The current outbreak of Ebola is getting pretty big, with ~4000 dead so far this year. The number of dead has doubled (with remarkable consistency) every 33 days so far, with no signs of slowing down despite whatever efforts are being made. There have been seven or eight previous outbreaks but the worst of them killed a couple hundred people at most.
Why is this outbreak so different from past ones? How were the past outbreaks stopped? and why aren’t those approaches working with the current outbreak?
Normally Ebola outbreaks happen in isolated rural areas. Viral Hemorrhagic kill quickly, so normally an outbreak would burn itself out before it spread far. This is the reason they are such a concern in urban areas.
There may well be other factors but one factor is that earlier outbreaks occurred in small rural villages and authorities were able to recognise the disease in time and limit travel and quarantine areas to limit its spread.
In this outbreak ebola had never been seen before in west Africa , it took several months for local doctors to realise the deaths were ebola rather than another disease and by that time it had spread over a wide enough area that local containment failed.
Once it reached the capital cities of guinea and Liberia that was it.
The World Health Organization knew ebola had occurred in March. It could have initiated a major effort then but didn’t–it was quite complaisant instead.
What are the chances that ebola becomes endemic, similar to polio or smallpox? That is, the disease indefinitely finds new human hosts without using any animal hosts.
As others have said, prior outbreaks occurred in rural areas, in small groups of people who did not have a great deal of outside contact. The disease would rip through such communities and within a month or so everyone vulnerable had had the disease and was either dead or recovered from it (although some people suffer long-term effects from damage the disease causes to the body).
Reaching a densely populated urban area is new.
A virus does not need to be airborne to become endemic - polio is water borne, as are thyphoid, cholera, and the various dysenteries. Typhus comes from lice. Malaria is blood-borne and transmitted by mosquitoes. And so on.
Could ebola become endemic? At it’s present virulence it’s unlikely due to both killing off hosts too quickly for truly efficient spread (really, it’s not as contagious as a lot of other diseases, it’s just that the common cold isn’t likely to kill you) and world-wide fear that will now bring more resources to bear on eradicating it from populations.
The animal reservoir is still out there, of course, in that sense it is already endemic, although in a different species than humans.
I am wondering how long the virus can live on a surface. A nurse contracted it by touching her face with a contaminated glove. This tells me it can enter through the skin from a contaminated surface which makes it more scary. I am wondering if the virus has picked up a little more ability to live on surfaces longer. With a 21 day incubation period it is not hard to imagine a real disaster on a global scale.
We’d have to ask Colibri, but I didn’t interpret that as a religious statement. I think it was sarcasm : essentially, nothing but luck has prevented a major outbreak in the very recent past. On a broader view, the reason these lethal outbreaks are possible is because Africa’s population has been growing and rapidly becoming urbanized. In the past, people lived in smaller villages, didn’t trade as much, and there weren’t as many of them.
But these trends establish themselves slowly over time : the conditions were probably ripe 5 years ago for an outbreak, but ebola probably doesn’t spread from it’s animal reservoir all that readily.
Pure chance is why we didn’t have an outbreak this major last year, the year before, etc. Or “prayer”.
It makes me wonder if we can learn something from those few, isolated areas of previous outbreaks. I heard one of the patients here in the US got a transfusion from one of the patients that lived. Perhaps there is a reservoir of people out in the rural areas of west Africa, who have lived thru the infection, where we could get antibodies? Is anything like that being considered at this point?
I based the note in part on the poster’s past history. If it wasn’t witnessing, then it could be taken as religious jab or trolling. If it was sarcasm, that should have been made explicit. A drive-by, one-word post like that was inappropriate for GQ, regardless of how it was intended.
May I ask you – or whoever – to give a little detail? Is it that they hemorrhage but survive, and the capillary damage is the collateral damage? Or is it something else? (Hmm, come to think of it: if the disease comes to internal hemorrhaging, is that it, game over, you’re a goner?)
Keep in mind that the disease causes extensive effects throughout the body. One of the major post-Ebola symptoms is fatigue and reduced stamina, which sounds to me like some sort of diffuse damage to the entire system leading to weakness and less efficient working of the body. Joint pains and a sort of generalized inflammation are also frequent among people suffering long-term effects. All of that, by the way, can be devastating for someone living by low-tech subsistence farming requiring a lot of manual labor. Other effects are inflamed testicles (obviously, a male-only symptom), peeling skin, and hair loss. It can affect the eye, leading to light sensitivity (that can’t be fun in tropical Africa), chronic irritation, or even blindness.
Internal bleeding isn’t always fatal, especially with access to modern medicine, but it can cause damage to internal organs so take your pick: liver, kidneys, lungs, brain…
These effects can persist for years after the infection is over, and in some cases are likely permanent.
Not everyone who survives will suffer long-term effects. There are even likely to be people out there walking around who had Ebola and didn’t know it because in them the disease did not manifest as strongly as normal. There’s a lot we don’t know about this virus, especially among survivors because I don’t think anyone has studied the survivors much. I think the assumption was “oh, they got better” and it’s only recently anyone has bothered to look into it.
The 1976 outbreak in Zaire reached the urban capital of Kinshasa and spread to medical workers who were treating a patient who traveled from the rural Yambuku Mission hospital. That was before anyone knew what was killing people in Yambuku.
What kept it from spreading to family members of the medical staff in Kinshasa is plain dumb luck. The nature of the illness and its transmission were unknown. Patient care was conducted without gloves or other barrier means.
As to obtaining blood transfusions from survivors… it needs to be relatively recently after recovery to be of much use. Otherwise the active antibody count in the blood drops back down.
It doesn’t help that Liberia recently had a couple of very damaging civil wars. Civil infrastructure is shaky, to say the least.
There was recently a paper in Science tracing the genetic history of this outbreak. In previous outbreaks, people have been in contact with the natural reservoir (probably bats), allowing multiple transmissions to people. This is the first outbreak in West Africa, and it appears that it’s been solely maintained by human-human transmission. The current strain is similar to the 2007-2008 outbreak, and is thought to have split from the larger central-African reservoir around 2004, based on the rate of mutation. They didn’t draw any conclusions about whether the current strain is any more virulent than previous ones.