Early symptoms of Ebola infection may include sudden fever, muscular aches, weakness, and sore throat. This then leads to vomiting, bleeding, and central nervous system damage. The mortality rate of the current outbreak is about 55%, though it can reach 90%.
The incubation period is between 2 and 21 days, and it is not considered contagious until symptoms appear. Presently, supportive care with rehydration is a major treatment.
There is no vaccine or known cure at the present time. An experimental drug, ZMapp, was used on at least five foreign aid workers, three of whom survived. The very limited supplies of this drug are now exhausted.
In August, the WHO approved the use of experimental drugs for patients in light of the severity of the current situation. Further production of new drugs for treatment or a vaccine are in the very early stages of development.
Early History of the Ebola Virus
Ebola was first reported in 1976 in Zaire (now the Democratic Republic of the Congo). Belgian scientist Peter Piot helped to identify this previously unknown disease and it was named after the Ebola River in the region. This initial outbreak killed about 300 people.
Subsequent Outbreaks of this disease since 1976 were in the Congo River Basin and East Africa, including Sudan, Uganda, and Gabon. There were no reported cases from 1979-1994. The outbreak in 2014 in countries of West Africa where it had not been previously noted is by far the largest outbreak in history.
Origins of the Ebola Outbreak of 2014 in West Africa
The death of a two year old girl in December, 2013 in a remote region of southeastern Guinea was the first reported case of the current out break. It was not recognized until it began to spread through southeastern Guinea. In March 2014, regional hospitals reported this outbreak of fever, vomiting and diarrhea that killed 59 out of 86 reported cases. Representatives of Doctors Without Borders, better known by its French name, Medicins Sans Frontieres (MSF) reported this to Guinea’s Health Ministry and the the World Health Organization (WHO). The WHO later confirmed this as Ebola.
From Gueckedou, a regional trading center, the disease spread into Liberia and subsequently Sierra Leone. By June 2014, MSF declared the spread of the virus as out of control.
Liberia and Sierra Leone are both very poor countries devastated by recent civil wars. There is very limited health care infrastructure. Liberia has one doctor per 100,000 population and Sierra Leone has one doctor per 50,000 population. While Guinea’s health care system is marginally better, all three countries have limited access to personal protective equipment (gowns, masks, gloves) and medicines, and few hospital beds available for treatment. This makes the disease very difficult to control, and puts health care workers at high risk for infection.
Nigeria reported its first case in July 2014. This led to the WHO providing 50 experts to help prevent its spread, and this aid was instrumental in limiting the effects in Africa’s largest populated country to eight deaths. Ebola is currently considered controlled in Nigeria. Senegal had its first case in late August, but it is now considered under control there with no current cases.
Cultural Implications and Myths that Affect Treatment of Ebola
Every outbreak of Ebola since 1976 included resistance to outsiders, with overt hostility and violence to foreign health care professionals. Numerous myths about the illness exist that health care workers are trying to dispel.
Myth: You cannot catch Ebola from a dead body
Fact: Touching bodily fluids of blood, urine, or sweat of a dead person puts one at high risk for contacting the disease. Limiting contact to bodies except to those trained to using personal protective equipment (PPE), such as gloves, gowns, and masks. This is very difficult in a cultural context of ritualistic burial rites and limited PPE resources.
Myth: Eating onions or drinking condensed milk or salt water will prevent the virus.
Fact: There is no truth to this. Drinking salt water in a hot tropical climate can actually be dangerous.
Myth: Foreign health care workers actually brought the disease.
Fact: The most likely source of the initial infection was from eating infected bush meat (chimpanzees, antelope, porcupine, or, most likely, fruit bats). It is strongly advised to avoid bush meat, but this is a cultural tradition that is hard to stop.
Myth: You cannot contract the disease from sexual contact.
Fact: The virus can survive in semen for up to seven weeks after the person has had the disease.
Myth: There is a need for effective hand sanitizers.
