Ebola: Facts, Fiction and the Future

 World Health Organisation Logo

‘Travel to and from Ebola-affected countries is low-risk‘  World Health Organisation

To any casual reader of the world’s headline news, the above statement runs contrary to almost everything they might know about Ebola Virus Disease (EVD or Ebola). After all, reports are that it’s 90% fatal, that the current four-month old outbreak’s spreading like wildfire, and that the affected countries are out of control. Even its author, the World Health Organisation (WHO), labels the outbreak as ‘unprecedented in size, severity and complexity’. No wonder we’re confused.

The facts: As WHO intimates, the current Ebola outbreak in West Africa is certainly the most serious to date. As of August 27th, it reports a death toll of 1,400 – that among 3000 known cases of infection. Over and above this, it estimates anything from another 3000 to 9,000 unreported cases of infection. The main countries affected are Guinea, Liberia and Sierra Leone, while significantly smaller outbreaks have occurred in Nigeria and Senegal*. As said, unprecedented. 

Thing is, Ebola is not new to central and west Africa. Outbreaks first appeared in 1976, in the Democratic Republic of Congo and in south Sudan, near Ebola River – hence its name. While there is thus far no licensed vaccine for the disease, the last forty-odd years have seen much work on the virus. We know, for example, that:

  • it is in fact one of three members of the Filoviridae (or filovirus) family and comprises of ‘5 distinct species’ of virus, four of which originate either in Central or West Africa, the other (non-lethal) occurring in the Philippines and parts of China
  • in the first instant, it is transmitted to humans ‘through close contact with the blood, secretions, organs and other bodily fluids of infected animals’, namely through the traditional or otherwise handling, slaughtering, preparation and cooking of so-called bush meat, of primates, fruit bats and species of antelope
  • once transmitted across species, human-to-human transmission of Ebola occurs either in the same way, via ‘direct contact through broken skin and mucous membranes’, and through sexually transmitted fluids; and also through ‘non-direct contact with environments contaminated with such fluids’
  • following an incubation period of between 2 and 21 days, symptoms of infection variously include flu-like characteristics, vomiting, diarrhoea, kidney and liver impairment and external bleeding
  • contrary to previous findings, death is not in the case of the present outbreak a 90% certainty; 47% of infected people have recovered   

Given this knowledge, the recent positive results with the currently unlicensed and therefore experimental drug ZMapp, and everything we know about the types of preventative measures that can be taken to minimise infection and transmission, Ebola is not today’s equivalent of a 15th century bubonic plague. It’s containable. The variant affecting West Africa today isn't nearly as lethal as previously supposed. In all, the number of recorded Ebola related deaths since 1976 runs so far to just fewer than 3000. While obviously terrible, Ebola is statistically speaking nothing against the effects of other seemingly less newsworthy diseases. In 2012 alone an estimated 600,000 sub-Saharan Africans died of malaria. In 2013 the same region lost 1.1 million to AIDS.  

So why should the WHO describe the current outbreak as ‘posing serious global health security challenges and risks’?  The answer, of course, isn’t Ebola per se. Rather it is, as the WHO acknowledges, a disaster compounded by bad luck, poor judgment, a lack of international co-ordination vis-a-vis policy, and a wholly inadequate on-the-ground medical response and treatment infrastructure:  Contrary to previous cases, all confined to rural populations, the present outbreak has occurred in the city. Affected communities have responded – in much greater numbers – in a series of contrary and disabling ways, some remaining deeply suspicious of government initiated responses, many underestimating the efficacies of preventative advice, others believing first-responders vectors for the virus. There is a widespread perception that hospitals and other medical centres are where the infected go to die. Many seek alternative therapies. The majority convalesce in the care of their families. 

Little wonder, then, that the WHO should describe the situation as being debilitated by ‘severely compromised health systems, significant deficits in capacity and rampant fear’ - and freely admit to making internationally co-ordinated contingency plans for up to a possible 20,000 cases, stating that its strategy is aimed at stopping ’Ebola transmission in affected countries within 6-9 months and prevent international spread’.  

However, and to return to the beginning, it also rightly continues to categorise Ebola affected countries as low-risk. The present outbreak may be unprecedented, but we know why. Contrary to the impression given by column inches devoted to Ebola, it is, statistically speaking, a comparatively unsuccessful virus. The affected countries are not so dangerous, says the WHO, as to suggest closing down borders. In fact, if anything, shutting out the world and cutting off trade links and stopping supply lines would greatly increase risk, suggest the WHO, as the effect on affected countries’ economies would result in greater unrest, much more movement and increased pressure on the borders of neighbouring countries.    

Given the unprecedented nature of the current outbreak, it’s easy to see why Ebola should be deemed newsworthy. Even the wonderful charity Medicines Sans Frontiers describes it as ‘one of the world’s most deadliest diseases’.  It could well be, but not now, and not if we get things right. Meanwhile, the sensationalist quality of the way such comments are interpreted does Africa a grave disservice. Three countries - Guinea, Liberia and Sierra Leone - in a continent large enough to comfortably fit China, the US and Europe (with room to spare) do not, by any stroke of the imagination, constitute the whole of Africa. Nairobi, first port of call for many of our East African safari clients is 3558 miles from Conakry, Guinea.  London’s closer. So is Rio de Janeiro. And Newfoundland.  

*The case of a concurrent outbreak in the Democratic Republic of Congo has been analysed as unrelated to those affecting Guinea, Sierra Leone, Nigeria and Senegal.

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