Ebola has reached America. This does sound extremely disconcerting but it’s important to look at the bigger issues surrounding the incident and get to the facts.
Although the case in the USA has been in the news recently it is important not to overlook the real issue, the outbreak in West Africa. It has been covered in the news extensively yet it seems that the response has been totally inadequate from the UN, and is almost being overshadowed by the case in America. This would be best addressed by first looking at what Ebola is, what causes it and the horrific effects it can have on those unlucky enough to contract it.
Ebola’s proper name is Ebola Virus Disease (EVD), Ebola Haemorrhagic Fever (EHF) or more often than not, just Ebola. It is a viral disease that affects humans and other primates and can be caused by four viruses, all classified under the genus (part of the naming classification of organisms) Ebolavirus.
The virus can be transmitted via blood or bodily fluids, therefore the disposal of dead bodies and the quarantine of the infected must be carried out with utmost care to ensure no further infection. Unfortunately, the lesser developed health systems of some African countries struggle to contain the spread of infection. Also, consuming bush meat such as bats, gorillas and chimpanzees increases the likelihood of transmission to people.
Ebola was origanally discovered in 1976, when the first identified case hit the small rural village of Yambuku in the northern Democratic Republic of Congo. The victim was village school master Mabalo Lokela, who had toured the area for ten days before being diagnosed with the new disease on 26th August 1976. He died almost 2 weeks later. Since then there have been multiple outbreaks in the other countries of Sub-Saharan Africa including Sudan, Gabon, Uganda and further outbreaks in the Congo.
The signs and symptoms of Ebola can first appear flu-like, with fatigue, headaches, joint, muscle and abdominal pain. In addition to that some sufferers also experience vomiting, diarrhoea and loss of appetite. Less common symptoms include hiccups, a sore throat, chest pain, shortness of breath and trouble swallowing. In about 50% of cases a skin rash is also present. These early symptoms can often appear to be like other tropical fevers such as malaria and dengue fever, but the worst is yet to come.
About a week after the appearance of the initial symptoms, the victim will begin to experience bleeding and a reduced blood clotting ability; this includes reddened eyes, alongside internal and mucous membrane bleeding, such as bleeding in the nose, gums, and genitalia. If that wasn’t bad enough, some sufferers vomit blood and also have blood in their stool. The heaviest bleeding is generally confined to the intestines and often indicates that death is on the doorstep. If there is no improvement within 7 to 16 days, the sufferer will most likely die from multiple organ failure.
Ebola, along with other viruses like the flu are spread virally, making them notoriously difficult to prevent and cure. Methods of prevention of spreading can be washing and sterilising surfaces, regular hand washing and avoiding contact with the infected. Any researchers or doctors working with the virus must wear sealed pressure suits to avoid infection. Quarantines are usually enforced around areas where infection is high. Any treatment administered is purely supportive, this includes management of pain and anxiety, and replacement of lost fluids.
Reassuringly, we shouldn’t be worried about an epidemic developing in America. The sole sufferer of Ebola in America was Thomas Eric Duncan, a Liberian national who travelled from Monrovia, Liberia on 19th September to Dallas, Texas. Prior to travelling to the USA, Mr. Duncan helped to transport his friend’s daughter, Marthalene Williams, to hospital as she was suffering from Ebola. Unfortunately they were turned away as the hospital was full, indicitave of how resources in Africa are being stretched to the limit. Tragically, along with almost 3500 other sufferers, Marthalene Williams died shortly afterwards.
Departing Liberia, Duncan covered up his exposure to Ebola. He arrived in Dallas on the 20th of September and stayed with his partner and five children. He began experiencing symptoms on 24th September and travelled to Texas Health Presbyterian Hospital later the next day. He was reported to have a fever, headache, abdominal pain and was urinating infrequently. When asked by a nurse, he confirmed he had travelled from Liberia but had not been around anyone who was sick. The hospital issued multiple statements detailing whether Duncan’s condition was relayed to the doctor, however this held no bearing once Duncan had begun treatment.
Due to the lack of information, he was diagnosed with a ‘low-grade viral disease’ and was sent home with antibiotics. On 28th September he began vomiting and was returned to hospital by ambulance; the Ebola diagnosis was confirmed by the Centre for Disease Control and prevention (CDC) on 30th September. The hospital is monitoring between 80 and 100 people who had contact with Duncan. Thomas Eric Duncan sadly passed away on Wednesday morning (8th October).
As of 3rd October, there have been around 8000 reported cases and roughly 3500 deaths due to Ebola in West Africa, and these numbers are only rising. Over 120 of those deaths were medical staff, making it difficult for the World Health Organisation to send sufficient numbers to the worst-affected areas. Over 1200 additional treatment beds are needed and experimental treatments are undergoing trials soon.
A new experimental drug exists for the treatment of Ebola, named ZMapp. The serum is one of up to 10 medications and three vaccines in development for Ebola but no cure or treatment has yet been confirmed. ZMapp was previously used on survivors in the US and Liberia, but supplies have run dry and manufacturers have admitted it will take months to replenish the supply. A Norwegian woman infected with Ebola in Sierra Leone is to be given the last remaining dose of ZMapp in the world.
It all seems too little, too late. Hospitals in the UK are on the lookout for possible cases, whilst airports and Eurostar terminals have introduced Ebola screening to restrict the spread of the virus, but undoubtedly more needs to be done. Some healthcare professionals are hopeful that the spread of Ebola to the US will kickstart a strong effort to isolate the virus, but we can only hope. And sterilise.
Sam McMaster
Feature image: ©EC/ECHO/Cyprien Fabre