Ebola threat ’no less than terrifying’

Fear, panic and denial are the lethal hallmarks of the response to the worst Ebola outbreak in decades. Without global action,its deadly march could even reach Europe, writes Michael Clifford.

IN THE developed world, the spread of a fatal contagious disease is the stuff of Hollywood and history. There have been occasions when a virus has engendered panic in wide swathes of the population. The urban legends that grew up around HIV in the 1980s, and into the following decade, are legion. Some were even true.

Infection came through contact with bodily fluid, including blood and saliva. Casual sex was the first casualty, but in the early years in particular, everybody from health workers to football players reached for the panic button at the mere sight of blood. Those years have passed.

The other major pandemic threat in the developed world in recent years was avian flu. Twice in the last decade, it threatened to spread from the jungles of Asia into major cities and across borders. Photos went around the world of besuited workers in cities like Hong Kong wearing masks to protect themselves from any airborne threat. Again, however, modern science and medicine were up to the task of containing the spread, and ultimately eliminating the threat.

Since the beginning of this year, a new plague has begun to reach across borders, but it has received little media coverage until recent days. The little West African country of Guinea is the epicentre of an outbreak of the Ebola virus, a deadly disease for which there is no known cure.

Since it was first confirmed in February, it has now brought death to its near neighbours Liberia and Sierra Leone and has spread into 10 neighbouring countries. At the time of writing, more than 480 deaths have been recorded, a much higher rate of fatalities than in any of the other periodic outbreaks that have occurred since the disease was first discovered in 1976.

Aid agencies such as the French organisation Médecins Sans Frontières (MSF) suggest that the world quickly needs to wake up to what is unfolding. According to Bart Janssens, the director of operations for MSF, drastic action is required.

“The reality is clear that the epidemic is now in a second wave,” he said. “And for me, it is totally out of control.

“There needs to be a real political commitment that this is a very big emergency,” he said. “Otherwise, it will continue to spread, and for sure, it will spread to more countries.”

This is the first serious outbreak in western Africa, the most underdeveloped region of the continent, and in recent weeks, the virus has spread into major cities, including the Liberian capital, Monrovia, which will make containment infinitely more difficult to achieve. On top of that, the prevailing culture and tradition in some of the affected communities means that the response at official level has been as much about playing down the threat rather than educating and responding.

An outbreak of this size anywhere would be a cause for international action. In a region which hosts some of the poorest countries in the world, porous borders and a totally inadequate health system, the threat is no less than terrifying.

Ebola kills over 90% of those who contract it, usually within weeks of infection.

The virus was first discovered in 1976 in what was then Zaire. (the name is taken from the Ebola river in the region where the first outbreak was recorded). It originates in fruit bats, who can apparently pass on the virus to its fellow species without any consequences. However, once passed to humans, the symptoms begin to appear between two days and three weeks after infection. Contraction by humans is believed to occur through contact, such as eating a bat, or from hunters coming into contact with the animals, even after they have been killed.

The symptoms include fever, throat and muscle pains and headaches. These are followed by nausea, vomiting and diarrhoea, all leading to reduced functioning of liver and kidneys. Somewhere along the line, bleeding sets in, and death, which occurs within weeks, is often attributable directly into internal bleeding. It is a horrible death.

There is no known cure for the disease. Infection occurs through the transmission of bodily fluids, although the contact need only be as innocuous as with the perspiration of an infected person. Such a manner of transmission means that the disease is not highly contagious in the normal sense, but without serious public awareness and education, infection does spread rapidly.

In West Africa, trade and movement across borders is extremely lax. The Sierra Leonean aid organisation Health for All Coalition told the AFP news agency that there was little prospect ever of ensuring that the spread was stopped at its border.

The stigma attaching to the disease is a major challenge for those tackling the crisis. Among large swathes of the population, there is often a reluctance to co-operate. Some who become infected simply run away, bringing infection with them. Then there is the problem of funerals.

Large gatherings are always a danger for infection, but at funerals the cleaning and preparation of bodies for burials can lead to further infection of up to a dozen more people.

All of this has contributed to making the current crisis worse than anything that has gone before. Previous outbreaks in recent years in the Democratic Republic of Congo, and Uganda, were contained.

