Crash Course on Ebola (Essay)

Ebola Virus at 108,000 Magnification

Ebola Virus at 108,000 Magnification

Most people’s view of Ebola is probably informed by Hollywood — they think of it as a deadly and contagious virus that swirls around the world, striking everyone in its path and causing them to hemorrhage from their eyeballs, ears and mouth until there is no more blood to spill.

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In reality, Ebola is something quite different. About half of the people who contract Ebola die. The others return to a normal life after a months-long recovery that can include periods of hair loss, sensory changes, weakness, fatigue, headaches, eye and liver inflammation.

As for the blood: While Ebola can cause people to hemorrhage, about half of Ebola sufferers ever experience that Biblical bleeding that’s become synonymous with the virus.

More often than not, Ebola strikes like the worst and most humiliating flu you could imagine. People get the sweats, along with body aches and pains. Then they start vomiting and having uncontrollable diarrhea. These symptoms can appear anywhere between two and 21 days after exposure to the virus. Sometimes, they go into shock. Sometimes, they bleed. Again, about half of those infected with the virus die, and this usually happens fairly quickly — within a few days or a couple of weeks of getting sick.

causes_of_death_africa.0There are five strains of Ebola, four of which have caused the disease in humans: Zaire, Sudan, Taï Forest, and Bundibugyo. The fifth, Reston, has infected nonhuman primates only. Though scientists haven’t been able to confirm this, the animal host of Ebola is widely believed to be the fruit bat, and the virus only seldomly makes the leap into humans.

The Ebola virus is extremely rare. Among the leading causes of death in Africa, it only accounts for a tiny fraction. People are much more likely to die from AIDS, respiratory infections, or diarrhea.

The current outbreak involves the Zaire strain, which was discovered in 1976 — the year Ebola was first identified in what was then Zaire (now the Democratic Republic of the Congo). That same year, the virus was also discovered in South Sudan.

Since 1976, there have only been about 20 known Ebola outbreaks. Until last year, the  total impact of these outbreaks included 2,357 cases and 1,548 deaths, according to the Centers for Disease Control and Prevention. They all occurred in isolated or remote areas of Africa, and Ebola never had a chance to go very far.

ebola_progression_fixed.0And that’s what makes the 2014 outbreak so remarkable: the virus has spread to five countries in Africa plus America, and has already infected more than 8,000 people. It has killed more than 4,000 people. That is more than triple the sum total of all previous outbreaks combined.

Ebola isn’t as contagious as Hollywood depictions would have you believe. It mostly spreads through direct contact with the bodily fluids — vomit, semen, sweat or blood — of someone who is symptomatic and shedding the virus. This means that when someone is sick, you need to get their bodily fluids into a cut on your body or your mouth, nose or eyes. That’s why it’s the health-care workers and family caretakers who nurse the sick that have borne the burden of Ebola.

Ebola can live on surfaces for a few hours, and in blood outside of the body, it can live for up to a few days. So there is a risk of getting Ebola by touching a contaminated surface and then putting your hands in your mouth or eyes. But this is a less common mode of transmission.

There is some contention about the virus being airborne. Some experts say it will never become airborne. As Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told the Senate recently: “Very, very rarely does [a virus] completely change the way it’s transmitted.” However, there are other experts and research labs that say it has.  I would rather err on the side of caution any way that I can to prevent inhaling someone else spew.

Ebola doesn’t spread quickly either, and as far as we know right now, it hasn’t mutated to become more transmissible. “The good news is that Ebola has a lower reproductive rate than measles in the pre-vaccination days or the Spanish flu,” wrote a mathematical epidemiologist who studies Ebola in the Washington Post. He found that each Ebola case produces between 1.3 and 1.8 secondary cases. Compare that with measles, which creates 17 secondary cases. “And the time that elapses between the first Ebola case and the generation of secondary cases is about two weeks. This should allow plenty of time to identify those who are sick and protect people who might come in contact with them.”

What makes Ebola scary is the fact that there is no cure or treatment yet on the market, but those who have access to hospital care — including fluids and antivirals — have a much better chance of beating the disease. The trouble is, Ebola usually strikes in Africa — and among populations where few have access to that kind of advanced medical care.

On September 30, 2014, the Centers for Disease Control and Prevention announced that Thomas Eric Duncan, a patient in Dallas, was diagnosed with Ebola — the first time the disease was diagnosed in the US. He died nine days later.

