Why Is This Ebola Outbreak Different From All The Other Ones? Ctd

Jason Koebler surveys the ongoing chaos as overwhelmed health workers struggle to contain the ebola outbreak:

“Every report I’m getting from the ground has health workers in a state of fear, and they’re feeling a siege from populations who despise and loathe them,” said Laurie Garrett, a senior fellow for global health at the Council on Foreign Relations who won a Pulitzer Prize for her on-the-ground reporting on the ebola outbreak in Zaire in 1996, on a conference call this morning. “They’re saying ‘we are terrified, we are exhausted, we want to leave, can someone take over?’” … Problem is, there aren’t many people who can take over. Already, more than 60 healthcare workers have died from the disease, and the countries’ governments haven’t been very successful at shepherding their people—who have never seen the disease before, often don’t speak the same language as relief workers, and don’t fully grasp what’s going on—to treatment facilities.

That’s why you have things like riots outside of health care clinics and patients making escapes from ebola quarantine centers. Healthcare workers have been called “cannibals” by protesters, and Garrett said that workers she’s talked to have been accused of cutting patient’s arms off and selling them on the black market. In other words, the situation is fairly out of control, and it doesn’t look to be getting better anytime soon.

Debora MacKenzie, Philippa Skett and Clare Wilson offer their take on why this epidemic has been so severe:

The overriding factor could be urbanisation.

In the past, village outbreaks remained small, unless people went to hospitals. “Population size and high mobility make it hard to do contact tracing,” says Peter Walsh at the University of Cambridge. Cities provide more chances to spread the virus, something that may also have enabled the spread of HIV. According to the African Development Bank, the continent has had the world’s highest urban growth rate for 20 years, and the proportion of Africans living in cities will rise from 36 per cent to 60 per cent by 2050.

Other factors also favour the virus. Justin Masumu of the National Institute for Biomedical Research in Kinshasa, Democratic Republic of the Congo, found that the increase in Ebola outbreaks since 1994 is associated with changes in forest ecosystems due to deforestation, which displaces bats. The part of Guinea where this outbreak started has been largely deforested. What’s more, wars in Liberia and Sierra Leone, and corruption in Guinea, have caused poverty, says [Tulane public health professor Daniel] Bausch, leading people to migrate for work and spread the virus further. It has also caused widespread mistrust of officials, even in public health – just when Africa’s cities need them most.

Julia Belluz outlines the worst-case scenario:

Even if the outbreak didn’t move across any other country border, intensification within the already affected areas is the most immediate health threat. “The worst-case scenario is that the disease will continue to bubble on, like a persistent bushfire, never quite doused out,” said Derek Gatherer, a Lancaster University bioinformatician who has studied the evolution of this Ebola outbreak. “It may start to approach endemic status in some of the worst affected regions. This would have very debilitating effects on the economies of the affected countries and West Africa in general.”

This dire situation could come about because of a “persistent failure of current efforts,” he added. “Previous successful eradications of Ebola outbreaks have been via swamping the areas with medical staff and essentially cutting the transmission chains. Doing that here is going to be very difficult and expensive. We have little option other than to pump in resources and engage with the problem using the tried-and-tested strategy—but on a scale previously unused.”

But Tara C. Smith emphasizes that the chances of an ebola outbreak in the US remain extremely low:

Ebola is a virus with no vaccine or cure. Any scientist who wants to work with the live virus needs to have biosafety level 4 facilities (the highest, most secure labs in existence, abbreviated BSL-4) available to them. We have a number of those here in the United States, and people are working with many of the Ebola types here. Have you heard of any Ebola outbreaks occurring here in the United States? Nope. These scientists are highly trained and very careful, just like people treating these Ebola patients and working out all the logistics of their arrival and transport.

Second, you might not know that we’ve already experienced patients coming into the United States with deadly hemorrhagic fever infections. We’ve had more than one case of imported Lassa fever, another African hemorrhagic fever virus with a fairly high fatality rate in humans (though not rising to the level of Ebola outbreaks). One occurred in Pennsylvania, another in New York just this past April, a previous one in New Jersey a decade ago. … How many secondary cases occurred from those importations? None. Like Ebola, Lassa is spread from human to human via contact with blood and other body fluids. It’s not readily transmissible or easily airborne, so the risk to others in U.S. hospitals (or on public transportation or other similar places) is quite low.