Fact: A most effective means of preventing the spread is simple hand washing with soap and water. However, in regions with chronic underdevelopment of sanitation and potable water, this is often difficult.
The current outbreak of Ebola includes over 7,400 cases with 3,439 fatalities as of September 30, 2014.
Liberia 2069 deaths
Guinea 739 deaths
Sierra Leone 623 deaths
Nigeria 8 deaths
The World Health Organzation (WHO) estimates 20,000 cases by November.
Health care workers are especially at risk for contracting the disease. Dozens of doctors and nurses have died in the region, including Ebola expert Sheik Umar Khan, the only virologist in Sierra Leone.
American aid workers Kent Brantly and Nancy Writebol were flown to Atlanta for treatment during the summer, and a family doctor from Massachusetts, Rick Sacra, recovered from the disease in a Nebraska hospital. These three colleagues had worked at the same hospital in Liberia with limited resources to protect workers, according to Ms. Writebol.
The first known case to be confirmed outside the region was on September 30. A Liberian national, Thomas Eric Duncan tested positive in Dallas Texas. He was exposed to an infected woman on September 15 in Monrovia. He had been screened prior to his flight from Liberia to Washington D.C., and arrived in Dallas to visit relatives on September 20.
On September 25, he sought treatment at Texas Health Presbyterian Hospital for a fever and abdominal. Despite telling workers he had come from Liberia, this vital piece of information was apparently not properly passed on, and he was sent home with an antibiotic and pain relievers. On September 28, he was taken back to hospital by ambulance after a friend contacted the Center for Disease Control in Atlanta.
There were four days between Mr. Duncan’s development of symptoms and placement in isolation. About 100 people who he came in contact with during that time are under observation for 21 days.
The Future impact
Most experts believe this illness, except for perhaps a few isolated cases, will not cause a serious threat to those in Europe or the U.S. due to much higher standards in health care and the ability to quickly isolate cases. For Guinea, Liberia, and Sierra Leone, and other regional countries in Africa, the outlook is far less promising.
Due to cultural differences already mentioned, combined with large-scale regional poverty and inadequate resources, controlling this outbreak will be extremely difficult. Restricting air travel from affected countries is highly controversial, limiting the ability to bring in foreign health care workers, medical supplies, and food. The economic impact is already devastating, and likely to get much worse. Food shortages are quite likely in coming months. Limited health care resources have been overwhelmed. This has already had an impact on treatment of endemic malaria, tuberculosis, and measles, affecting tens of thousands annually, even more difficult.
U.N. Secretary General Ban Ki-Moon, President Obama, and others have called for a much greater response on the part of Western countries. This epidemic will likely become much worse before it improves, with speculation that it could affect 100,000 or more during the coming year. A massive world-wide response is necessary to provide adequate medical supplies and trained health care workers to control this disease in countries affected and limit its spread to neighboring poor countries with limited health care resources.
The Ebola virus shows no sign of abating anytime soon. This will continue to be a major health story with international implications well into 2015, if not beyond. There have been calls from many quarters for a much greater response on an international scale. While in mid October 2014 there were about 8000 cases reported in the three West African countries with the greatest impact, The World Health Organization predicts about 20,000 cases by November. If the current rate of infection is not quickly brought under control, some believe that there could be 1.4 million cases by January 2015.
Current rates of infection are spreading at a rate of one to two persons infected from each new case, and the rate of this spread is rising exponentially. The initial response internationally has been slower than the spread of the disease. In economies with inadequate health care resources, over 230 front-line health care workers have died.
Many believe that this is the worst epidemic on and if current trends continue could perhaps exceed the impact of AIDS / HIV spreading in the 1980s and 1990s. There is a great need for rapid response from the international community. The European Union, the United Kingdom, and the United States are finally all stepping up with deployment of military personnel and health care workers. The WHO is setting up a regional center in Accra, Ghana to help fight this crisis.