Breaking Down the Ebola Epidemic

As is the case with all contagious epidemics, the 2014
outbreak of Ebola virus disease (EVD) began with a single person—Patient Zero.
According to a Sept. 19 study published in The
New England Journal of Medicine
, the patient was a two-year-old
boy living in the Guinean border town of Guéckédou.
Though Guéckédou hasn’t had a census since 1996 due to destabilizing civil wars
in neighboring Liberia and Sierra Leone, its population is estimated to exceed
200,000 and the city is known for a large weekly market that draws traders
from across the neighboring countryside.

It
is impossible to determine just how this Patient Zero initially contracted the exceptionally
fatal Zaire strain of EVD, which historically has a mortality rate of 75-90 percent,
but what happened after the child’s death on Dec. 6, 2013 is easier to
pinpoint. His sister, mother and grandmother all died from fever, vomiting and diarrhea—the classic symptoms of EVD—within a matter of weeks.

Attendees at his grandmother’s funeral brought the virus, which can be spread through
bodily fluids even after death, back to their villages and infected others:
healthcare workers, family members and mourners at their respective funerals. Add to
the equation Guéckédou’s popular weekly market, and
the seeds of an epidemic were planted months before African and Western
healthcare workers in the region even knew of the virus’s return.

Fast
forward 10 months to September 2014. The situation is grim. The current
outbreak has killed more people (2,811) than the total number of people infected
in every past outbreak combined (1,755), and the virus is spreading
exponentially with a doubling time of three weeks, meaning the number of
infected people doubles every 21 days. Geographically speaking, cases have been
reported in Senegal, the Democratic Republic of Congo and, most concerning, the Nigerian city of Lagos. The mega-city is the largest in Africa and outstrips the
metropolitan population of New York City by 2 million. Luckily, Nigeria hasn’t
reported a case since Sept. 5—good news given the 700 new cases reported since
then.

Things
don’t appear to be getting better overall. According to a Sept. 18 PLoS Currents Outbreaks paper, the virus
continues to spread faster and faster despite months of intervention from the
World Health Organization (WHO) and other public health leaders. Mathematical
models predict around 10,000 cases by the end of October and over 60,000 by the
turn of the year, but the worst-case scenario prediction comes from the Centers
for Disease Control (CDC): 500,000 cases by January.

Why has this instance of Ebola been so significantly
worse than previous outbreaks? There are numerous theories and explanations. One factor is chance—Patient Zero happened to crop up in a fairly populated border town that
receives heavy outside traffic. Another is location. West Africa has never been
affected by EVD, and its healthcare infrastructure is not established to
adequately respond, especially in countries with relatively minimal levels of
governmental control over the populace.

Related
to this issue is the cultural mistrust of Westernized health workers and local
governments in the largely rural and recently war-torn region of the outbreak. On
Sept. 18, a delegation of journalists, health workers and government officials
sent to increase EVD awareness was killed by a village mob in Guinea. A
Liberian facility responsible for quarantining suspected cases was similarly attacked
in August, and the locals released roughly 30 ill patients.

This
violence underscores how the increasing spread of Ebola and its rapidly rising
death toll threaten to critically destabilize the already tenuous political
regimes of the region. While Sierra Leone’s government successfully completed a
three-day lockdown to curb transmission, rumors circled that the initiative was
actually meant to help the government spread poisoned soap and food rations. Similar
rumors in Liberia fed the widespread belief that the outbreak was a government
scam. Will these political entities, some of which have withstood coup attempts
as recently as 2011, be able to maintain order after six, seven, eight months
of sustained epidemic?

Even
more insecure than the region’s governments are the healthcare networks, which
have been deeply strained by the outbreak. Hospitals that aren’t set up to
handle Ebola cases may become mini-epicenters through which the virus can
spread easily. On Sept. 20, for example, five Guinean doctors were infected
after performing a C-section on a woman with the disease. 

Compounding
this problem is the unwillingness of medically advanced world powers to
transfer infected foreign doctors to the West for treatment, as was the case
with two American healthcare workers who received treatment and survived at
Emory University. Sierra Leone has already lost two of their top physicians to
Ebola, a significant loss in a country with only 3 doctors per 100,000 people
(that ratio is around 250 per 100,000 in the United States). With malaria
season around the corner, the legacy of this outbreak may be the devastation of
a healthcare system that already has other enormously difficult tasks to deal with. 

Given
this confluence of alarming circumstances, it may seem the world is teetering on a dangerous precipice, between outbreak and pandemic, local
tragedy and near-global catastrophe. But the real story of the 2014 outbreak
isn’t the astronomically low chance of the virus somehow spreading to other regions of the world despite strict border closures in the affected countries. The
real story concerns the very palpable effects of an extremely deadly and
fast-moving virus in a highly unstable region of the world.

Despite
our media and country’s self-obsessed fear of catastrophe, one that’s
particularly fond of the famed Ebola virus, this outbreak never has been and
never will be about the West or an imminent global apocalypse. Rather, it is
about the courageous fight of an unstable and poverty-stricken corner of the
globe to control the worst recorded outbreak of one of the world’s deadliest and
most disturbing diseases. Let’s hope the battle turns their way soon. 

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