care of the ill and
dying that they begin to make potentially fatal errors. They have gone on strike
in Liberia because they are not being adequately protected or even paid
for their risky service. Hearses have been commandeered as ambulances; motorcycles are used to transport patients long distances, putting drivers at risk of becoming the next victim.
Fear and misinformation are as deadly as the virus itself. Eight Ebola workers were recently murdered in Guinea,
in the area where the virus first came to the world’s attention in
March. Liberia’s largest newspaper featured a story describing Ebola as a
man-made virus being purposely unleashed upon Africans
by Western pharmaceutical companies. Reports abound of doctors and
other workers being chased away, sometimes violently, by fearful
families. A second outbreak was triggered in Nigeria after an infected
diplomat broke quarantine and fled from Liberia to Port Harcourt.
So far, other West African countries have been largely spared. Senegal experienced one imported case in late August, but to date other contacts have tested negative for the virus. Ivory Coast is watching closely
and working to keep the virus out of the country. Perhaps the most
extreme measures are currently being taken in Sierra Leone, where the
country has been under a lockdown for three days
to track cases of infection and minimize transmission. The country’s 6
million residents were ordered to stay indoors while volunteers went
door-to-door to educate citizens, document new cases, and remove bodies.
The response
To date, nongovernmental organizations have largely been leading the
fight against Ebola in West Africa. Doctors Without Borders (also known
by its French name, Médecins Sans Frontières,
or MSF) has led the international battle against Ebola, and where its
workers have had success in the past, they have been completely
overwhelmed now for months. MSF International President Joanne Liu has
made multiple appeals to the United Nations, begging for additional
assistance, noting on Sept. 16:
As of today, MSF has sent more than 420 tonnes of supplies to the affected countries. We have 2,000 staff on the ground. We manage more than 530 beds in five different Ebola care centres. Yet we are overwhelmed. We are honestly at a loss as to how a single, private NGO is providing the bulk of isolation units and beds.
The plea has fallen on sympathetic ears, but the response has been
slow and insufficient. The United States has answered the call to some
extent, promising 3,000 military personnel and up to $750 million in aid. Even this massive amount is less than what the World Health Organization has called for: a minimum of $1 billion, and even that will only keep infections contained to the “tens of thousands.”
No one has sounded the alarm more clearly or critically than journalist Laurie Garrett, who wrote about Ebola in her 1995 book The Coming Plague. Writing for Foreign Policy,
she has denounced the international response and lack of coordination,
criticizing individual countries as well as the United Nations, World
Health Organization, and the World Bank, noting that the world “just doesn’t get it” when it comes to Ebola.
The virus
If there can be a faint silver lining to this outbreak, it’s that
researchers have been able to study the evolution of the virus in a way
no previous Ebola epidemic has allowed. With thousands of cases
documented to date, investigators have been able to track mutations in the virus’ RNA genome—and they found hundreds of mutations just in viruses examined before the publication of a paper in Science in August. In a tragic footnote, five of the authors of this paper died of Ebola during this outbreak.
While we do know that the virus is mutating, what remains murky is
what those mutations are actually doing in patients. Genomic data itself
is really only as good as the epidemiologic information that goes along
with it, such as patient location, outcome of infection, symptoms
exhibited, familial transmission patterns so it can be traced back
between family members or members of the same geographic area, etc.
Given that the outbreak has been so explosive and understaffed, much of
this data may be lost, and it’s estimated that almost half of all those infected probably aren’t even reporting to hospitals—unfortunately limiting the conclusions of some of these genetic studies.
However, we do know that the risk that this outbreak may spawn an
airborne Ebola virus is still incredibly tiny. Virologist Vincent
Racaniello sums up the history of viruses mutating to a novel route of transmission,
noting, “There is no reason to believe that Ebola virus is any
different from any of the viruses that infect humans and have not
changed the way that they are spread,” and that “the likelihood that
Ebola virus will go airborne is so remote that we should not use it to
frighten people.”
The big concerns
Even without an airborne form of Zaire Ebolavirus, we still have
plenty to be concerned about. Models have suggested that this outbreak
could go on for several more months at a minimum. The worst-case
situation suggests that half a million cases are possible before the outbreak is finally brought under control. New research proposes that the current outbreak is so different from past Ebola epidemics that modeling is simply not informative, and “as a result, we are not in a position to provide an accurate prediction of the current outbreak.”
Besides the incredible potential number of lives lost, a huge concern
is the destabilization of the affected countries—and even of those
around them that have not shown any cases of Ebola. WHO Director-General
Margaret Chan noted that this outbreak “is
a social crisis, a humanitarian crisis, an economic crisis, and a
threat to national security well beyond the outbreak zones.” Partly in
response to the testimony of Chan and others, the United Nations announced the establishment of an emergency mission to fight Ebola.
Countries were also asked to lift travel bans to the affected
countries, which have made it more difficult to move supplies in and out
of the area.
While 5,300 cases may not be a lot in the grand scheme of things,
hospitals and clinics have been crippled, and mortality rates in these
countries may be affected beyond just the Ebola virus. Patients who have
other ailments, pregnant women looking to enter hospitals
and clinics to give birth or to bring in ill children with
non-Ebola-related diseases have been turned away. Crops are not being
harvested or transported, making hunger an issue equal or greater to Ebola in many areas.
Finally, all of this is only examining the West African Ebola
outbreak. Ebola also re-emerged in the Democratic Republic of the Congo
in August; to date, there have been at least 60 cases in that country
and 35 deaths. With all of the concern about West Africa, much less
attention and aid has been given to the DRC, which has a much more extensive history of Ebola epidemics, mainly in rural areas. It is hoped that history and experience will more quickly bring the outbreak there under control.
The coming months
Even with massive international intervention, the situation will
still worsen before it improves. The influx of funds and assistance from
the United States and other countries is certainly welcome news, but it
remains to be seen exactly how that will be allocated, who will be in
charge, and how coordination will be established. This will be a
long-term effort, and even after this Ebola outbreak has been
extinguished, additional doctors and nurses will need to be trained to
replace those that have been tragically lost in this epidemic. Some of
Ebola’s victims will survive, but they and their families may face harsh stigma in their hometowns. It may take a year, but this fire from the pit of hell will eventually be extinguished. At what cost to human life, we do not know yet. http://www.slate.com/articles/health_and_science/medical_examiner/2014/09/ebola_outbreak_status_and_predictions_the_virus_the_response_the_biggest.single.html
