Updated: May 15
You have very likely heard about the Ebola outbreak a few years back as a disease which caused ‘blood to ooze out from different parts of the body’ and ‘skin to open into hollow blisters’. But not many people were aware of more than that and eventually it didn’t gain much of the media attention as it was born and died out in the poor countries of Africa itself. After the sudden outbreak of Ebola in early 2014, doctors and researchers around the world were asking themselves 'why did the virus which was not bothersome since its origin had suddenly turned out to be a great threat to the lives of the inhabitants of Central Africa?'. The devastating casualties that it yielded gave rise to numerous controversies and fingers were pointed at the authorities of different fields. It also helped us to question our vulnerabilities to the various germs that we considered to have been removed from our threat matrix long ago. In this article, I am going to discuss Ebola, its origin in 1976, the socio-political reasons for the cause of the 2014s outbreak, it’s devastating ending, and the controversies that followed. The various scientific aspects of the disease and its epidemiology will be discussed in the following article of this 2-part article coverage of Ebola.
How it started in 2014
In December 2013, an 18-month-old boy in Guinea was rushed to a local hospital after he showed symptoms of fever, nausea and abdominal pain. The following day, he started having bloody diarrhea and vomit, throwing blood out. Several days later, he died a painful death.
Soon after his admission, his family members also started showing symptoms and all of them died as well. After registering five more fatal cases of diarrhea reported in the area, the official medical alert was issued in January 2014, to the health officials. This soon spread a wave of worry among the health department people and the Ministry of Health issued an alert for an unidentified illness. Little did they know at that time, the disease which caused these few gruesome deaths could be drawn back to the 1970s and the sporadic endemics that occurred during the late 20th Century. Moreover, the premonitions of a few health authorities and citizens didn’t even cross the actual data that was waiting for them in the coming months. In March 2014, with 49 confirmed cases and 29 deaths, the WHO officially declared an outbreak of EVD. This outbreak would eventually turn out to be the most unpredictable and deadliest among the previous EVD outbreaks and would go on to bring out the severe negligence practiced by the health departments and organizations and also our own shortcomings.
Origin - 1976
The first discovery of the Ebola virus dates back to 1976 in Sudan. The index case was a young male who worked in a cotton factory in a city near the Zaire/Sudan border. He was admitted to a local hospital when he showed up with high fever, headache and chest pain. The next day he started having bloody nose and bloody diarrhea. He, unfortunately, died a week later after he got admitted to the hospital.
Few of his colleagues became ill several weeks later and this lead to an outbreak. In total, there were 284 cases of Ebola in 1976 and 151 deaths in the outbreak that lasted less than 11 weeks. The Case-Fatality Rate was 88%. The caregivers and medical personals were among the most affected in the outbreak as they had more exposure with respect to other people and they didn’t have any protective gear at that time. The source of the spread of the virus couldn’t be determined but it was suspected that it had been spread by an animal that was living in the factory itself. An outbreak also appeared simultaneously in Zaire, now COD, in the same year which caused 280 fatalities out of 318 infected. But, interestingly, the Zaire outbreak was caused by a different virus from that of Sudan. It was a completely separate outbreak which caused more fatality than in Sudan. The high fatality rate was due to poor health facilities, illiteracy, and lack of proper technology. Surprisingly, the 2014 epidemic caused the highest cases ever registered in EVD history of outbreaks.
The Cause and the Effect
Ebola lives very mysteriously in the deep equatorial forests of Central Africa. The animal reservoirs of the virus still haven’t been identified but it is suspected it lives in fruit bats. With proper medical care and caution, the disease can now be easily cured and prevented even though there is no definitive treatment for the disease. Ebola virus is a filovirus and currently, the Ebola virus disease is caused by EBOV out of the other seven strains.
