The Age of Endemic Ebola

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 21^st 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.

Cholera on Hispaniola- An Ongoing Story

Highlights

Cases since 2017: 17, 027

Deaths since 2017: 200

Case Fatality Rate: <1%

Pandemic Threat Level: 3/10

Cholera is a waterborne illness known for causing severe, watery diarrhea. In some cases, the symptoms can become so drastic that the body succumbs to dehydration. It can be spread through contaminated water, and sometimes death can come just hours after the first symptoms present themselves.

The outbreak of cholera in Haiti has been continuous since shortly after an earthquake decimated the infrastructure in 2010. In the eight years since its first reporting, cholera has killed at least 10,000 people in the small country, and is still running rampant across the island- even spreading into the Dominican Republic, though not as widespread.

Cholera had not been seen in almost century in Haiti until after 2010, and when it hit, the flooding and poor hygiene that was rampant in the area post-earthquake allowed the disease to spread like wildfire. In fact, throughout history, we have often seen rises of epidemics immediately following a natural disaster. Even more so with waterborne illnesses, since clean water can become hard to come by after earthquakes, floods, hurricanes, and other disasters.

Another contributing factor was the Haitian peoples own immunities. As cholera had not been seen in almost a century, the Haitian people had practically no natural immunities to the disease. Think of the stories of smallpox covered blankets being administered to the American natives. In the same manner, the natives had no immunity and were almost wiped out by smallpox. The Haitian people’s own lack of immunity has only helped to promote this outbreak, and has made it difficult to eradicate.

It wasn’t until years after the disease had already become endemic to Haiti that the source of the outbreak was discovered. In 2016, the United Nations admitted that Nepalese UN peacekeepers had brought cholera into the country with them when they had come to help with earthquake recovery. The disease started near the Nepalese camp, where it was discovered that the peacekeepers had dumped their sewage into local waterways.

Now, in the 8^th year of the outbreak, the disease remains endemic to Haiti, and even if the outbreak is finally brought under control, it is unlikely to be completely eradicated. The introduction of cholera from Nepal to Haiti is a great example of how easily it is in this century for diseases to spread from one location to the next. Historically, civilizations could rely on great mountain ranges and oceans on separating them from their next epidemic, but this isn’t the case anymore. We are all just one flight away from introducing a new disease to a defenseless population.

I gave the Haiti outbreak a Pandemic Threat Level of 3 because of its mode of transmission. Cholera is a waterborne disease and often thrives in locations that do not have water filtration systems. This is why it was so easy to transmit across the island of Hispaniola after the 2010 earthquake. In developed countries that have working water filtration systems, cholera is less likely to be spread. And while cholera is one of the most common diseases seen in developing countries, there are rarely any incidences in the western world.

Cholera can become life threatening in just a matter of hours, but there are ways to prevent its transmission even in endemic regions. Those in infected areas should be sure to wash their hands with warm soap and water and boil any water that could be contaminated before using it for food or washing. But even once infected, modern medicine can do a lot to curb the risk of death. It is also possible to make a homemade solution of water, sugar, salt, baking soda, and fruit to help restore electrolytes of the infected. There is no cure for cholera.