Ebola outbreak: the deadliest in history

As of 4th August 2014 and since the first cases of Ebola were identified in West Africa in July 2014, four countries – Guinea, Liberia, Nigeria and Sierra Leone - have recorded 1711 cases of Ebola and 932 fatalities. 

Global Health defines communicable diseases as ‘diseases which spread from one person to another or from an animal to a person. The spread often happens via airborne viruses or bacteria, and also through blood or other bodily fluids’. Communicable diseases are also called infectious and contagious diseases. In Botswana the prominent infectious diseases are Malaria, Tuberculosis, HIV/AIDS and Diarrhoea. The Deputy Permanent Secretary at the Ministry of Health, Shenaaz El-Halabi says these four diseases are also ‘endemic’ which means they are common or prevalent. El-Halabi further explains that there are ‘emerging and re-emerging’ infectious diseases such as Ebola and Multiple drug resistant MDR-TB and Extensively drug resistant XDR-TB. 

The World Health Organisation (WHO) states that, “An emerging disease is one that has appeared in a population for the first time, or that may have existed previously but is rapidly increasing in incidence or geographic range.” The Baylor College of Medicine’s Department of Virology and Microbiology explains that, “Many emerging diseases arise when infectious agents in animals are passed to humans.” The scientific term for this transmission from animals to humans is Zoonotic. The Baylor College of Medicine further clarifies that in the case of re-emerging diseases this, “Is the acquired resistance of pathogens to antimicrobial medications such as Antibiotics. Both bacteria and viruses can change over time and develop a resistance to these drugs, so that drugs, which were effective in controlling disease in the past are no longer useful.” 

The observations from medical opinion are that any animal species has the potential to host an infectious agent and that for as long as humans have close contact with animals there will be an increase in risk. “When that factor is combined with increases in human density and mobility, it is easy to see that this combination poses a serious threat to human health,” shares the college of medicine. El-Halabi agrees with her colleagues in public health that apart from the four major contagious diseases prevalent in Botswana – HIV, TB, Malaria and Diarrhoea - any other infectious disease, emerging or re-emerging such as Ebola can possibly affect people living in Botswana.

“For as long as we have travellers to and from the infected countries, mixing of individuals from infected countries with others they meet in regional or global meetings and conferences the risk is there.” She also emphasises that in the case of TB, both MDR and XDR, the disease is airborne which means it is easily transmitted. 

The World Health Organisation (WHO) shares the same sentiments with El-Halabi and cautioned in The World Health Report 2007 that, “In our increasingly interconnected world, new diseases are emerging at an unprecedented rate, often with the ability to cross borders rapidly and spread.” The report continues that, “Since 1967, at least 39 new pathogens have been identified, including HIV, Ebola haemorrhagic fever, Marburg fever and SARS. Other centuries-old threats, such as pandemic influenza, malaria and tuberculosis, continue to pose a threat to health through a combination of mutation, rising resistance to antimicrobial medicines and weak health systems.” Infectious diseases are also said to be associated with places or countries with high levels of poverty. 

The SADC region, which is recorded as having one-third of the population of people living with HIV globally, is faced with a triple threat. “Eight SADC Member States are among those with the highest rates of Tuberculosis; and 75 percent of the SADC population is at risk of contracting Malaria. This trio - HIV, TB and Malaria - of diseases is a major threat to sustainable development in the region,” states information from SADC.  The current outbreak of the Ebola Virus has been dubbed the ‘deadliest outbreak in history’. The Ebola virus is emerging. The first case was discovered back in 1976 in the Democratic Republic of Congo, which was then called Zaire. 

The source country for the current outbreak is reported to be Sierra Leone in West Africa, which has recorded 800 fatalities from Ebola. The international media have since reported cases in at least three other different countries such as Guinea and Liberia; a nurse who was affected died in Nigeria; other hospital workers or front line staff in Nigeria were also suspected to have the virus. Two doctors who were working in affected areas in West Africa were quarantined and observed in Atlanta (USA) and a Spanish Priest working in Liberia was flown back to Spain in a medical equipped airplane suspected to be infected with Ebola. At the time of writing the article the WHO had recorded 932 fatalities and certain airlines such as British Airways had stopped all flights to affected areas. 

