Last year, the world saw the largest recorded outbreak of the hemorrhagic fever Ebola unfold. As of the day of this post, 11,163 people have died as a result of the outbreak. West Africa had the most of the affected countries, although the United States, the United Kingdom, and Spain had cases of Ebola as well. Although the Ebola outbreak still lingers in West Africa, we continue to see a decrease in the number of overall cases. Enough time has passed since the height of the outbreak that we can take a look back at some lessons learned. Read on for my take from a public health perspective. When you mention the word Ebola in the United States, most often you will see people visibly cringe. Ebola is incredibly scary to most Americans. However, most Americans have never been around a person who has been to an Ebola-affected country, let alone an actual person affected by the virus. Ironically, public health officials struggle to give people flu vaccinations each year, yet the flu kills thousands annually. What is it about this rare but deadly virus that inspires such panic?
What Is Ebola?
Let’s start off by talking about what Ebola is in the first place.
Ebola is a virus (see a cute lil’ picture above). According to the CDC, there are five different types of the Ebola virus, four of which can cause disease in humans. We’ve known about Ebola since 1976, when it was discovered near the Ebola river in the Democratic Republic of Congo.
What Makes Ebola So Scary?
Ebola is not kind to the human body. In addition to fever, muscle pain, weakness, and fatigue, Ebola can also cause severe headaches, diarrhea, vomiting, and hemorrhaging. The average survival rate for an Ebola infection is 50 percent – a literal coin flip – but in some outbreaks it claims up to 90 percent of its victims (World Health Organization). A person can contract Ebola from an infected person, whether he is living or dead. There is no cure, but antibodies from survivors and an experimental antibody treatment grown in plants have been administered to infected people in emergency situations. Early supportive care can also increase the odds of survival. Ebola outbreaks have happened periodically, but none have been as large as the recent 2014 outbreak.
What Went Wrong?
There’s still a lot that scientists don’t know about Ebola. This particular outbreak probably started with a single infection from a wild animal, although scientists cannot pinpoint the origin. Regardless of the initial infection spread through peon-to-person contact. We know that Ebola outbreaks have happened in regions of Africa before. What made this outbreak so large as opposed to other outbreaks? How did we get from one single infection to thousands of infections? In previous Ebola outbreaks, the infections happened in small clusters and were more easily contained. In other words, if a person got sick, if they did infect other people, the infection didn’t spread as rapidly or as far as this outbreak. For some great reporting on the beginning days of the outbreak, read this NY Times story from last December and this fantastic recap by Amy Maxmen on the Pulitzer Center for Crisis Reporting. So what made this outbreak so deadly, especially compared to previous outbreaks? I’ve outlined a few of the reasons below.
Poor Public Health Infrastructure
The role of public health differs from country to country, but usually shares the same principle: Protect the public, prevent disease, and promote good health. In the United States, we have disease surveillance specialists and epidemiologists who work to identify data coming in from hospitals, the public, and other sources to keep the public safe. They can take this data and see if, for example, larger-than-normal numbers of people are going into hospital emergency rooms complaining of flu-like symptoms. In Guinea, a lot of sick people went to hospitals or other health care settings when they became sick. Without protective equipment, a lot of healthcare workers became sick as well. In countries that did not have a strong public health infrastructure, the health care system was overwhelmed early on in the outbreak. With no proper health care and very few health workers, it became almost impossible to stop the Ebola outbreak, let alone keep track of patients with Ebola, without outside help.
Lack of Funding and Protective Equipment
Many people in Western African countries suffer from extreme poverty. Looking at this epidemic from that context, it’s surprising that such a large outbreak hasn’t happened before. There is little money to build hospitals or care centers equipped to handle Ebola outbreaks. With little money for health care basics, it is not a surprise to learn that there is not enough money for personal protective equipment (PPE) to keep health care workers safe. So how much protective equipment does a person need to avoid Ebola? See the CDC recommendations about what to wear, how to wear it, the proper procedure for putting the equipment on, taking it off, and everything else in between. Even if you just glance at the CDC recommendations, you can tell it’s no joke. This process for putting on and taking off the PPE’s has many steps and requires help from other people. It’s easy to see that since some West African countries don’t have the personnel and money for using proper equipment, the virus spread much easier. Even in the U.S., at the Texas Presbyterian Hospital in Dallas, a patient with Ebola transmitted the virus to two healthcare workers. These healthcare workers were wearing PPE’s and were still infected. How were they infected? More on this a little later on in this post.
