The latest outbreak of the Ebola virus is of global concern. But it highlights our blindspots and hysteria when it comes to contagion. By Mike Seccombe.
Ebola panic real, but worse contagions are rife
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The world will probably never be sure exactly where or when the worst-ever outbreak of the Ebola virus began. But the educated guesswork of the relevant health agencies now suggests it began some time last December in the steamy jungle of southern Guinea, with a hunting expedition for bush meat.
It might have been any one of a number of kinds of bush meat. The World Health Organisation (WHO) says Ebola infection has been previously documented through the handling of infected chimpanzees, gorillas, forest antelope and porcupines.
But most likely it was a fruit bat. Unlike other species, fruit bats can harbour the virus without themselves becoming sick. And they are commonly eaten in those parts.
Cooking usually kills the virus, so the transmission would have occurred when the kill was fresh, maybe through a cut or by being rubbed into a mucous membrane, such as the eyes or nose. Whether the prey was consumed by the hunter or sold in a market, we don’t know.
Months passed before the wider world became aware of the growing epidemic. On March 10 this year health officials in the towns of Guéckédou and Macenta, about 700 kilometres south-east of the capital, Conakry, informed the national health authorities about an outbreak of a mysterious disease. They reported it had killed not only a number of patients but also some local medical staff.
If this lag time seems long, bear in mind that Ebola was not thought to be endemic to the area, and its initial symptoms of aches, fever, severe diarrhoea and vomiting are typical of a number of other diseases, including malaria. Indeed workers for the medical charity Médecins Sans Frontières (MSF) – who were informed a couple of days later – were carrying out a malaria project in the area at the time, and also dealing with a cholera outbreak.
Things began to move much faster after those authorities were notified. A specialist team from the health ministry arrived four days later, and another from MSF Europe arrived a few days after that. Samples were taken and flown to France and Germany for analysis. The results confirmed the worst: the Zaire strain of Ebola.
But the outbreak was moving fast, too. On March 23, according to WHO data, about 50 cases had been identified in Guinea. Then a few began to be reported in neighbouring Liberia. Within three weeks the cumulative number of Ebola cases passed 200, still mostly in Guinea.
In late May, though, the epidemic moved into Sierra Leone and took off, from zero to almost 400 known infections in just seven weeks. Shortly after that the number of cases in Liberia jumped almost as sharply from the low double digits in early June to more than 300 by late July.
As of early Thursday this week, according to the WHO, the total number of confirmed cases was more than 1700, and there had been 932 deaths.
Since it was first identified in Zaire (now the Democratic Republic of Congo) in 1976, there have been more than two dozen outbreaks of Ebola, but nothing like this one. It’s not just the numbers of cases that make it different, although there have been four times as many as occurred in the previous biggest epidemic.
In the past, the outbreaks have been of relatively short duration and then they have faded out. They have been confined to remote areas. They have not crossed borders.
This one, though, is not fading out. It has crossed borders and moved into cities, starting with Conakry, which has an estimated population of 1.5 million. As of August 1, the US Centres for Disease Control (CDC) reported 95 cases there, 41 of them fatal.
In Monrovia, Liberia, population about one million, people have reportedly dragged dead bodies into the streets, to avoid the prospect of quarantine. And in Sierra Leone, which has had the most Ebola cases, troops have been mobilised to help police enforce quarantine restrictions and quell civil disturbances in the capital Freetown, population about 850,000.
Worryingly, Ebola also has moved into Africa’s largest city, Lagos, population somewhere between 10 and 20 million crowded people. At the time of writing, there have been two deaths in Nigeria: an American man of Liberian descent who fell ill on a flight to Nigeria, and a nurse who treated him. On Wednesday, health authorities there said there were at least five more suspected cases, and there are some 70 other known contacts.
Back in the three West African countries where the plague continues to rage, medical authorities are struggling to persuade an uneducated populace that they are there to help. Many see health workers, kitted out like extras from Star Wars, as a threat. They see loved ones taken away, and they never come back. In some cases, Ebola victims have been forcibly busted out of isolation units. In other cases, health workers have been held off with weapons while the sick hide.
Many Western nations, including Australia, have issued travel warnings to their citizens. Some airlines have ceased flights to and from West Africa. WHO officials reckon this crisis may persist for months more, at least. The World Bank has pledged $200 million to the fight. The WHO emergency committee is conferring on whether to declare a “public health emergency of international concern”, and what actions might follow.
All in all, it’s a terrible tragedy, and it will be a tragedy for some time to come.
But no problem is ever so bad, it seems, that some people will not try to exaggerate it. There have been some wild and occasionally horrifying claims made about the West African outbreak.
The founder of France’s racist National Front party, Jean-Marie Le Pen, suggested it could solve the global population explosion and by extension Europe’s “immigration problem”.
In the United States, right-wing shock jocks have begun warning – on the basis of no evidence at all – of the threat of Ebola-infected illegal immigrants coming across the Mexican border. The mixture of illegal immigrants from Ebola outbreak countries, and others from Pakistan, Yemen and Somalia, one widely syndicated radio host warned, “sets the stage for … a biological attack on America”.
Numerous mainstream media have run stories hinting at the possibility terrorists could “weaponise” Ebola.