Typically, when there is an outbreak of Ebola, a medical team has gone into the infected area and identified the cases, and those who might have come in contact with the infected people. Isolation ensures that the outbreak can be contained, and then the spread peters out relatively quickly.

In the current outbreak, the virus has already spread from rural to urban centres and the manpower required to track all the cases simply isn’t available.

Instead, there has been confusion and panic, and some lamentable conduct by leaders in the region.

In one incident, an angry mob attacked a health clinic on the basis that the health workers were actually bringing the disease into the locality. The mob arrived and berated the health workers, members of Médecins Sans Frontières. Younger people among the mob threw rocks at the health workers. The message was clear — get out of town and bring your deadly disease with you. MSF did just that. Under threat of such violence, there was no option but to withdraw their support.

“We understand very well that people are afraid because it is a new disease here,” a spokesman for MSF said. “But these are not favourable working conditions, so we are suspending our activities.”

That was back in April, when the disease was but a light stain across the southern region of Guinea. By then, in the town in question, Macenta, 14 people had died locally from the plague. But in the nature of these matters, rumour and superstition, rather than an urgent response, drove the reaction. To die of a mysterious disease was to bring shame on a family, so instead, best to find other reasons why people were dropping dead at an alarming rate.

One local resident in the town accused the doctors of isolating healthy patients. “As soon as someone is brought here, they don’t try to figure out whether he is sick or not, they just transfer him directly to the sick ward. So it’s them who are killing the people who are in good health,” the man told an international news agency.

In a rural outpost in the developing world, it’s perfectly natural that fear finds crazy expression. What is not acceptable, however, was the response of the national government. Still in April, the president of Guinea, Alpha Condé, visited the HQ of the World Health Organisation (WHO) in Geneva and declared that the outbreak was contained. “For the moment, the situation is well in hand,” he said. “And we touch wood that there won’t be any new cases.”

A few days after that meeting, he hosted a congress for the leaders of neighbouring countries in the capital of Conakry, and thanked them for coming “despite all this noise about Ebola”.

Three months down the line from such wanton recklessness, the Ebola plague has spread right across West Africa. Fears that it could make its way to Europe were raised in April when one plane from Guinea to Paris was briefly quarantined on arrival in the French capital.

Recent weeks have seen a major acceleration in the outbreak. As of June 23, the World Health Organisation (WHO) had recorded 339 deaths, but this jumped to 467 by last Monday. This was in line with a 20% jump over the same period in the number of cases detected.

Finally, however, national governments appear to be taking the matter seriously. Liberian president Ellen Johnson Sirleaf said in a statement that the crisis had now become a national public health emergency. The government has become particularly concerned at reports that some families, faith healers and traditional doctors were reported to be removing patients from hospitals for special prayers and traditional medicine.

These issues have been emphasised as crucial by the WHO, which stated last week that there were three major factors contributing to the deteriorating situation.

“These factors include transmission in rural communities, facilitated by strong cultural practices and traditional beliefs; transmission in densely-populated peri-urban areas of Conakry in Guinea and Monrovia in Liberia; and cross-border transmission of the disease along the border areas of Guinea, Liberia and Sierra Leone, where commercial and social activities continue among the border areas of these countries,” according to the WHO statement.

Where to from here? Despite the elevation of the outbreak to emergency status, old habits die hard in some parts. Just last week, a Red Cross van was surrounded by angry locals, again in southern Liberia. The mob wielded knives and threatened health workers, and the aid agency has been forced to pull back its operations in the region.

A two-day summit convened in Ghana last week made appeals for the international community to wake up to the enveloping crisis.

“Abubakaar Fofanah, the deputy health minister of Sierra Leone, said cash was needed to pay for drugs, basic protective gear and to pay staff, which has been deployed to tackle the outbreak. The deputy health minister for Liberia Bernice Dahn articulated the biggest fear of her and her colleagues in neighbouring countries.

“In Liberia, our biggest challenge is denial, fear and panic. Our people are very much afraid of this disease. People are afraid but do not believe that the disease exists, and because of that, people get sick and the community members hide them and bury them, against all the norms we have put in place.”

For now, the prospects of containment remain weak, but only a major input from the international community will be able to stop a further spread of what is turning out to be the most serious outbreak of this deadly disease in nearly 40 years.

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