Malaya Pimentel-Santos, MD
“Ebola virus disease is a severe, often fatal illness, with a case fatality rate of up to 90 percent. It is one of the world’s most virulent diseases.” – WHO
My breath catches and my hands shake a little as I write, and I watch with dread as the crisis continues to unfold. As of August 4, 2014, the World Health Organization (WHO) has reported 1,603 cases of Ebola virus disease (EVD) and 887 deaths, across four countries in West Africa. Seven months after the estimated start of what has now become the worst EVD outbreak in history, new cases are still being found, and the death count is rising.
Already, several health workers have been infected. Two physicians at the forefront (one from Sierra Leone and one from Liberia) have died from the disease. And still the numbers keep climbing. Transmission is actively ongoing in the community and sadly, even in the treatment centers. With all of this is happening in one of the poorest regions of the world, it is the stuff that bad dreams and Hollywood movies are made of. Only this time, it’s real.
On the surface, 887 deaths in four countries may not be much, but already the deadly virus has wreaked havoc throughout the region, and across the world. Flights have been suspended, borders have been closed; school and sports activities have been cancelled; riots have occurred. WHO Director-General Dr. Margaret Chan has been quoted as saying that a failure to contain this outbreak could be “catastrophic”.
This lethal virus was named after the Ebola River in Zaire (now the Democratic Republic of Congo) where the first known outbreak occurred in 1976. Ebola is a filovirus, a group of viruses distinguished by their unique thread-like appearance. It is one of a broader group of viruses known to cause a disease syndrome known as viral hemorrhagic fever (other viruses that cause hemorrhagic fever are dengue, lassa and yellow fever).
Ebola is one of the deadliest viruses known to infect man. It has no specific treatment, no vaccine, and no cure. Several distinct species of Ebola virus have thus far been recognized. Data varies and for every 10 persons infected with the virus between six to nine will have fatal disease. This current outbreak involves Ebola-Zaire, the most virulent and aggressive of all the species.
Previous outbreaks have been traced to non-human primates and other sources of “bushmeat” (meat from wild animals). Infection is transmitted from person to person though contact with blood and body fluids such as saliva, stool, urine, sweat, and vomit. It can also be spread via objects – such as masks, gowns, and linen – contaminated with these body fluids. In order to prevent transmission, diagnosed cases must be isolated and strict precautions taken during their care. Patients are also given fluids, electrolytes, and others forms of supportive care.
The 2014 EVD outbreak is thought to have started in the early part of this year. The first official report was made by Guinea on March21. In the days and weeks that followed, the outbreak evolved rapidly, with additional cases and fatalities reported in the neighboring countries of Liberia and Sierra Leone. One patient is said to have travelled from Liberia to Nigeria, where he later died. Case count in Nigeria is currently at four. Every day, hundreds of cases are being reported across the region.
The biggest question in my own mind at the moment is: Why are health providers getting infected? Transmission is supposed to be prevented by using standard “barrier nursing” procedures. I guess the key phrase here is “supposed to be”. Although the infection control techniques are well known, applying them on the ground is a different matter.
News reports have described the sheer, overwhelming scale of the outbreak: Patients being treated in makeshift treatment centers by health workers dressed in protective gear resembling space suits, in 40-degree weather. And while previous EVD outbreaks were mostly confined to rural areas, this one has spread to highly populated urban centers in three adjacent countries, as well as to Nigeria. Fear and a lack of information have resulted in a reluctance to seek care. In some instances suspicion has been directed towards health workers, who have even been blamed for spreading the disease.
Outbreak response plan
The WHO has graded this outbreak as a level three emergency, and a large multinational and multisectoral response plan is currently in place. Between now and December, human and financial resources will be mobilized, implementing a scale-up in surveillance, case management, infection control, and public awareness.Besides the WHO, the US Centers for Disease Control and Prevention, and humanitarian organizations such as Médecins Sans Frontières, Red Cross, and Samaritan’s Purse (at least twi of whom have been infected) are at the forefront of the fight against the disease.
Even so, EVD appears to be spreading faster than the response. As I watch the story unfolds, my heart goes out to those who have lost their family and friends to this dreadful disease. It is my fervent hope that science and medicine will soon triumph against this terrible adversary. And it is my further hope that once the outbreak is contained, that we can soon find a cure – and a vaccine.
My hat goes off to the named and unnamed workers at the frontlines who have set aside personal concerns in order to care for those afflicted. Their dedication and compassion are unparalleled. They are no less than the superheroes of the medical profession, the medical champions of humanity.
VitalSigns Issue 66 Vol. 3, August 1-31, 2014