Courtesy of Arunachalam Sathananthan
Ebola is thought to have originated in fruit bats and to have been introduced into the human population through close contact with the bodily fluids of the bats themselves or other known carriers such as chimpanzees, monkeys, forest antelope and porcupines that form part of the diet in many poor African regions.
Human-to-human transmission occurs by direct contact through broken skin or mucous membranes with the blood or other bodily fluids of infected people, or by contact with surfaces and materials such as bedding or clothing contaminated with these fluids.
People remain infectious as long as their blood and body fluids contain the virus. Men who have recovered from the disease can still transmit the virus through their semen for up to seven weeks after recovery.
Humans are not infectious until they develop symptoms.
Symptoms of the Ebola Disease: The incubation period is from two to 21 days. First symptoms are the sudden onset of fever, fatigue, muscle pain, headache and sore throat, followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding.
The average Ebola virus disease fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
Prevention and Control: The World Health Organization relies on controlling outbreaks through case management, surveillance and contact tracing. “Community engagement is key to successfully controlling outbreaks. Raising awareness of risk factors for Ebola infection and protective measures that individuals can take is an effective way to reduce human transmission,” the WHO advises.
Risk-reduction messaging focuses on factors such as reducing the risk of wildlife-to-human transmission, reducing the risk of human-to-human transmission and containment measures including prompt and safe burial of the dead, identifying people who may have been in contact with someone infected with Ebola, monitoring the health of contacts for 21 days, and separating the healthy from the sick.
Treatment and Vaccines: With no licensed drug treatment, care is based on giving patients intravenous fluids to stop dehydration and antibiotics to fight infections.
Although there is as yet no proven treatment available for EVD, a range of potential treatments including blood products, immune therapies and drug therapies is currently being evaluated. No licensed vaccines are available yet, but two potential vaccines are undergoing human safety testing.
A 1976 photograph of two nurses standing in front of Mayinga N’Seka, an Ebola virus disease patient in the 1976 outbreak in Zaire. N’Seka died a few days later due to severe internal haemorrhaging–Wikipedia
SEE “Ebola’s Deadly Advance” in Sunday Times, 17 October 2014, . http://www.theaustralian.com.au/news/world/western-panic-in-the-face-of-ebolas-deadly-advance-out-of-africa/story-fnb64oi6-1227093048934
AS Teresa Romero battled for her life in a transparent plastic tent in a Madrid hospital last week, her brother Jose Ramon was looking for someone to blame. Not only was he in danger of losing a loved one to the Ebola virus but the day before he had lost his job as a carpenter. His employer told him not to come back — “just in case”.
Madrid is gripped by panic, its citizens living in dread of a disease that had never before infected anyone outside Africa.
In Romero’s home district of Alcorcon people were wearing surgical face masks — “just in case”. Until her apartment building was disinfected on Thursday, neighbours wore gloves to touch lift buttons or door knobs.
“It’s very scary,” says Carmen Ruiz, who lives on the floor below Romero and had been using a paper tissue to press the lift buttons. “Nobody has told us what is safe and what is not.”
Tragically for Romero the response to her illness has been — as one expert put it — a “lesson in what not to do”.
After falling ill, Romero, a 44-year-old nurse, spent five days at home before being hospitalised, despite the fact she had cared for Manuel Garcia Viejo, a missionary who died after catching the disease in Sierra Leone.
She believes she became infected after accidentally touching her eyes or nose as she took off protective clothing. Seventeen people including Romero’s husband, Javier, were admitted for observation and the family dog was put down.
At the hospital hundreds gathered to demonstrate against the Spanish government’s handling of the crisis, calling on Health Minister Ana Mato to resign.
“(Teresa) was doing her job … and she was infected with Ebola,” Ramon says. “There are more people responsible than just her.”
Romero’s plight has reverberated around the globe. The Western world has been given the starkest of warnings about the spread of the virus: it is no longer just a West African problem.
