Highlights
Total Cases in 2018: 341
Total Deaths in 2018: 215
Case Fatality Rate: 63%
Pandemic Threat Level: 7/10
This week, I’d like to talk about Ebola. I don’t know if you knew this- but right now there is an objectively worse outbreak of the disease going on than what we saw in 2014 when it infected almost 30,000 people across West Africa. I’m sure many of you remember this outbreak. It was the first time the hemorrhagic fever had been seen on such a massive scale, killing anywhere between 60 and 90 percent of all it infected.
The symptoms of Ebola are not for the faint of heart. It begins with flu like symptoms, making it difficult to diagnose at the beginning. Then, as the disease progresses, it can lead to vomiting, diarrhea, and stomach pain. Most startling, however, is the final stages of the disease. You see, by the end, the victim’s organs have begun to liquefy causing blood to pour out of every orifice of their body before they are finally allowed to succumb to death. During all of the stages, the disease is contagious to anyone who comes into contact with the bodily fluids of the infected.
When Ebola hit West Africa in 2014, the scale of the outbreak was unprecedented. World Health Organizations barely knew how to handle it, and in fact have stated numerous times since then that they did not handle it as well as they could have. The outbreak led to some cases spilling over to the United Kingdom, the United States, Spain, Mali, as well as others. Eventually, over two years later, the disease disappeared back into the forest and health organizations declared the outbreak over.
The current outbreak has shown up in the Congo, in an area that was no stranger to the disease. So far, it’s infected over 300 people. Compared to 30,000 people, this number seems frightfully low to even consider this a serious outbreak. However, there is one key difference between this outbreak and any other Ebola outbreak that has occurred before this.
Historically, Ebola outbreaks always have a source. Even when epidemiologists were tracking the 2014 Ebola outbreak, each cluster was connected to another cluster. Let me explain how this works- using the 2014 outbreak as the example. In 2013, an 18 month old boy in Guinea contracted Ebola virus and died in late December. It would be almost an entire year before he was identified as the source of the outbreak. Working backwards through disease serotyping and interviews, epidemiologists were able to trace the path of the outbreak (through thousands of infected) to determine that the entire outbreak had been started by this young child. When jumping from one location to another, or from one population to another, epidemiologists are often able to follow the path a disease travels. So, as mother gives it to son, son gives it to friend, friend to cousin, cousin to shop owner, and so on, epidemiologists are often only a few steps behind course. Such investigative work is often responsible for developing the best measures to put into place to prevent the disease from spreading further.
However, for the first time ever, this isn’t the case for the current Congo outbreak. In fact, almost a third of all new cases that healthcare workers are seeing are coming from unknown origins. They are completely untraceable. Every day in the Congo, daily cases are steady with no sign of decreasing any time soon, and many of them are showing no connections with known sources. The fact that many cases are untraceable proves that we are entering a new era of Ebola outbreaks- the era of endemic Ebola. Soon, it won’t be a matter of responding to new outbreaks- efforts will instead need to be placed on controlling the never ending cases of infected.
It takes the transmission of infected bodily fluids to spread the virus, and Ebola cannot be spread from one person to another when the infected person shows no signs or symptoms of having the disease. That being said, the virus can survive inside its host for 2-21 days before an infected person may began exhibiting signs and symptoms. In the 21st century, a person can be anywhere they want to be in the world in a lot less than 21 days, and without being able to track the disease- it’s only a matter of time before we’ll see Ebola show up naturally outside of Africa.
I gave this disease a 7/10. In 2014, when rating the same virus, I would have probably given a 5/10 or 6/10 because of its traceability. One of the resources we have that we didn’t have in 2014 is the emergence of an Ebola vaccine. The administration of the vaccination to 30,000 people in the Congo is widely accepted as the main reason why the numbers of infected aren’t higher. However, the Ebola vaccination is still in its human trials, and is only being used in the Congo in a “compassionate use” capacity in an attempt to curb the current outbreak (where the plan is working). This means that the vaccine is also only given to patients who have had direct contact with the disease or diseased patient. Well, those and healthcare workers. So, while this does help to limit the spread of the virus among known routes, it still leaves a big question over the “untraceable” outbreaks.
Ebola is about to be at a larger turning point than we could have ever expected. It’s possible we are hitting an age when outbreaks of Ebola are no longer newsworthy and are considered common- much like each new malaria or cholera outbreak. Regardless of the path Ebola takes, we should never forget the bravery and selflessness of the healthcare workers who work tirelessly in often overcrowded and underfunded facilities to give help to those suffering. Each one of them does so at great personal risk to their own health- and in many cases are separated from their families while they do so. Our best hope now lies with the completion of the human trials and an effective deployment of the vaccine.
Pestilence 