Saudi Arabia had sent out travel bans to affected regions. Due to the nature and rapid spread of infectious disease, the WHO advises and shares that, “The need for global solidarity is especially clear in the response to outbreaks of infectious diseases.”  El-Halabi says Botswana should be alert about the growing number of cases of Ebola because, “The number of countries infected is increasing. The number of cases and mortalities has increased and it has taken long to control the outbreak. The longer it takes the more difficult it is to contain it at the source country,” shares the Deputy PS. The WHO highlights that, “High and rapid mobility of people is one factor. Airlines now carry more than 2 billion passengers a year, enabling people and the diseases that travel with them to pass from one country to another in a matter of hours. The potential health and economic impact was seen in 2003 with SARS, which cost Asian countries an estimated US$ 60 billion of gross expenditure and business losses.” 

Another contributing factor to outbreaks and spreading of infectious diseases is, “The inadequate investment in public health resulting from a false sense of security in the absence of infectious disease outbreaks”. Since the Ebola outbreak public health activists are quoted as saying that, “Right now, more money goes into fighting baldness and erectile dysfunction than hemorrhagic fevers like dengue or Ebola”. The other arguments are that the Ebola virus is a ‘poor man’s disease’ and that the outbreak is an indication that health systems are ignoring the health problems of the poor. Climate change is also said to be contributing to the emergence of new infectious diseases; people moving from specific areas and diseases spreading into new geographical spaces. 

The Deputy PS shares that social and cultural practices also contribute to the spread of Ebola particularly in West Africa. When a family member dies from Ebola the remaining family wants to clean the body, hold it and sometimes kiss their loved one who has passed on. Ebola is transmitted from infected person via bodily fluids. “Death by Ebola will cause changes to the manner in which we bury the dead. There should be no bodily contact so cremation is the appropriate burial method in such cases.” She also states that there are still people in West Africa particularly those in remote areas who are continuing to eat ‘fruit bats’ and ‘rodents’ because they need the high protein content. 

El-Halabi explains that Botswana might not have carriers or reservoirs of the Ebola Causing Virus. She attributes this to good personal hygiene and feeding characteristics. The prime prevention method for Ebola is as simple as good basic hygiene and taking precautionary measures not to get infected. Front line workers - nurses, doctors - in areas hard hit by Ebola are being seen wearing protective wear to avoid infection; masks, gloves and protective shields over their clothes. A lack of proper equipment and hygienic practices is the likely cause for the transmission from patient to doctor or nurse. Quarantining people or cordoning off infected areas is another step used to stop the spread of the disease. Ebola has a high mortality rate 50 - 90 percent of people infected will die. Even more unfortunate is that there is still no known treatment or vaccine for Ebola.  

What can the public do to prevent an outbreak of Ebola in Botswana? El-Halabi shares that the public should follow government and public health officers’ advice. “Government will advise on the mode of prevention and treatment as the disease (Ebola) evolves.” The Deputy PS stresses that, “Unless absolutely necessary the public should refrain from travelling to Ebola affected countries. Keep good infection control and personal hygiene is recommended at all times.” Public is also advised to promptly visit the nearest health facility if showing any symptoms of an infectious agent. 

Ebola symptoms include initially flu-like symptoms, as well as fatigue, fever, headaches and pains from the joints, muscles and abdomen. Sometimes patients will vomit blood and have blood shot eyes. The public should always take heed of public health advice on how to prevent infection for all infectious diseases as well as the management of infection for those already with the disease, emphasises El-Halabi. “In the case of Ebola we need to be prepared. Should it come to Botswana the system must be able and prepared. The public must also help to facilitate prevention of the illness by following the public health advices.”

At the time of going to print African countries like Zambia had issued travel warnings to its citizens to avoid affected countries.