Since then, health workers who cared for him have been getting sick, spreading fear and panic among the health-care community and general population. On October 12, Nina Pham —  one of Duncan’s nurses — tested positive for the disease. This was the first-ever transmission of the virus in the United States. On October 15, officials announced a second nurse, Amber Vinson, got the virus while caring for Duncan, too.

DALLAS, TX - SEPTEMBER 30:  A general view of Texas Health Presbyterian Hospital Dallas where a patient has been diagnosed with the Ebola virus on September 30, 2014 in Dallas, Texas. The patient who had recently traveled to Dallas from Liberia marks the first case of this strain of Ebola that has been diagnosed outside of West Africa.  (Photo by Mike Stone/Getty Images)

DALLAS, TX – SEPTEMBER 30: A general view of Texas Health Presbyterian Hospital Dallas where a patient has been diagnosed with the Ebola virus on September 30, 2014 in Dallas, Texas. The patient who had recently traveled to Dallas from Liberia marks the first case of this strain of Ebola that has been diagnosed outside of West Africa. (Photo by Mike Stone/Getty Images)

The first patient, Thomas Eric Duncan, was a Liberian visiting family in Texas. He left Monrovia on September 19 and arrived in Dallas on September 20. He had no symptoms when he departed Liberia or entered the US, which means he wouldn’t have been infectious on the flight.

Four days later Duncan started to feel ill, and soon after, sought care at Texas Health Presbyterian Hospital. Ebola was not initially suspected. Instead, Duncan was diagnosed with a “low grade, common viral infection” and sent home with an antibiotic.

On this first hospital visit, staff were informed about Duncan’s recent travel history, which should have raised red flags. But this vital information “was not fully communicated throughout the full team,” said Mark Lester, executive vice president of the health-care system that includes Texas Presbyterian.

In other words, hospital staff missed an opportunity to diagnose Duncan, get him into care, and also stop him from spreading the virus while he was contagious.

By September 28, Duncan — who is 42 and recently quit his job in Monrovia as a driver for a shipping company — had fallen gravely ill. He was sent to Texas Presbyterian in an ambulance. This time, hospital staff suspected Ebola.

That misstep in failing to diagnose Duncan at an early stage might have affected his outcome, but it has also affected the lives of everyone with whom he came into contact.

Officials are following up with 48 people who had some kind of exposure to Duncan or his family prior to his diagnosis. None have fallen ill.

The CDC is also following up with a group hospital workers who had contact with Duncan while he was in isolation and the contacts of Pham and Vinson.

It’s not yet clear how Duncan’s nurses got the virus, but the CDC said they both had contact with Duncan’s bodily fluids before he was diagnosed Ebola. Despite this,Vinson took a Dallas-Cleveland flight, raising questions about how potentially exposed health workers movements will be tracked and how they will be prevented from flying.

The CDC says it can contain any US outbreak

“It is certainly possible that someone who had contact with [Duncan]… could develop Ebola in the coming weeks,” the CDC’s Frieden said previously. Still, he added: “I have no doubt we will stop this in its tracks in the US. I also have no doubt as long as this continues in Africa, we need to be on guard.”

Frieden has some reason to be confident. While the Texas patient is the first-ever diagnosed with Ebola in America, several travelers have brought similarly deadly viruses to the US in the past and didn’t give them to anyone. (Including four cases of Lassa hemorrhagic fever, a disease common in West Africa that spreads through bodily fluids, like Ebola.)

That said, the failure to screen and diagnose Duncan initially — and recent news of two health workers falling ill — has raised public concern about Ebola.

It’s important to keep in mind that his was also the first case of Ebola diagnosed and treated at a regular US hospital. (All the other Ebola patients in the US were flown from Africa to specialized hospitals that are designed to deal with deadly pathogens.)Also, that you can still count the number of Ebola infections in the US on one hand. You can’t do that with the 8,000-plus cases in Africa.

Seven Americans have been diagnosed with Ebola in all

In addition to Texas nurse Nina Pham and her co-worker Amber Vinson, five other Americans have been infected with Ebola. All got sick overseas in Africa and later received treatment in the United States. And all of them survived.

Most recently, Nebraska Medical Center took in Ashoka Mukpo, a freelance cameraman who got Ebola while working in Liberia with NBC News. He is in stable condition.

