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 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. In an epidemic that began in December 2013, Ebola infection for the first time occurred outside Africa. That provoked panic in the U.S. and Europe, but in all there were just seven cases and one death from Ebola there. In Africa, the outbreak killed more people than all previous waves combined.
In June, data from the World Health Organization suggested the epidemic may have finally come to an end. The agency warned the three hardest-hit countries — Guinea, Liberia and Sierra Leone — to remain vigilant for new infections. Since the virus can linger for some time after recovery, for example in the eyes, testes and spinal cord, infection can occur through exposure to survivors’ body fluids. About 28,600 people were infected with the disease and 11,300 died, according to the official count. Almost as many extra deaths from malaria, HIV/AIDS and tuberculosis are thought to have occurred because the epidemic reduced access to healthcare services. It also created an estimated 23,000 orphans. The World Bank calculated that the economic disruption caused by Ebola cost the three countries at least $2.8 billion in foregone economic growth in 2014 and 2015. In contrast, nations with better medical systems — Nigeria, Senegal and Mali — were able to contain Ebola when it spread there. The Democratic Republic of Congo controlled an outbreak of a different strain of the virus.
Earlier Ebola outbreaks, which produced a total of 2,387 cases and 1,590 deaths since 1976, were contained within months. Those occurred largely in remote rural areas. This epidemic, however, began at a crossroads where people move frequently across porous borders in search of work or food, and cities became centers of contagion. It was Ebola’s first appearance in western Africa, in three of the world’s poorest countries. Early on, the disease was transmitted by victims who avoided hospitals because of stigma and fear, as well as by unsafe burial practices. The countries’ relatively rare health workers — Liberia has just 1 doctor per 100,000 people — were unprepared to deal with the patients they saw. A few foreign volunteer groups pitched in, but the WHO was slow to recognize and respond to the threat. The U.S. temporarily deployed 2,800 military personnel to Liberia to help fight the outbreak. There are no drugs or vaccines approved to treat or prevent Ebola, although companies and government-funded labs have accelerated their development. In July 2015, an experimental vaccine made by Merck was found to be 100 percent effective in an interim analysis of results in a continuing trial in Guinea. Ebola jumps to humans through contact with 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.
Ebola doesn’t travel through the air, making it harder to transmit than many other pathogens as long as proper health-care practices are followed. Thus, the disease’s tear through three impoverished countries raises questions about whether richer nations should focus their aid more on strengthening health-care systems. Assistance programs are often directed instead at combating a particular disease. Defenders of this approach say it gets quicker results, which are measurable. Critics say it creates a duplication of services for different diseases, and leaves few resources for primary care. For its part, the WHO — acknowledging criticisms of its performance — created a special fund and an emergency workforce program to better react to crises such as the Ebola outbreak.
The Reference Shelf
- A CDC Q&A explaining how survivors can spread the virus.
- The WHO’s 2015 plan to respond to the West Africa Ebola outbreak.
- A report on ethics and Ebola by the U.S. Presidential Commission for the Study of Bioethical Issues.
- 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.”
Makiko Kitamura contributed to the original version of this article.
First published April 4, 2014
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