Ebola: History And Analysis of the Current Outbreak

The spread of Ebola has been much-publicized in the media, due to the fact “the current outbreak in West Africa, (first cases notified in March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first discovered in 1976. There have been more cases and deaths in this outbreak than all others combined” (“Ebola, 2014). This paper will summarize contributing factors behind the epidemic, suggesting that in addition to biological characteristics of the pathogen, critical structural deficits in the health system in Africa are also contributing to its spread.

The nature of Ebola

According to the World Health Organization’s fact sheet on the disease, the Ebola virus was first identified in 1976 during two simultaneous outbreaks, one in the Sudan and the other in the Congo. The virus is believed to have originated in the fruit bats of the Pteropodidae family and entered the human population “through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest” (“Ebola, 2014). Human-to-human transmission occurs through the transmission of bodily fluids. Symptoms include a “sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools)” (“Ebola, 2014). Death is possible as a result of contracting Ebola.

Underlying issues

The hardest-hit countries have some of the least developed health infrastructures in Africa. The nature of the disease requires strict adherence to infection control protocols. “Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced” (“Ebola, 2014). Additionally, traditional burial practices have facilitated the spread of Ebola, given that they require close contact with the deceased person.

Challenges of global governance

WHO has been criticized for its handling of the initial outbreak. The “virus easily outran the plodding response. The WHO, an arm of the United Nations, is responsible for coordinating international action in a crisis like this, but it has suffered budget cuts, has lost many of its brightest minds and was slow to sound a global alarm on Ebola” (Sun et al. 2014). There was “a disconnect between the aspirations of global health officials and the reality of infectious disease control. Officials hold faraway strategy sessions about fighting emerging diseases and bioterrorism even as front-line doctors and nurses don’t have enough latex gloves, protective gowns, rehydrating fluid or workers to carry bodies to the morgue” (Sun et al. 2014). The lack of knowledge about the reality of the poor healthcare infrastructure led to recommendations that may have been sound medically but countries lacked the ability to fully implement them, based upon the resources available.

The high rate of transmission to healthcare workers who volunteered their time to help the sick created a climate of fear outside of Africa rather than inspired donations and aid to help the affected population. A doctor at a hospital in Liberia contracted the illness simply by touching the forehead of an infected patient to check for fever. Also, the virus has a relatively long incubation stage and patients can carry the pathogen for long distances before they become visibly ill. A typical scenario is was that of “the New Kru Town slum in Monrovia has no public water supply, no toilets, no sanitation system, no electricity. People live in hovels slapped together from wood and metal. Most people have no running water, other than what’s in the streets when downpours soak the neighborhood,” leading to high infection rates coupled with almost no domestic financial resources to improve the conditions (Sun et al. 2014).

Organizations responsible for controlling the outbreak

As well as WHO, the CDC has also been involved in the response and criticized WHO’s involvement. “Early in this outbreak, the CDC ran into bureaucratic resistance from the WHO’s regional office in Africa. The American officials wanted a greater leadership role in managing the outbreak response, including data collection and resource deployment” (Sun et al. 2014). The CDC also initially met with pushback from local populations in areas where distrust of local governments runs high. Organizations such as Doctors without Borders and the Red Cross have become involved in efforts to contain the disease, as has the U.S. military which is “gradually arriving in West Africa. The basic plan is to get as many people as possible into treatment centers where they can be properly isolated. Troops will build 17 treatment centers, each with a 100-bed capacity” (Sun et al. 2014). However, the economies of the affected nations, already weak even before the crisis, have been even more crippled since, thanks to the loss of population and resources to illness and death. This has further hampered their ability to respond and engage in effective treatment measures and more outside assistance may be needed. For example, Doctors Without Borders “said foreign donors had concentrated on building clinics but did not provide medics to staff the centers. The group repeated its call for countries to deploy biological-disaster response teams” with adequate expertise (Paye-Layeh & DiLorenzo 2014).

Summary

Ebola is a deadly disease and has certain biological features that make it difficult to contain, including the ease of interspecies contact (sufferers may have contracted the illness from animals or humans) as well as the long incubation period which can mean that persons experiencing only mild symptoms may spread the virus over long distances. However, certain structural issues endemic to the area of West Africa where the outbreak occurred have exacerbated its spread. Poverty and a lack of healthcare infrastructure have conspired to create a toxic combination of a poor response to the outbreak and a lack of trust in authorities to manage it. Additionally, responses by WHO and other NGOs that have inadequately emphasized the need for sending trained personnel to the region have caused the outbreak to spiral out-of-control, further damaging both the economy and the ability of locals to deal effectively with Ebola.

Fighting Ebola requires a multifaceted strategy. It demands containment of poverty and a rebuilding of the existing health infrastructure as well as a more effective way of dealing with the virus itself. Thus far, improved hygiene and improved medical approaches such as the development of the experimental Ebola drug called ZMapp have improved the survivability rate (Sun et al. 2014). But to contain the disease requires a permanent response and a change in how infectious disease is managed in the region.

References

Ebola. (2014). WHO. Retrieved from: http://www.who.int/mediacentre/factsheets/fs103/en/

Paye-Layeh, J. & DiLorenzo, S. (2014). Doctors Without Borders criticizes international Ebola

Response. The Huffington Post. Retrieved from:

http://www.huffingtonpost.com/2015/01/03/alan-dershowitz-sexual-assault_n_6410380.html?ncid=fcbklnkushpmg

Sun, L. (2014). How Ebola sped out-of-control. The Washington Post. Retrieved from:

http://www.washingtonpost.com/sf/national/2014/10/04/how-ebola-sped-out-of-control/