A friend of mine just returned from Sierra Leone, one of four countries affected by the biggest Ebola outbreak ever. I met him for a drink on Saturday afternoon. I expect I’ll start bleeding from the eyes this evening, and be dead by Friday. It’s been fun, everyone.
If you believe what you see on television, you’d think a mate of mine insane. He works for a large mining company in Sierra Leone. The work is hard and he only gets to see his wife for three weeks out of twelve. The conditions are rough, the discipline strict.
But that’s not why you’d think he’s insane. After all, many people work on similar terms for big companies in poor countries. The pay is good, and remittances support families and sometimes entire economies back home.
You’d think him insane because he is not afraid of Ebola, although Sierra Leone is in the heart of the worst-ever outbreak of this terrifying disease. At the time of writing, there have been 1,145 deaths out of 2,127 cases, roughly equally distributed between Liberia, Guinea and Sierra Leone, and a dozen cases have been reported in Nigeria.
No, my friend’s biggest fear concerning Ebola is that Sierra Leone will close its borders, or airlines will suspend flights, as British Airways and Emirates Airlines have done. Then he won’t be able to get back to work.
He’s not stupid. He follows the news. He does fear deadly tropical diseases, of course. But top of his list are malaria and tuberculosis. Ebola is an afterthought.
So why, despite high-profile calls not to panic, did Kenya ban contact with affected countries? Why did Korea Airlines suspend flights to Kenya, when there have been no confirmed cases there, Nairobi is 5,800km from the outbreak, and Kenya’s own borders are closed to affected countries?
One station, NBC, has an Ebola story count of 152, with an average of six items every day. CNN has run 68 Ebola stories in the last month. The network quoted its own resident doctor, Sanjay Gupta, out of context. “We’re going to see Ebola around the world,” ran the headline, and right at the end of the piece you discover that he added: “But I think it’s not going to turn into lots of mini outbreaks.”
Fear of Ebola may be the only thing 60% of Americans agree on. There is hysteria on the conspiracist fringes of both the left and the right. The UK’s Daily Mail thinks you can get Ebola by photographing it.
Is it serious? Yes, most definitely. There are indications that the affected countries are not coping with the outbreak, and that many more people will die. Any death is one too many and cause for legitimate concern. But should you panic?
Hey ho, hey ho, off to facts we go.
Ebola is a virus that attacks the body’s immune and blood-clotting systems. It leads to severe immuno-suppression and in the later stages, bleeding, which is why it is commonly described as a “haemorrhagic fever”. The ultimate cause of death is often shock, or dehydration caused by gastric problems.
There are five known strains of Ebola, named for the Congolese river near where it was first reported. The current outbreak involves the most deadly of them, the Zaire strain. No cure has yet been discovered, nor is there a preventative vaccine. Experimental drugs exist, but they’re untested. During past outbreaks, between 50% and 90% of patients died, many despite symptomatic and supportive care. Because the disease progresses very rapidly, outbreaks usually burn themselves out, but they aren’t pleasant deaths. You really, really don’t want Ebola.
This outbreak started in December 2013, in a rain-forested region in the south-east of Guinea, where it borders Liberia and Sierra Leone. The World Health Organisation (WHO) was notified of a “rapidly evolving outbreak” involving 49 cases and 29 deaths three months later.
It is believed that there are one or more non-human “reservoir” species that host the virus. If you’re patient zero, you probably ate infected bush meat from bats, monkeys or other game.
Ebola has an incubation period of anything between two days and three weeks, during which patients are not contagious. Once patients start showing symptoms, and particularly as those symptoms advance, they become contagious.
Human to human transmission happens by contact between broken skin or mucous membranes (such as mouth, nose or genitalia), and the bodily fluids of a patient, either after they became symptomatic or shortly after death. The virus can remain active in fluids and dead bodies for a few days, though a good bleach disinfection will kill it.
To reiterate, the body fluids of a symptomatic patient must enter another person’s body, via mucous membranes or wounds, for transmission to happen. Ebola can be transmitted via droplets at coughing distance, but it is not airborne.
Many new cases of Ebola have been reported among those who care for Ebola patients. This includes medical staff who do not follow good disinfection protocols, or do not have access to proper protective gear like gloves, gowns and masks. A few cases outside Africa have involved medical staff who accidentally prick themselves with infected needles.