Scientists point out many factors as the leading cause of the epidemic in 2014-15. The practice of funeral and burial rituals performed in African villages involved very extensive contact with the infected dead bodies. This led to being a major cause for the increase in the number of cases as the crowded slums of Monrovia, Freetown and Conakry acted as an excellent transmitter of the disease. The medical inadequacies in the slums were the reason they couldn’t isolate the infected patients from the others effectively and the hygiene couldn’t be maintained and the infected wastes couldn’t be cleaned properly due to lack of equipment. The medical staffs were also not well prepared and trained for such kind of situations. Moreover, the people refused to go to the hospital after they started showing related symptoms and their relatives encouraged them by hiding them from professional supervision. The fear of being isolated and being abandoned prevailed among the villagers and ironically, many of the infected died alone in their home. The unprotected medical supervisors and nurses increased the problem drastically as they began to die and the caregivers started decreasing in numbers.
In July 2014, Washington Post op-ed, Dr. Michael T. Osterholm said, “Ebola virus didn’t change. Africa changed.” He further explained in his book, The Deadliest Enemy, that deforestation in Guinea from large scale forest mining and timber operations was highly responsible for the transportation of the Ebola virus from deep forests to near the human civilizations. Further, he pointed out that due to industrialization of the African villages, people now travel farther than they did in the earlier years and this made the virus ‘hyper revolutionary’. The amalgamation of rapid heterogeneous or uneven urbanization and technological advancement in few sectors while still holding on to unscientific beliefs and superstitions were very helpful for the virus to spread densely and swiftly.
The common symptoms that the infected show is fever, chills, a severe headache, joint and muscle pain and fatigue. The incubation period stands between 5-10 days after exposure. Later, the patient showed more severe indications and uneasiness like bloody vomiting and diarrhea, rashes and blisters with bruising and bleeding. The most severe cases show internal bleeding, organ failure and low blood pressure leading to circulatory failure and high fluid loss.
It is inevitable for controversies to rise during the time of a crisis. The Ebola controversies range from alleged personal benefits to promoting political agendas, from irresponsible communities in-charge to playing the “blaming game”.
1. Many academics and journalists like Alexander Kentikelenis wrote in The Lancelet, that policies are partly responsible for “underfunded, insufficiently staffed, and poorly prepared health systems” in the countries that were severely affected by EVD. The cuts in budgets of health care and fewer staff appointments were also responsible for the rapid outbreak.
2. Many believed that the political authorities of the non-affected developed countries used Ebola as a “symbol of their own fight”, using it to propagate their own political agendas.
3. ‘MSF had been warning WHO Regional offices since March 2014, only in August 2014 did the WHO declared the outbreak an international emergency’. The heads of the WHO country offices in Africa are “politically motivated appointments” made by the WHO regional director for Africa, Dr. Luis Sambo, who has had made very bad coordination with an office in Geneva, thus lacking cooperation. Moreover, WHO straightforwardly denied taking the lead role to bring Ebola under control and some individuals also kept arguing that Malaria should be given more priority than Ebola and the funds should not be diverted towards fighting it.
4. The controversies regarding the travel bans and quarantine have revealed many shortcomings in policies and inferred violations of privacy and freedom of individuals under concern. The medical staff, who volunteered from the non-affected countries were quarantined and isolated without consent and were under rigorous supervisions of medical care. They were banned from traveling to the groceries and to carry out their daily errands. They were restricted from meeting people for the fear that they might transmit the virus to others, even though it has been observed that people didn’t start the transmission process unless they started showing the symptoms, which are very hard to be neglected. The implementation of the travel bans and quarantine demotivated the volunteers who were willing to risk their lives for the people in need, to travel to the affected places. Moreover, the governments were very poor in convening the importance of such regulations and people took them very negatively.
The Final note
The 2013–2016 Western African EVD outbreak has helped us to learn important lessons and has exposed us more to the mechanisms of the disease and our shortcomings in handling the needs in a crisis.
The outbreak has caused immense evolution and effective implementation of care but it has also left us with the sad fact that the system of supportive clinical care and preventive measures is severely uncoordinated. The several controversies that occurred during the crisis exposed the conflict of interest among media, doctors and politicians. But it has been a huge learning ground for all of the fields and the in-charges have felt the price of misrepresentations, negligence, and self-centered motives. Though Ebola is still lurking around the corners of Africa and has the potential to pose a huge threat to humankind, the authorities are hopefully preparing to prevent and curb a future crisis.
Read part 2.....here
For further readings:
Book: The Deadliest enemy by Dr.Michael Osterholm and Mark Olshaker