Dr. Clif CleavelandEbola virus disease presents the world with its most serious epidemic threat in decades. From an initial victim, a 2-year-old who died in a remote area of the African nation of Guinea in December 2013, Ebola has effectively isolated Guinea, neighboring Sierra Leone and Liberia from the rest of the world.
Travelers from Liberia infected a few people in Nigeria; that outbreak has been contained. More than 3,000 had died from the infection by the end of September. The current outbreak carries a 60 percent mortality rate. Without control, an estimated 1 million people could be infected by January 2015.
The first patient to be diagnosed with Ebola in the U.S., a traveler from Liberia, was admitted to a Texas hospital on Sept. 30. Officials say he may have come in contact with as many as 100 people.
Ebola made its first appearance in 1976 in Zaire and South Sudan. Initial outbreaks occurred in small, rural pockets, making containment feasible. The virus gained its name from the Ebola River near the site of the initial occurrence.
Intensive study isolated the cause — a virus consisting of a single strand of genetic RNA enclosed in a protein shell. Ebola is a zoonosis, a disease harbored in one species that jumps to another species. Fruit bats are the likely reservoir for the virus, but it can spread to man and other primates. Of five distinct species of the virus, the Zaire strain is responsible for the great majority of current cases. It is unclear if immunity to one strain will protect against infection from the others.
Ebola begins with high fever, profound weakness, vomiting and diarrhea. A rash may develop. Bleeding may develop in up to half of patients because of a decrease in platelets, which are essential for clot formation. Symptoms may appear from two to 21 days after exposure. In an area of Africa in which malaria and other febrile diseases are common, Ebola may be difficult to diagnose initially.
It is transmitted by direct contact with infected bodily fluids: blood, saliva, semen, stool and vomit. Traditional burial practices in the affected countries involve washing the corpse by family members, greatly increasing their risk of contracting the disease.
The countries afflicted by the current outbreak are among the world’s poorest. In Guinea, annual gross national income per capita is $520, $460 in Sierra Leone and $410 in Liberia. Fragile economies will be devastated by the epidemic. The health care infrastructure is primitive in most affected locales. Many health care professionals died of Ebola while caring for patients; others fled their countries in the face of the epidemic.
To combat the outbreak, both a vaccine and an experimental drug were rushed into use before comprehensive testing could be completed. Transfusion of blood from survivors of Ebola has been used to a limited extent. Care of those patients lucky enough to gain entry into a treatment facility involves careful isolation, intravenous fluid therapy, transfusions as needed and nutritional support. Staff must wear goggles, masks and protective suits, which become intolerably hot after short intervals. Only a small minority of victims can be accommodated in hospitals.
A limited number of countries have responded to appeals for help from the World Health Organization. Their shared goal is to identify and isolate those who come in contact with Ebola patients, provide care for victims by all available means and prevent spread to other countries and to other species.
For its part, the U.S. has sent Army personnel to Liberia to build temporary clinics and in-patient treatment centers, to train caregivers and assist with laboratory testing. Intensified testing of both vaccines and medications will continue at the National Institutes of Health and pharmaceutical companies. The effort will cost an estimated $1 billion. The Gates Foundation, a major supporter of international health, has committed $50 million to the fight.
Critics of foreign aid overlook the enormous good which these funds achieve. Without our assistance, Ebola could become a worldwide pandemic rivaling in its destruction the epidemic of plague that raged for centuries after its 14th century eruption in Europe and Asia. Hopefully, the U.S. and United Nations can stimulate a global response. Viruses do not respect borders.
Contact Clif Cleaveland at cleaveland1000@comcast.net.