Here is an op-ed piece that I wrote last week reflecting on the Ebola outbreak.
As part of the team that updates a news website, bioethics.com, I have been documenting the Ebola outbreak since it first hit the international news in March. Looking back over the headlines between now and then, you get a sense of the progression of the outbreak. On March 27, I posted an article from ABC News reporting that 103 people in Guinea had Ebola and 66 people had died. After that, there was a lull until June 4 when I posted an article from The Guardian that 208 people had died from Ebola in Guinea. At that point it was dubbed “the worst ever outbreak of the disease.”
Every week I would post at least one article with an updated death toll as the outbreak spread through Guinea, Sierra Leone, and Liberia. I posted articles on the weak medical infrastructure in these countries that was exacerbating the effects of the outbreak, and ways that these countries improvised to accommodate the influx of patients. On July 24, I posted that Sierra Leone’s top doctor was infected. On July 29, I posted that he had died. In August, I posted articles about two Americans working in West Africa who were infected and flown back to the states to receive medical treatment, including an experimental Ebola drug that had not been used in humans. On August 9, I posted an article that traces the first Ebola case for this outbreak to a two-year-old boy in Guéckédou, in southeastern Guinea, who died on December 6. His whole family died a week later. I posted articles on country-imposed lock-downs, aid workers being attacked, and people with other illnesses being left untreated because too many doctors had died and too few beds were available. Finally, before writing up a summary of the outbreak for bioethics.com, on September 25, I posted an article from The Wall Street Journal stating that 2,917 people have likely died from Ebola, although the count might be higher, and there has been a total of 6,263 confirmed cases, all concentrated in Guinea, Sierra Leone, and Liberia.
Prior outbreaks of this form of Ebola (Zaire ebolavirus) had occurred in sparsely populated areas that remained relatively contained. The current outbreak has been particularly destructive because of a combination of population size, lack of medical resources, and poor infrastructure. By way of example, compare the outbreak in Guinea, Sierra Leone and Liberia to Nigeria. Nigeria is Africa’s most populous country. They identified the first patient early, and the public health authorities engaged in a concerted effort to visit every person that may have had contact with the Ebola patients and continuously monitored them for symptoms. They eventually identified all twenty people that had contracted Ebola. They followed protocols for isolating individuals and providing proper medical care resulting in a survival rate of 60%, higher than the afflicted West African countries. A report in The New York Times says that by August 31, the last confirmed case in Nigeria was detected. All other contacts passed the 21-day incubation period.
Why did Nigeria contain the outbreak while Guinea, Sierra Leone, and Liberia did not? They had the infrastructure already in place. Nigeria already had a public health center with qualified professionals, including some from the CDC, to combat Polio and HIV, which have been on-going problems in the area. The center ‘s resources were turned toward containing Ebola, and through concerted efforts successfully eradicated the outbreak in their country.
This is an example of the difference between a country without an infrastructure and resources and a country with them. Liberia, in particular, has been severely hit by this outbreak because their country was still in the process of rebuilding itself after being ravaged by a civil war that ended in 2003. I posted several news articles speculating on the lasting effects that the Ebola outbreak will have on Liberia’s economy and social structures.
Because I had been following the outbreak from the beginning, I had a certain attachment and concern for the people involved even though they were an ocean away on a continent I had never seen. My summary piece was due to my editor on Tuesday, September 28. I turned it in on Tuesday morning. By Tuesday evening, I was taking notes on a televised press conference regarding the first positive case of Ebola in the U.S., which happens to be in the city where I live.
According to the CDC’s press conference and follow up information provided by the patient’s family, Thomas Eric Duncan left Liberia on September 19, flew to Brussels, then to Washington, DC, and arrived in Dallas on September 20. People leaving Liberia are checked for a fever before leaving the country as this is the first symptom of Ebola. He did not have a fever, which meant the virus was incubating in his system. The way Ebola (and most viruses) work is patients are not contagious during the incubation period, but are once they show symptoms. The patient did not express symptoms until September 24 and sought treatment on September 26, at which point Texas Health Presbyterian wrongly sent him home with antibiotics. He returned on September 28 when his symptoms worsened and was admitted to the hospital.
Now the headlines are not across the Atlantic, but a little over ten miles away. The situation is completely different from the one in West Africa. I have no doubt that Dallas has the infrastructure and personnel to contain this Ebola case, even in light of the hospital’s failure to follow protocol, but it is still strange to have been following this story for so many months, only to find my research is now outside my proverbial front door.