Commentary: Ebola Could Soon Be The West's Problem, Too

There is a crisis brewing in the world that we ignore at our peril. The Ebola virus is back, and it's spreading.

Until now, major outbreaks of this incurable and highly contagious disease have occurred in the Congo, Sudan, and Gabon, three of Africa's poorest nations. But in mid-October an Ebola epidemic broke out in two regions of relatively well-off Uganda, with deadly results. As of Nov. 17, 329 people had been stricken with the disease, and 107 had died.

This is, of course, a horrific tragedy, and the West should respond for humanitarian reasons if for no other. But self-interest should kick in as well. Tuberculosis, malaria, and AIDS may be far more widespread, but Ebola will likely not be isolated in Africa forever. It is only a matter of time before an infected person boards a plane and arrives in one of those countries that pays little attention to Africa now. "International travel is always a concern," warns James W. LeDuc, acting director of the Centers for Disease Control & Prevention's viral-disease division.

Case in point: In October, a man returning to Madison, Wis., from a visit to his native Senegal fell ill, complaining of severe headaches, and soon died. Concerned that Ebola may have been the culprit, county health officials asked all those who had come in contact with the dead man to confine themselves to their homes. The cause of death turned out to be hepatitis, but if it had been Ebola, everyone the dead man had been in contact with, even after death, could have been infected---including the police and fire teams who raced to the scene. "It got our attention," admits Dane County Public Health Administrator Gareth Johnson.

Ebola is one of the scariest viruses the world has known. Scientists are uncertain of its origin, though monkeys are widely suspected. The disease was first identified in the Congo in 1976 when an outbreak killed 318 people, 88% of those infected. Another epidemic hit the Congo in 1995, killing 315 people, and 97 died in Gabon in 1996. Ebola was accidentally imported to the U.S. in 1989 via a shipment of infected monkeys to quarantine labs in Virginia, but it was successfully contained.

Scientists can't explain why the virus can lay dormant for years or why it breaks out in a new locale. They suspect that an epidemic starts when an animal somehow infects a human. That first victim's blood or secretions infect others--a means of transmission that often wipes out entire families. Patients develop a high fever and within a week suffer massive internal bleeding, shock, and finally, an excruciating death. Some recover, but no one can predict who or explain why.

Significantly, the Uganda outbreak has killed only about one-third of its victims, compared with 90% in prior epidemics. Dr. Patricia Campbell, in Kampala with a team from Doctors Without Borders, attributes the lower mortality rate in part to "the really excellent capabilities of Uganda's health structure." But the survivors give rise to a new concern--the virus may be able to hide in the bodies of recovered patients, who could go on to infect others, or it could mutate. "Our fear is that it will change into something more like measles or influenza, where there is easy airborne transmission," says LeDuc.

NO CURE IN SIGHT. Researchers have recently made some progress in understanding Ebola. In July, a team from the National Institutes of Health identified a protein in the virus that is likely to be responsible for the massive internal bleeding that kills most Ebola victims. And in October, scientists from Mt. Sinai School of Medicine in New York and Philipps-Universitat in Marburg, Germany, found a protein that the virus uses to disable the immune system.

But a cure is still a long way off. Near-term, the early-warning and response systems of key African nations must be bolstered, along with their medical storerooms. In Uganda, the disease was quickly contained because its hospitals could afford such simple precautions as soap, clean water, rubber gloves, and face masks--unheard-of luxuries in the Congo.

Africa's many problems may seem intractable, but wealthy nations would be well advised to figure out a solution to this one. We really are a global village when it comes to communicable diseases.

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