Just last week, that paragon of populist stupidity and former Republican presidential hopeful Donald Trump tweeted his terror at the thought of two infected US aid workers being flown home for treatment.
“Stop the EBOLA patients from entering the U.S.,” squealed Trump. “Treat them, at the highest level, over there. THE UNITED STATES HAS ENOUGH PROBLEMS!”
Hardly any wonder then, that CDC officials reported being deluged with hundreds of hostile phone calls from panicked people opposed to the repatriation.
To be fair, there is something about this disease that taps our most primal fears. It emerges at unpredictable intervals from darkest Africa and kills most of those who contract it, in a most horrible way. Its provenance remains uncertain and there is no vaccine or cure.
While the media here have been comparatively restrained, New York’s Daily News covered its front page on Tuesday this week with the headline “EBOLA SCARE IN CITY” and the sub-head “Test result looms as NYers wait in fear”. The test came back negative.
Even sensible journals such as The Washington Post and The New York Times have taken to running extensive stories about cases proved not to be Ebola.
Australia has had its own panics in the past. Professor Lyn Gilbert of the Marie Bashir Institute for Infectious Diseases and Biosecurity, at the University of Sydney, recalls that decades ago, after Ebola first appeared, the federal government built a special high-tech unit at Fairfield Hospital in Melbourne.
“It turned out to be a bit of a debacle. The first time it was turned on with some volunteer dummy patients the negative pressure in the room was so strong the ceiling fell in,” she says.
“As far as I know only two patients were ever admitted to that unit,” Gilbert says. “One was an Australian missionary who’d actually developed Lassa fever [another, similar haemorrhagic fever] and been evacuated to Britain, where she recovered, then came to Australia for a holiday. She’d been here a couple of days when they more or less arrested her and put her under quarantine. For a very nice, gentle Christian lady, she was extremely annoyed.”
The other one was an African businessman who proved to have nothing more serious than sore throat.
“After a while the unit was effectively closed,” says Gilbert.
These days, she says, Australia is much better prepared, with secure labs and isolation units in all the states, and detailed response plans. Still, given the way popular fears have been stoked over the latest Ebola outbreak, it seems a reality check is called for.
Consider this: Every three days measles kills more people around the world than have died in the whole West African Ebola outbreak. Tuberculosis kills more people every day than have died in all the Ebola outbreaks combined.
Each year, there are 1.6 billion cases of diarrhoea worldwide, caused by various bacterial, viral and parasitic organisms. It is the greatest killer of children under five, about 760,000 each year. On average, about 3000 Australians over the age of 50 die from influenza each year.
There are good reasons why Ebola falls so far down the list of deadly diseases.
For a start, it’s endemic to a relatively limited area in Africa.
Also, says Grant Hill-Cawthorne, a virologist and lecturer in communicable disease epidemiology at the Marie Bashir Institute, its not very transmissible. “It’s harder to transmit than influenza or the common cold,” he says. “It essentially requires contact with some secretion, usually direct contact, through mucous membrane contact or broken skin.”
People do not become infectious until they exhibit symptoms – again unlike the flu, which spreads rapidly because sufferers are at their most infectious before they even know they have it. “If you take reasonable precautions, it’s actually quite easy to control,” says Hill-Cawthorne.
If we’re going to worry, he suggests, better to worry about other health threats. “Tuberculosis, for example,” he says. “Queensland in particular has been seeing a big increase in extensively drug-resistant TB, coming over from Papua New Guinea. I believe last year they had seven or eight cases of extensively drug-resistant TB. And TB is far more transmissible than Ebola.
“The other thing we should be more concerned about is the impact of climate change,” Hill-Cawthorne says. “Increasingly, we are concerned about the spread of the mosquitoes which carry diseases like West Nile virus, dengue, chikungunya virus coming south as far as Sydney. Then there’s H7N9 [avian flu], which continues to bubble in China. The MERS coronavirus in the Middle East, which has seen a very high number of cases. And we’ve got a far higher level of contact there than with West Africa. I think we’re more likely to see a MERS case emerge here than an Ebola case.”
Professor Peter Collignon, microbiologist and director of the infectious diseases unit and microbiology at Canberra Hospital, is another who says there are far bigger concerns than Ebola.
“I think we should be really worried about multiresistant bacteria, because we have antibiotics that are no longer working, due to a mixture of using too many in people – three-quarters are used in food animals – and using them in an uncontrolled way,” Collignon says.
“That’s a big deal. If you look at malaria, it’s developing resistance around the world,” he says. “We’ve got resistant TB. In China and India now, the common bug E. coli – half of them for practical purposes are untreatable. We’ve got poor water supplies in a lot of countries, so you ingest them when you visit.
“We know that when Australians visit South-East Asia, more than half come back with superbugs in their bowel. Then if they’re unlucky enough to get appendicitis or a liver abscess or gall bladder disease, these opportunistic bacteria can come from the bowel, and you have a very difficult-to-treat infection. Perversely, the more corrupt and incompetent a country is, the more antibiotic resistance you tend to have.”
One could recite all the risks at vast length, but the lesson is clear, and it’s not just that Ebola is a major threat. It is that instilling good infection control, good governance and education around the world makes us all safer.
That’s worth thinking about in the months to come, when the government announces its cuts to the aid budget.
This article was first published in the print edition of The Saturday Paper on August 9, 2014 as "World Ebola panic".
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