Ebola: can we contain this killer disease?
In western countries Ebola is confined to thrillers and horror movies, but the biggest outbreak of the disease has health workers worried that the virus will get out of control
Airlift: western health workers have been flown home for treatment. Photograph: Ignacio Gil/ABC/Reuters
Threat: in Sierra Leone and other African countries, victims are being buried. Photograph: Tarik Jasarevic/WHO/Reuters
Experimental: ZMapp, a possible treatment for Ebola, is made with specially grown tobacco leaves. Photograph: Kentucky Bioprocessing/EPA
It starts with flu-like symptoms, progresses to nausea and vomiting and, in fatal cases, ends in confusion and unstoppable bleeding, internally and externally.
Ebola-virus disease has held the public imagination – and not in a good way – since it was first identified, in the mid 1970s, probably because of its gruesome symptoms and high death rate. Since then it has inspired bestselling books about future plagues, as well as Hollywood movies about killer microbes.
This summer the virus is back with a vengeance, with the biggest outbreak yet spanning four west African countries. The World Health Organisation (WHO), which has so far counted 1,711 cases and 932 deaths, says the current epidemic is beyond the national capacity of any affected country to control on its own.
For the first time the disease has come to Europe and the US, as infected aid workers and missionaries are airlifted out of Africa so they can receive the kind of treatment not available to sufferers back on the ground in impoverished Liberia, Sierra Leone and Guinea. Several leading airlines have stopped flights to the region in an effort to contain the spread of the virus.
“The fear is palpable. People are terrified of each other,” says Sr Anne Kelly, one of a number of Irish Missionary Sisters of the Holy Rosary working on literacy and land projects in the heart of the Ebola-affected area in rural Liberia. “If someone is suspected of having the disease they can be left high and dry by the side of the road.”
Kelly says Ebola first struck in her area more than three months ago; it was quickly – and briefly – contained. “It took a long time for anyone to believe this was real. At first people were saying their water was being poisoned, when what was actually happening was the spraying of chlorine and water for infection control.” Relief was short-lived, as the virus came back in a second wave. “It’s much more out of control and scattered around the place, even across the border with Sierra Leone.”
Borders in this part of west Africa are porous, she points out, with much intermarriage across frontiers. Efforts to contain the virus are hampered in some quarters by distrust of western medicine and an adherence to unsafe burial practices.
The scale of the outbreak, the first in the region, forced the closure of many hospitals and caused overcrowding in the treatment centres that remained open. The deaths of so many nurses and doctors has further exacerbated the situation. With the borders closed, the fragile local economy has gone into a slump.
Infecting citiesThe present epidemic is noteworthy not just for its scale. For the first time, Ebola, which until now was largely confined to the rainforests, has reached the cities. That’s a terrifying prospect, although as Prof Sam McConkey, head of the department of international health and tropical medicine at the Royal College of Surgeons in Ireland, points out, four cases out of a total population of 150 million in urbanised Nigeria is a tiny figure.
But with the world more mobile than it ever has been, the fact that some victims travelled on airlines before being properly diagnosed has spooked health experts and caused western countries to fret about their potential exposure to the disease.
The number of health workers killed in the present epidemic is also striking: doctors and nurses account for about 10 per cent of victims. If the professionals can’t protect themselves, what chance have ordinary people, some might be led to think. But this figure is most of all an indication of the paucity of facilities and basic equipment in the health services of west African countries.