An expert witness recounts an epidemic without modern precedents.
There’s never been anything quite like the Ebola virus epidemic that has broken out in West Africa in terms of the areas involved, the number of cases and the death rate. It is the first epidemic of this disease to affect more than one country at the same time, spreading into cities and resulting in three times more cases and deaths than those reported worldwide in all the various epidemics from the 1970s to the present day.
The high number of contagions complicates the reconstruction of contact had by infected individuals, and what in the beginning seemed to be a local issue has become an international humanitarian crisis. This emergency has not only struck the healthcare sector but it has also devastated the society of the affected countries, wreaking widespread ruin.
Since this bout of Ebola first appeared at the start of 2014, more than 5,000 deaths and 13,000 cases have been reported (confirmed, probable and suspected), according to figures published by the World Health Organization (WHO, November 2014). From Guinea, where the epidemic was corroborated for the first time on 22 March 2014, the virus quickly spread to Liberia, Sierra Leone and, to a lesser extent, to Nigeria and Senegal. Leaving the African continent, Ebola at this point has reached the United States, Spain and Germany, albeit in localized transmission and in isolated cases.
In 2014, the organization I belong to, Medici Senza Frontiere (MSF), which was already on the ground in all of the countries affected by the virus, set up and managed isolation centres to treat patients infected with the disease, tending to the sick to limit the spread of the contagion.
MSF lent support to health ministries in monitoring the epidemic, sending experts out into local communities to map contact, spread awareness about adopting correct health and hygiene measures and to train local healthcare operators.
Since March, MSF teams have treated a total of approximately 60 percent of reported cases. More than 5,600 people have been hospitalized by MSF, about 3,500 of which tested positive for Ebola. More than 1,400 have recovered (figures updated as of 7 November 2014).
On several occasions during 2014, MSF has called for massive intervention by the international community in an effort to stem the epidemic and to ensure that the already fragile healthcare systems do not collapse. Unfortunately, the international response only started to make itself felt in late autumn when most of the healthcare operators still unaffected by the virus had already fled out of fear and both public and private facilities had closed due to a lack of personnel. As a result, even those suffering from other more commonplace complaints, no longer had access to healthcare.
The epidemic has actually spread more frequently among healthcare staff due to a lack of hygiene measures and the absence of personal protective equipment (masks, overalls, gloves and glasses) as well as among the relatives of the sick due to high probability of contact. Entire households have been wiped out.
Direct contact with the deceased at burials has also played a significant role in spreading the disease in the afflicted countries. Inadequate healthcare facilities, lack of supervision and shortcomings in epidemiological monitoring have done the rest.
So far there is still no specific treatment for the disease, neither has anyone come up with a vaccine of proven effectiveness on humans that has been registered for use on patients. Organizations such as MSF lower the death rate by treating the symptoms and thus helping patients to develop a sufficient immune response to overcome the disease.
Due to a lack of medicines and vaccines, prevention relies on strict compliance with hygiene measures, the ability to diagnose the disease at an early stage, patient isolation and mapping of high-risk contact.
To restrict the epidemic and identify the chain of transmission, MSF contributes to the active research into all individuals who have come into contact with the diseased. All individuals who have had potential contact are monitored for three weeks after the last known contact and hospitalized and isolated at the first sign of infection. Even if there’s no more than a suspicion of infection, the patient is isolated and then tested. The epidemic and its surprising speed of diffusion emphasize how health must be regarded as a global concern. Although the number of new Ebola cases recorded in Liberia has dropped in recent weeks, the epidemic isn’t over, and new hotbeds continue to appear throughout the country as well as in Guinea and Sierra Leone.
In the wake of repeated and long since underestimated calls for help, the international response has finally arrived. Substantial international aid is now financing the response to Ebola, in particular the large-scale construction of treatment centres. In Monrovia and in other areas of Liberia as well as in other countries affected by the outbreak, isolation units now have sufficient capacity to treat the infected population.
Today’s priority is a more flexible approach that might enable a rapid response to new breeding grounds of infection as well as a restructuring of local healthcare systems in order not to undo the progress achieved to date. Resuming basic medical services is crucial.
Countless hospitals and health centres that are still open turn away patients with high temperatures or vomiting out of fear that they are suffering from Ebola. Infection checkpoints, such as triages, must be implemented urgently within ordinary healthcare facilities, so as to reduce the spread of the virus and to prevent people from dying from preventable illnesses and untreated complications.