The response has been understandably confused. In the French town of Cergy-Pontoise, northwest of Paris, the authorities locked 60 people in a building after four residents from Guinea complained of headaches and fever; the death of a Briton in Macedonia was wrongly attributed to Ebola; and at LaGuardia airport in New York aircraft cleaners went on strike over fears of contamination.
Elsewhere in the US, panic gripped the midwest with news that a second nurse from Dallas had contracted the disease from a now deceased patient and flown to Cleveland, Ohio.
Nor has the rest of Europe escaped: one person is dead and two in treatment in Germany, while a Medecins Sans Frontieres aid worker is being treated in Oslo.
Add to all this the fact supplies of ZMapp, which had been called the “miracle drug” for treating Ebola, have run out and vaccines are only in trial stages, and it is no surprise that people are scared and prone to overreaction.
Is all the anxiety justified? The fears in Western countries appear to be advancing at a greater pace than the virus itself. In West Africa, however, the disease is outpacing all attempts to contain it.
IN the seaside town of Lakka outside Sierra Leone’s capital, Freetown, Wilfred Onta holds his head in his hands as he waits in the shade outside the Ebola treatment centre. His son, Christian, 7, lies sprawled on a piece of cardboard beside him. They have been waiting for eight hours.
“There is no space inside,” says Onta. “But I hope soon they will have a bed and will come and get us.” Onta has seen 10 of his family die from Ebola, including his wife. His only other child, his daughter Lionella, tested positive too and is in the treatment centre.
Komba Songu, a clinician in another treatment centre in the town of Hastings, 25km from Freetown, says: “We’ve been at full capacity ever since we opened. Right now we have 101 patients for 100 beds. We can’t take any more.”
Originally a training school for police recruits, the treatment centre sits on a broad plain. Workers clad in protective yellow suits tend the patients in what is known as the red zone.
Until a few days ago Jalikatu Koroma, 10, was one of the inmates of the red zone. But after two weeks she was discharged — a survivor. She has come to visit her younger brother who stands on the other side of the 1m-high plyboard fence around the red zone. She smiles as she hands him a boiled egg, happy that he seems to be making good progress.
They are in the minority. Songu estimates that between 60 per cent and 70 per cent of patients die. Jalikatu’s father was one of them.
According to Sierra Leone’s health ministry, the Freetown area has seen 575 cases since the first one in late May but many say the disease is moving more quickly.
In a tattered exercise book, cemetery keeper Abdul Rahman Parker has been compiling figures of his own. He says he and his teams have buried 423 Ebola victims in less than a month. “On October 6 we buried 30 in just one day,” he says. “Yesterday we buried 20 more.”
The bodies are brought in by eight burial teams patrolling the streets of Freetown. Each burial must be carried out in full protective gear. “I am afraid,” says Parker. “We’re doing it because it’s our country and God wanted us there. But it’s very hard to see so many of our citizens dying.”
So far the virus has killed 4447 of about 9000 people infected in West Africa. Health services have been overwhelmed and the death toll among medical staff has been high: of 401 staff infected by patients, 232 have died.
At the present rate there will be more than 20,000 cases by November 2. The US Centres for Disease Control and Prevention warns there could be 1.4 million cases by January 20.
Analysts at Northeastern University in Boston, Massachusetts, who modelled the expected progression of the virus, identified Britain as the sixth most likely country to have a case of “imported Ebola” in the near future. Only the US and France are considered more at risk among developed Western nations.
Alessandro Vespignani, a physicist at Northeastern University, says: “In October and November we would expect a very small number of importations. Maybe one or two in the UK, but the longer the problem lasts in West Africa the higher the probability becomes of more imported cases.”
The British government did a rapid U-turn last week and agreed to introduce checks at London’s Heathrow and Gatwick airports and at the Eurostar railway terminals in response to public concern.
David Mabey, professor of infectious diseases at the London School of Hygiene & Tropical Medicine, dismisses such checks. “The money would be better spent on setting up places where people can be tested and telling them where that is,” he told the BBC.