Many more cases have occurred among those who prepare bodies for burial or mourners themselves, because of customs involving washing, kissing the deceased, or otherwise coming into contact with remains that are, literally, oozing Ebola.
Complicating the matter is a lack of infrastructure and skills, as well as a widespread distrust of hospitals among locals, who typically are rural villagers with little education. Aside from conspiracy theories about foreigners, many view a hospital as a place that turns sick people into dead people.
To some extent, that suspicion is justified by their inadequacy. While good hospitals exist, many in the region are terrible. For some insight into conditions, consider that while you’d expect medical staff to scrub fairly vigorously if they’re treating you for a deadly contagious virus with no cure, the WHO considers it worth explaining to local healthcare professionals that hand hygiene is important.
Around the work compound back in Sierra Leone, my friend’s temperature is taken and logged daily. Like all his colleagues, he is required to wash his hands and boots in a chlorine solution every time he returns to the work site. He says if you walk the streets of Freetown you are likely to step in human excrement, and you are certain to step in human urine. The boot-cleaning routine is a sensible precaution against all manner of disease and contamination, including Ebola.
The same routine occurred at the airport on his way back home. And all international arrivals in Johannesburg, no matter where they come from, get screened for fever. Recall that until symptoms develop, even an Ebola carrier is non-contagious.
This is why air travel from outbreak countries carries very low risk, unless you happen to join the mile high club with a partner who is already presenting with symptoms and therefore wouldn’t have been allowed on the plane in the first place. That can only happen in your imagination, so you won’t get Ebola while flying.
Ebola can, of course, be spread by airline passengers, because pre-symptomatic patients can carry it, but decent sanitary and medical facilities outside the very poor circumstances of West Africa will likely prevent the disease from spreading to any major extent.
In general, unless you’re in direct contact with the dead or dying, and your healthcare quality is adequate, basic hygiene precautions are all you need.
If you don’t believe me, or my mate who works in the heart of the outbreak, or the WHO, try a Swedish member of Doctors Without Borders, working on actual Ebola cases in Sierra Leone, who wrote to a friend: “People seem to think that we will have an Ebola pandemic, which is not the case. Single, isolated cases can appear in our parts of the world, but in terms of Ebola spreading at the pace it is spreading in West Africa is rather impossible. The disease is not as contagious as people are led to believe. It is not an airborne disease and you need close contact with a patient with symptoms to catch it.”
My mate’s more urgent fears about malaria and tuberculosis are indeed justified.
Half the world’s people are at risk of malaria. The statistics are sketchy, but about 200 million people had malaria in 2012. Of those, 670,000 died, by WHO numbers. So for every Ebola victim this year, there were more than 500 malaria deaths. Recent reports suggest that the mortality number ought to be doubled.
Fewer people get tuberculosis, but more die of it. Unlike malaria, but like Ebola, it is contagious and can be spread by international travel.
It ranks second to HIV/Aids in terms of deaths attributable to a single infectious agent. In 2012, 8.6 million people got it, killing 1.3 million of them. That’s more than 1,000 fatalities for every Ebola death.
Although tuberculosis is preventable and curable, new drug-resistant strains have emerged. The main cause of this is that too many patients do not stick to a strict six-month drug regimen, as required. About 5% of tuberculosis cases are resistant to two or more indicated medicines, and 0.5% are resistant to most available drugs. Genetic research holds the promise of future treatments for these cases, but, like Ebola drugs, they are not yet available.
So there are 20 drug-resistant tuberculosis cases for every Ebola case. The WHO rightly calls drug-resistant tuberculosis “a deadly, infectious disease that knows no borders.”
This also gives the lie to conspiracy theorists who think Ebola is a biological weapon created in a CIA laboratory, or that the authorities are covering up the real numbers. If it was meant to be the former, it is the worst such weapon in the world ever. If the latter were true, why don’t they also lie about malaria and tuberculosis statistics?
For anyone not closely connected with the outbreak, the only serious threat that Ebola poses is that the easily excited will panic and start to stock up on fuel, food and water.
If you’re going to panic, direct your energy to where it can do some good. Go work for an organisation that fights malaria or tuberculosis. If people who work in Sierra Leone aren’t terrified of Ebola, you probably shouldn’t panic, either.
Stress kills too, you know. DM
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