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Ebola

By | Updated Sept. 16, 2014

It’s one of the deadliest diseases on Earth, with a fatality rate as high as 90 percent. It’s also grotesque, sometimes causing bleeding from the eyes, ears, mouth and rectum and a bloody full-body rash leading to a quick demise. It’s Ebola, one of a handful of illnesses that are so deadly governments consider them a threat to national security. Each wave of new cases raises questions about what can be done for Ebola’s victims and how to prevent public panic.

The Situation

The 2014 Ebola outbreak has led to more deaths than all previous waves combined. It’s centered in the area where Liberia, Sierra Leone and Guinea meet and has killed more than 2,400 people since December. The disease reached Nigeria in July, causing a much smaller outbreak, and Senegal reported its first case in late August. This outbreak is the first in West Africa, an area with an acute shortage of doctors and supplies. Early on, the disease was transmitted by victims who avoided hospitals because of stigma and fear, as well as by unsafe burial practices. As cases increased, efforts to contain the epidemic were hampered by a shortfall of personnel equipped and trained to cope with it at a time when humanitarian groups were dealing with multiple crises elsewhere, including in Syria, Ukraine, Central African Republic and South Sudan. The U.S. responded with a plan to send about 3,000 military personnel to the affected countries to lead and coordinate the relief effort. Ebola jumps to humans through contact with blood and other secretions from animals such as chimpanzees, gorillas and bats. It spreads among humans the same way, with medical workers and family members the most at risk. In the current outbreak, sick people begin to show symptoms four to six days after exposure. Liberia and Sierra Leone have quarantined villages, shutting schools and markets. Guinea and Cameroon have banned the sale and eating of bats. The WHO has stopped short of recommending a general travel and trade ban. A separate outbreak reported in late August has killed dozens of people in the Democratic Republic of Congo.

The Background

Researchers think fruit bats are the most likely host of Ebola, which was first identified in 1976 near the Ebola River in what is now the Democratic Republic of Congo. Outbreaks are typically contained within a few months. Prior to the current wave, a total of 2,387 cases had led to 1,590 deaths. There are no drugs or vaccines approved to treat or prevent Ebola. The rarity of the disease and its prevalence in rural areas of poor African nations have provided little incentive for big drugmakers to invest in treatments, leaving smaller biotechnology firms and government-funded labs to take up the challenge. But now, companies including GlaxoSmithKline and Johnson & Johnson are accelerating programs for development of preventive vaccines, which would command a larger market than treatments. The U.S. Centers for Disease Control and Prevention lists the virus, alongside anthrax and smallpox, as a Category A bioterrorism agent, compelling an expensive search for remedies.

The Argument

Ebola doesn’t travel through the air, making it harder to transmit than many other pathogens as long as adequate health-care practices are followed. Other diseases kill many more people. Influenza kills up to half a million people a year around the globe, and resurgent diseases such as tuberculosis and the growth of antibiotic resistance are a bigger focus for global public health organizations. Nevertheless, Ebola’s tear through some of the world’s poorest countries — Liberia  has just 0.1 doctors per 10,000 people — raises questions about whether richer countries and the WHO responded quickly enough to the outbreak and whether development aid should focus more on strengthening health-care systems.

The Reference Shelf

  • Bloomberg News Q&A on the Ebola outbreak.
  • Read fact sheets on Ebola at the Centers for Disease Control and Infection (CDC), World Health Organization (WHO), and the National Institutes of Health (NIH).
  • A Bloomberg News article on treatments in development for Ebola, including antibody cocktails being developed at Mapp Biopharmaceutical in San Diego, which is working with the U.S. Defense Advanced Research Projects Agency, the National Institutes of Health and the Defense Threat Reduction Agency.
  • Richard Preston’s 1994 best-selling book about Ebola, “The Hot Zone” and Laurie Garrett’s 1995 book “The Coming Plague: Newly Emerging Diseases in a World Out of Balance.”

(First published April 4, 2014)

To contact the writer of this QuickTake:

Makiko Kitamura in London at mkitamura1@bloomberg.net

To contact the editors responsible for this QuickTake:

Leah Harrison Singer at lharrison@bloomberg.net

Lisa Beyer at lbeyer3@bloomberg.net