The countries of Western Africa are facing a medical crisis of an intensity not observed before. The Ebola Virus Disease (EVD) has so far claimed upward of 1,000 lives and has infected more than 2,000 individuals in Guinea, Sierra Leone, Liberia, and Nigeria. The worst part of this epidemic with grave casualties, both civilian as well as medical professionals, is that there seems to be no end in sight. The individual cases for this disease have managed to appear as distant from each other as a hundred miles, making containment of the virus extremely difficult.
History and first appearance of EVD
First appearing in Zaire, or the Democratic Republic of Congo, in 1976, the virus claimed almost 280 lives before it was contained. In the same year it also caused a similar outbreak in Sudan. The disease got its name from a river in Zaire close to one of the first epicenters of the disease. Since then, the Ebola virus has appeared in regular outbreaks on the African continent. From the heavily affected country of Guinea to the usual epicenters of Uganda, DR Congo, and Sudan, among many others, it has spread rapidly.
Research indicates that the disease was first introduced in the human population through close contact with infected animals. Handling infected gorillas, chimpanzees, fruit bats, monkeys, antelopes, etc., found ill or dead in the bush, was the commonly documented method of contracting the virus. Fruit bats have often been considered the possible natural hosts of this virus.
This disease has been associated with great stigma in the African regions. Past outbreaks resulted in survivors being ousted from their communities; some were even abandoned by their partners. Funeral practices that bring mourners in contact with the deceased can also put them at risk of contracting the disease.
In some African tribes, healing rituals, including invasive techniques like cutting or bleeding, also lead to the increased spread of the Ebola virus. Some outbreaks of Ebola also saw the victims’ personal belongings and homes torched by mobs because of a lack of understanding of the disease. This misunderstanding persists even today.
Ebola virus vaccine and treatment
There are no licensed vaccines or treatments available for the Ebola virus. However, its rampant spread in various parts of Africa has brought about a change. Many pharmaceutical manufacturers are now trying to be the first to reach the finish line with a treatment.
Considering the relatively small number of people infected by this disease, it was not until the recent outbreak of Ebola, the worst ever documented, that the World Health Organization (WHO) finally made it a priority. Only recently Canada said it will ship up to 1,000 doses of its experimental Ebola vaccine, VSV-EBOV, to Africa to battle this outbreak. But even that may prove to fall much short of the mark.
Another treatment drug called ZMapp, manufactured by Mapp Biopharmaceutical, has so far only been tried on monkeys and has shown positive results. Two American citizens who were infected with the disease in Liberia were given this serum with positive results. The treatment gives the infected individual antibodies directly rather than waiting 2‒3 weeks after vaccination for the antibodies to work.
It usually takes the immune system 2‒3 weeks to get to a protective level after a vaccination. In outbreaks, like the one being witnessed by Africa, such vaccines often will not help. However, keeping in mind the gravity of the Ebola pandemic, the WHO declared that it was “ethical to offer unproven interventions with as yet unknown efficacy and adverse effects as potential treatment or prevention.”
Only one drug so far has moved to the early testing phase in humans. Called TKM-Ebola, this drug is manufactured by Tekmira Pharmaceuticals. It interrupts the genetic code of the virus and prevents it from making the disease-causing proteins. It was tried on healthy volunteers in early 2014 and the manufacturer has indicated that its human studies will resume soon.
Serum from individuals who have managed to survive the disease can also be used to neutralize the virus. American authorities are leaning toward fast-tracking the development of these medicines so as to make them available from 2016.
The spread and types of the Ebola virus
During the initial outbreaks, with no protocol to be followed for containment, hospitals ill-prepared for the disease often acted as amplifiers. With many of the victims of this disease being healthcare workers, this also gave rise to the rumor that it was a disease brought by healthcare professionals.
Many medical facilities were forced to shut because of the high number of deaths among staff members due to the disease. This worked in favor of checking the spread of the disease by eliminating the need to use unsterilized needles and the lack of barrier-nursing techniques. Quarantine protocols were soon enforced as the transmission of the virus began to be understood, and patients in affected villages were segregated.
Five main strains of the Ebola virus that have been identified:
- Bundibugyo ebolavirus (BDBV)
- Zaire ebolavirus (EBOV)
- Reston ebolavirus (RESTV)
- Sudan ebolavirus (SUDV)
- Tai Forest ebolavirus (TAFV).
The Ebola Virus Disease outbreaks in Africa have been attributed to BDBV, EBOV, and SUDV. The RESTV strain, found in the Philippines and China, can infect humans, but no death from this has been reported to date.
Symptoms and diagnosis
The onset of the Ebola Virus Disease is often accompanied by fever, intense weakness, muscle pain, headache, and a sore throat. This is followed by diarrhea, vomiting, rashes, impaired kidney and liver functions, as well as internal and external bleeding. Laboratory results have shown the victims to have a lower than normal white blood cell and platelet count along with elevated liver enzymes.
This virus has an incubation period of 2‒21 days, which means that the time interval from infection to exhibiting symptoms is lengthy. As long as the virus is present in the blood and other secretions it can still be contagious. The disease has a fatality rate of up to 90%.
Diagnosing this disease is essentially a process of elimination. Other viral hemorrhagic fevers such as cholera, shigellosis, typhoid fever, malaria, and meningitis, among others, should be ruled out. Ebola virus infections can be identified definitively through tests like:
- Antibody-capture enzyme linked immunosorbent assay (ELISA)
- Antigen detection tests
- Serum neutralization tests
- Reverse transcriptase polymerase chain reaction (RT-PCR) assay
- Electron microscopy
- Virus isolation by cell culture
Tests for this disease are a biohazard and the cultures should never come in contact with the handler. The tests should always be conducted in maximum containment.
Impact of the disease on the world
The fragile economies of the already impoverished West African nations have been put in serious jeopardy because of this pandemic. Sierra Leone disclosed that up to 32 nurses had died from Ebola in the course of their duties between May 24 and August 13. Guinea has already declared a state of “health emergency” and has ordered strict controls at border points; it has banned moving bodies between towns until the epidemic has been controlled. The rating agency Moody’s has warned that if there is a serious outbreak in Lagos, where a fourth victim of Ebola was identified recently, it could seriously hamper the oil and gas industry in Nigeria.
Many senior health professionals working on the frontlines have said this epidemic will likely take more than six months to get fully under control. It now remains to be seen if the radical spread of this disease is checked in time or if we are just going to see the number of fatalities rise.
Michael Georgiou is a dynamic business and marketing professional in the marketing division of Wilson Law, PA based in Raleigh, NC. He is an entrepreneurial guru with a proven success record in creative strategy, online branding, project management, and communication projects in both public and private sectors.