British universities are preparing for 20,000 students from West Africa to arrive for the new term and some are considering whether those from countries with Ebola outbreaks should be sharing rooms with other students.
Public Health England insists the chance of contracting the virus remains low; Tom Solomon, director of the health protection research unit in emerging infections at Liverpool University, says: “Every one person infected (in Africa) goes on to infect another 1.7 people. That is pretty low for a virus so the chances of it really taking hold in this country are pretty much non-existent.”
In Africa, however, it is spreading all too swiftly. The question being asked with increasing urgency in Liberia, Guinea and Sierra Leone is: how can it be stopped?
IN a large polytunnel in Kentucky stand rows of tobacco plants. Their leaves are turning yellow and they may hold the key to future treatment of Ebola.
The plants have been injected with a genetically engineered Ebola virus. They then produce antibodies. As they turn yellow, the leaves are harvested. Cloned “humanised” antibodies are separated from the plant, purified and transformed into doses. It appears to be effective, but it can take up to six months to generate a dose because of the growing process — and supplies have been exhausted.
Jonathan Ball, professor of molecular virology at England’s Nottingham University, says: “The real worry is that the virus could become endemic in West Africa; then you have a real problem. If it becomes endemic you are going to see sporadic exports around Africa and around the world, and that will cause chaos every time it happens.”
Alongside the development of drug treatments for Ebola, blood transfusions from survivors appear to be effective, boosting patients’ immune systems by exposing them to antibodies from those who beat the disease.
William Pooley, a British nurse who caught Ebola in Sierra Leone and survived, has visited the US to donate blood to other victims.
But the battle against the disease will have to be waged, at least for the next year, without the one key weapon that has given humans the ability to defeat deadly viruses: a vaccine.
Given that Ebola has been killing people since 1976, why is there no vaccine?
The simple answer is money: until now, nobody has been willing to spend the $40 million or so needed to get vaccines through trials and into production.
“It is quite possible to design a vaccine against this disease. The bottleneck is not creating a vaccine but the cost of testing it and then producing it,” says Peter Walsh, a Cambridge University zoologist who has studied Ebola since it spread across Africa in the 1970s, killing thousands of gorillas and chimps.
The vaccine Walsh has worked on failed to get funding despite trials on 80 monkeys and six chimps that showed it protected the animals against direct exposure to Ebola — and so may work for humans too.
The most advanced vaccine is made by pharmaceutical giant GlaxoSmithKline. However, it hit the same funding wall when it contacted the World Health Organisation in March asking for funding to start human trials.
“The answer was, ‘Thanks, we’ll get back to you,’ ” Ripley Ballou of GSK told Science magazine. A GSK spokeswoman says: “We might be able to make enough vaccines to protect some health workers but there is going to be no wide-scale vaccine available for this outbreak; maybe for the next one.
“They are going to have to fight it the old-fashioned way.”
In other words, the tactics being deployed in West Africa will be the same as always: isolate patients and trace their contacts. The treatment is largely a matter of care and rehydration.
The US is sending 3000 military personnel, Britain more than 750, and the charity Save the Children is ready to open a 92-bed treatment centre in Kerry Town, an hour from Freetown.
Eventually Britain will provide 700 Ebola beds in a series of treatment centres, caring for up to 8800 patients in six months.
Australia has contributed $18m to the international effort to contain the virus, but so far the government is reluctant to send military or medical personnel into the danger zone.
Among those going to the stricken region are engineers and water experts to help rebuild vital infrastructure, but the area still needs 750 more doctors and 3000 more nurses.
To the people of the region, the response from the West seems too little, too late.
Every day Parker and his team dig more graves and he adds more names to his exercise book. It raises a haunting question: how many of them could have been saved?
THE SUNDAY TIMES
Reporting team: James Gillespie and Tommy Trenchard in Freetown; Matthew Campbell in Madrid; and Jonathan Leake, Mark Hookham, Beezy Marsh and Iain Dey in New York.