Lack of Knowledge About How Ebola Spreads
Let’s talk a little about how the Ebola virus spreads. According to the CDC, Ebola is spread through direct contact with a person who has the Ebola virus. The spreading of the virus, or transmission, can be through:
- Blood or other bodily fluids
- Objects (like needles and syringes)
- Infected animals
- Possibly from contact with semen from a man who has recovered from Ebola
Once a person contracts Ebola, the virus replicates over and over again, and more and more of the virus builds up in the body. This is referred to as a person’s viral load. If a person dies from Ebola, their body has a very high viral load. At this point, the virus is extremely contagious. Combine the highly contagious dead body with rituals people undertake when someone dies, and you can see why the virus spread so fast. From PBS NewsHour: “In Liberia when a loved one dies, the family washes the body and the mourners lay their hands on the departed. These are dearly held burial rituals, but they also contributed to the spread of the Ebola virus before health authorities brought an end to the practice.” We’ve talked about some of the reasons why Ebola spread easily in West Africa. Now let’s talk about…
Ebola in the United States
Thomas Eric Duncan – A Timeline
On September 20, 2014, Thomas Eric Duncan arrived in the United States from Liberia to visit family. When he left Liberia, he was showing no symptoms of Ebola. However, four days later, Mr. Duncan began feeling ill. Mr. Duncan went to Texas Presbyterian Hospital on September 26 with a fever. He told at least one member of the staff that he had been to Liberia, but he was sent home with antibiotics and Tylenol. Two days later, on September 28, Mr. Duncan returned to Texas Presbyterian with Ebola-consistent symptoms. This time, the hospital isolated him and sent samples to the CDC for testing. On September 30, 2014, Mr. Duncan became the first laboratory-confirmed case of Ebola to be diagnosed in the United States. He died on October 8.
That sane day, Texas Presbyterian nurse Nina Pham is diagnosed with Ebola. Pham had treated Mr. Duncan. Seven days later, on October 15, a second Texas Presbyterian nurse, Amber Vinson, was also diagnosed with Ebola.
How Did Ebola Spread in the US?
After many years of Ebola outbreaks in Africa, the day that American public health officials feared had arrived–we had active cases of Ebola in the United States. Our society is increasingly mobile, which can make it incredibly difficult to track and monitor diseases and disease carriers. There were many questions: How did the nurses contract Ebola? Were proper precautions taken? Thankfully, both nurses survived. However, there are still unanswered questions surrounding exactly how the nurses contracted Ebola. Eight months after the nurses were diagnosed, the public has received few answers. Nina Pham sued Texas Presbyterian Hospital earlier this year, accusing the hospital of failing to provide adequate protection and training. We continue to wait for more definitive answers.
This crisis has helped public health officials in the U.S. prepare for an Ebola outbreak should one happen here in the future.
Public Health Monitoring Works
Public health officials monitor a lot of information every day, as I mentioned earlier in this post. Even though the situation at the hospital in Dallas was far from perfect, the Ebola virus did not spread in the general public. Part of the reason the virus did not spread is because of our monitoring system, which links public health departments with state and local officials, including the CDC.
One Last Thing
On a personal note, I am frustrated by the response of some Americans to the Ebola outbreak. The vast majority of Americans didn’t pay much attention until Ebola hit the homeland. Perhaps that can be attributed to human nature and self-preservation, but it doesn’t excuse some of the behavior exhibited during the few months where active Ebola cases occurred here in the U.S. Some politicians wanted to ban travel to affected countries. Some politicians wanted to ban people traveling from the affected countries to the U.S. Some politicians even wanted to go so far as to ban travel to and from all of Africa. Some politicians clearly have no understanding of the geography of the continent of Africa and how big it is. It’s big. A lot bigger than the United States: Banning travel to ALL of Africa for an outbreak that’s just happening in one part of a giant continent makes as much sense as banning travel in America because of an outbreak in Brazil. We Americans have a lot of hubris, but sadly, our politicians’ hubris is only a facade that masks their ineptitude at understanding distance, disease, and human behavior. Finally, let’s remind ourselves of what’s we’re talking about here. Mothers, fathers, daughters, sons, aunts, uncles, grandmothers, grandfathers, spouses, friends. Every person who has died because of the Ebola crisis was loved by someone, and people are grieving their loss to this day and will continue grieving. I leave you with these images from John Moore with Getty Images to remind you of the true heartache people suffered and will continue to suffer until we devote the time, money, and resources to finding a cure for this horrendous disease.
If you want to learn more about the recent Ebola outbreak, I would highly recommend watching this excellent Frontline documentary. It gives a great overview of the first days of the outbreak and mistakes that were made that would go on to shape the outbreak for months.