Story-ideas-1011172

Ebola - humanitarian tragedy on monumental scale

  • BARRY SCHOUB
The extent of media coverage of the current Ebola outbreak in West Africa has surpassed even the swine influenza scare of 2009. Much of it has been alarming and global bodies have responded accordingly. On August 8 the Director-General of the World Health Organisation declared the disease a public health emergency of international concern. PROFESSOR BARRY SCHOUB, recipient of the Jewish Report Achiever Award for Arts, Science, Sports & Culture in 2012, volunteered his services to explain more about it for SAJR readers. This is a fascinating read…
by PROF BARRY SCHOUB | Oct 29, 2014

Soon after, the UN Security Council, on reviewing the unprecedented extent of the outbreak, declared it a threat to international peace and security. As at October 22, 10 114 cases and 4 912 deaths (49 per cent) had been recorded in the three affected countries, Liberia, Guinea and Sierra Leone.

These are only the officially recognised cases; undoubtedly the numbers are significantly higher and certainly the death rate is considerably greater - more likely 70 per cent. The epidemic has shown no signs of abating and with the number of cases doubling every 20 days, it is predicted to reach 20 000 by early next month and the Centre for Disease Control in the US calculated the figure to be 1,4 million by the end of January next year.

There are now grave concerns that the Ebola epidemic could destroy what is left of the civic structures in the three main affected countries. To date 450 healthcare workers have been infected and 244 have died, dramatically depleting the meagre health resources of these poverty stricken countries and further aggravating other formidable health challenges such as malaria and diarrhoeal disease.

Their fragile economies have also been hard-hit by the necessary control measures such as the curtailment of movement affecting, among others, the food supply. Ebola is truly developing into a humanitarian tragedy on a monumental scale. How did this come about and what are the risks of this dreadful epidemic spreading beyond these countries?

Ebola is a new disease, with the first outbreak recognised in 1976 in Sudan and Zaire (now the Democratic Republic of the Congo. The virus was named after the Ebola River in the DRC.

Since then there have been some 25 outbreaks in eastern and central Africa, each involving a few hundred cases, with death rates varying from 25 to 90 per cent. These outbreaks have generally lasted from a few weeks to a few months and have then died out

The virus is spread by direct contact with infectious body fluids from a patient who has developed symptoms of the disease. There is no evidence of it being spread by any other means, including through the air.

Therefore, by identifying a patient and isolating him/her for 21 days (the upper limit of the incubation period of the infection), as well as identifying contacts and similarly quarantining them for 21 days, the epidemic should be stopped in its tracks. Indeed this has been the case in the US and Spain, as well as in Senegal and Nigeria, following isolated imported cases.

Paradoxically the infection should be relatively easy to control, but why then has it spiralled out of control in West Africa where it has now lasted close on a year and is still on an upward trajectory?

A number of socio-economic, political and cultural factors are involved. These three countries rank among the poorest in the world - the multi-dimensional poverty index of the UNDP (United Nations Development Programme) puts Guinea having the highest rate of severe poverty in the world, 68,6 per cent, with Liberia and Sierra Leone not too far behind at 52,8 per cent and 46,4 per cent respectively.

Liberia and Sierra Leone have also just emerged from ruinous civil wars, further aggravating the resistance, distrust and anger of the communities and several healthcare workers have even been murdered. Ingrained cultural practices, especially relating to the preparation of the dead for burial, have promoted the spread of the virus in at least 50 per cent of cases. Health services are pitiful. For example, Liberia has 0,1 doctors, 1,7 nurses and eight hospital beds for every 10 000 people.

Could infection spread beyond the three affected countries? Fifteen countries with land borders have been on high alert for potential importation. But what of more remote spread by air travel, as has occurred in the US, Spain and Nigeria?

Fortunately control is facilitated by the virus only becoming transmissible once symptoms of the disease develop. The risk from a planned medical evacuation under strict bio-containment is extremely remote. However, unplanned entry of infected patients may pose a somewhat higher risk to healthcare workers and other contacts, particularly if Ebola is not suspected.

Ebola is thus not an imminent threat to countries outside of those already affected, other than the isolated imported sporadic cases, but there is no cause for concern that these could develop into significant outbreaks. However, the history of global health will, in the future, record this Ebola outbreak to be one of the humanitarian disasters of this century.

  • Barry David Schoub MB BCh, MMed , MD, DSc, FRC Path, FCPath,  FRSSAf, MASSAf was appointed the first professor of virology at Wits in 1978; director of the National Institute for Virology, 1982 and founding executive director of the National Institute for Communicable Diseases,2012, retiring in August 2010.
  • He served on several international advisory committees of WHO including polio, measles, RSV, influenza, the Advisory Committee for Poliomyelitis Eradication [ACPE] and the International Health Regulations [IHR], as well as the Board of the International Association of Public Health Institutes (IANPHI).
  • He was founding chairman of SA’s National Advisory Group on Immunization. He has published over 280 scientific publications.
  • Among his awards are: the Order of Mapungubwe from the State President; the Paul Harris Award of Rotary International; the 2012 Jewish Achievers Award; the first Lifetime Achievement Award of the African Society for Laboratory Medicine.

 

3 Comments

  1. 3 Denis Solomons 14 Nov
    At first glance , like avian influenza, severe acute respiratory syndrome ,and HIV / AIDS before it , might seem like a particularly modern epidemic , a product of globalisation , fragile states , and social economic shifts that are placing ecosystems under increasing strain. But in other respects Ebola has more in common with the epidemics of yellow fever and cholera of the 18th and 18th centuries.
    Then ,as now,reports of the spreading depradations, carried on ships plying the triangular trade between Africa, the Caribbean and Europe , or by Jewish immigrants fleeing pogroms in Tsarist Russia , fuelled colonial fears of the " dark continent " and contamination from the " uncivilised " East.Then as now the loss of bodily fluids was deeply disturbing to a culture grown accustomed toconcealing human emissions behind a veil of polite discourse. And then, as now, politicians struggled to balance free trade concerns with the growing popular clamour for restrictions to safeguard public health and national security. 
  2. 2 Denis Solomons 17 Nov
    18th and 19th centuries !
  3. 1 Denis Solomons 24 Nov
    Health care professionals treating patients with Ebola have learned that transmission arises from bodily fluids of a person who is symptomatic - that is has a fever , vomiting , diarrhoea and malaise .
    there is a strong reason to believe that transmission occurs when the viral load is high , on the order of millions of virions per microlitre. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid.Therefore an asymptomatic health care worker returning from treating patients with Ebola , even if he or she were infected , would not be contagious. We also know that workers who are unknowingly infected would not be contagious.
    We should be honoring not quarantining health care workers who put their lives at risk not only to save people suffering from Ebola virus disease in West Africa but also to help achieve source control., bringing the world closer to stopping the spread of this killer epidemic !

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