It has been 35 weeks since its outbreak and it is worrying to hear Medicine San Frontiers
announce as it did so emphatically and publicly recently,
“Six months into the worst Ebola epidemic in history, the
world is losing the battle to contain it,” said Dr. Liu. “Leaders are failing
to come to grips with this transnational threat. The WHO announcement on August
8 that epidemic constituted
a ‘public health emergency of international concern’ has not led to decisive
action, and states have essentially joined a global coalition of inaction,” she
said.
(MSF International President Dr. Joanne Liu)
she went on to stress
“States with the required capacity have a political and
humanitarian responsibility to come forward and offer a desperately needed,
concrete response to the disaster unfolding in front of the world’s eyes.
Rather than limit their response to the potential arrival of an infected
patient in their countries,
they should take the unique opportunity to actually save lives where
immediately needed, in West Africa.”
This outbreak has spread from Guinea to Liberia, to Nigeria,
Senegal and Sierra Leone. The map of
Western Africa shows how geographically this looks.
and it does not look good.
“The clock is ticking and Ebola is winning,” said Dr. Liu.
“The time for meetings and planning is over. It is now time to act. Every
day of inaction means more deaths and the slow collapse of societies.”
“Every day we have to turn sick people away because we are
too full”, said Stefan Liljegren, the MSF coordinator at ELWA 3. “I have
had to tell ambulance drivers to call me before they arrive with patients, no
matter how unwell they are, since we are often unable to admit them.”
MSF’s care centers in Liberia and Sierra Leone are
overcrowded with suspected Ebola patients. People continue to become ill and
are dying in their villages and communities. In Sierra Leone, highly infectious
bodies are rotting in the streets.
These guys are on the front line and if they say we are
losing the war then we should listen, for many moral and also totally selfish
reasons. The Ebola virus is so deadly
that normally restricts its ability to spread among a population. But this latest outbreak in Western Africa
shows little sign of abating. Looking
at the WHO map, in its statement today the degree of the outbreak becomes
clear.
Most people are infected by giving care to other infected
people, either by directly touching the victim's body or by cleaning up body
fluids (stools, urine or vomit) that carry infectious blood.
Traditional African burial rituals have also
played a part in its spread. The Ebola virus can survive for several
days outside the body, including on the skin of an infected person, and
it's common practice for mourners to touch the body of the
deceased. They only then need to touch their mouth to become infected.
However,
a recent paper (http://jid.oxfordjournals.org/content/196/Supplement_2/S142.full)
has shown that the virus can be found as long as 61 days
after original illness in the semen of patient. This means that sex after recovery, for a period of months, can
still spread the disease. This is
worrisome as the recent areas where the disease has been found are hubs of
international travel. Also, since the
incubation of the Ebola virus can take 2-21 days it is possible that a person
could climb on a plane not showing symptoms and then develop them subsequently
and be contagious on arrival at their destination, spreading the outbreak
globally. In the west we are better at
isolating
and treating the victims, our nursing practices help stop
infection spreading so easily but in today’s world of interconnectivity
the importance of these travel hubs cannot be overestimated.
Just
in case you think that this is impossible some one has already worked out
estimates of numbers predicted in various countries if via these hubs the
disease spreads.
Not
nice to see these graphs at all. Mind
you it all assumes that spread of Ebola by air routes is possible. After all most of the people who are
contagious are often bleeding and vomiting, pretty easy to spot, you'd think. Unfortunately, it has already happened. The first case in Nigeria was
reported by the WHO on 25 July: Patrick Sawyer, a Liberian Ministry
of Finance official, flew from Liberia to Nigeria after
exposure to the virus, and died at Lagos soon after arrival. In
response, the hospital where he was being treated was shut down and
quarantined, and the health officials who were treating him were isolated in an
attempt to stop the spread of the virus. However, a doctor and nurse who
treated Sawyer both died from Ebola.
Nigeria’s outbreak has arisen because of this one individual catching a
plane.
In
addition, there could be something worryingly different about this virus.
“Scientists from the Broad Institute and Harvard
University, in partnership with the Sierra Leone Ministry of Health and
Sanitation, may have uncovered clues that set this Ebola outbreak apart from
previous outbreaks. For this study, 99 Ebola virus genomes were
collected and sequenced from 78 patients diagnosed with the Ebola virus
during the first 24 days of the outbreak in Sierra Leone. The team found more
than 300 genetic changes that make the 2014 Ebola virus distinct from previous
outbreaks. It is still unclear whether these differences are related to the
severity of the current outbreak. Five members of the research team became ill
and died from Ebola before the study was published in August.”
Given
the presence of internal travel hubs effected by this present outbreak, Ebola’s
high mortality rate, the chances of it spreading internationally and our own
moral responsibility we should be fighting this virus with energy and
commitment not inaction.
Whether
this outbreak is contained in the next few months or not, it is a valuable
exercise in how we can respond to such viruses in future events. So far we are looking rather ineffectual and
sluggish. There is a lot going on at
present on the global stage, Ukraine, Syria, Iraq etc and it is easy to see how
a few thousand deaths in Africa don’t appear on the radar. The Spanish flu came in the midst of a World
War and killed 50 to 100 million people—three to five percent of the
world's population. This Ebola virus
does not spread as easily but the Spanish Flu had a mortality rate of 2.5%
whereas this Ebola virus can have a mortality rate of 50-90%. It’s time we
united to fight this disease for those suffering and dying in Africa and for
ourselves.