Before him, an unnamed American who worked for the World Health Organization in Sierra Leone returned to Emory University Hospital in Atlanta for treatment.

Three American medical missionaries — Kent Brantly, Nancy Writebol, and Richard Sacra — came down with the illness in Liberia. Brantly and Writebol were treated at Emory. Like Mukpo, Sacra was treated in Nebraska. All of them have survived.

Separately Patrick Sawyer, a Liberian-American, got Ebola in Liberia where he worked at the Ministry of Finance. He died in Lagos, Nigeria in July.

Before this year, Ebola was a disease that was mostly confined to remote African villages. Health officials didn’t worry about it going global. But that’s all changed with the current Ebola epidemic in West Africa.

Ebola first appeared in 1976 during twin outbreaks in Zaire (now Democratic Republic of Congo) and South Sudan, likely spread by bats from nearby jungles. Since then, there have been 20 further outbreaks, but they have usually occurred in isolated rural areas and died out quickly. The countries involved — DRC, Gabon, Sudan — have experience in stamping out the virus before it spreads.

This year has, in many ways, changed people’s notions about Ebola — not the biology of the virus but how it can move through populations. In December, the virus is believed to have first turned up in the body of a child in Guéckédou, a rainforest region in southeastern Guinea. That geography was unfortunate: Guéckédou happens to share a very porous border with Sierra Leone and Liberia, where people travel in and out every day to go to the market or conduct business.

ebola_caseCountryCount_1015.0

By the time the Ebola outbreak was identified in March, it had already spread to all three countries along the border.

And it keeps spreading further: In July, a Liberian-American got on a plane bound for Nigeria, bringing the virus with him and spurring 20 cases and eight deaths in Africa’s most populous country. Soon, another case turned up in Senegal and, on September 30, the first-ever case was diagnosed in the United States. There is also an unrelated outbreak of Ebola in the Democratic Republic of the Congo involving a different type of the virus right now. In October, Spanish officials announced that a nurse who had been caring for a repatriated priest got the virus in Madrid. That’s eight countries hit with Ebola in one year.

The usual methods for containing Ebola, like contact tracing, don’t scale to an epidemic of this size. In the past, public-health officials had a playbook for stopping Ebola. Because the disease isn’t very contagious and spreads slowly, they just needed to find all those infected, quarantine them, and identify everyone they’d been in contact with. This could be done in sparsely populated rural areas or places with only a few cases.

But an epidemic is much harder to contain when suddenly many countries are dealing with hundreds and then thousands of cases. Since West Africa had never seen Ebola, the virus had a three-month head start before health officials in the countries involved even realized they were harboring an outbreak. It didn’t help that the international community was slow to bring aid to the region, only declaring a public health emergency in August, five months after the first international spread.

This is why the current Ebola epidemic in Africa is outpacing health agencies’ efforts to contain it — and why the number of infected people keeps growing exponentially.

Ebola has infected 8,000 people and could infect 1.4 million by January

There have been more cases of Ebola this year than in all previous outbreaks since 1976 combined.

As of October 2014, roughly 8,000 people have been infected and the death toll has surpassed 4,000. How bad could the Ebola outbreak get? There are lots of predictions floating around. The World Health Organization projects that 20,000 people will be infected in November. HeathMap, put the number at about 14,000 if there’s no improvement in the situation.

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But there are fears that the supplies and health-care workers needed to bend the epidemic curve downward and save lives won’t reach Africa quickly enough. Doctors need to be trained. Hospitals need to be built. There are dire shortages of supplies. (The Liberian government estimates it needs 84,841 body bags, while it has only 4,901.)

Many suspect that there has been widespread under-reporting of actual Ebola cases, since people have been turned away from overflowing hospitals and others have been hiding in their homes, afraid that coming out with Ebola will mean they never see their families again or that they are ostracized by their neighbors.

Assuming the worst is true, the Centers for Disease Control and Prevention has a much bigger projection for this epidemic: up to 1.4 million people infected by January.

No matter the precise figure, all these models assume the growth in cases will continue to rise for some time. “We’re nine months into an exponential growth process,” says infectious disease modeler David Fisman. “This is an impossibly huge epidemic, and it’s been allowed to reach a point where it’s basically the biggest infectious-disease forest fire one could imagine.”

There is no idea how bad the Ebola outbreak actually is

While official estimates suggest there are already more than 8,000 cases of Ebola this year, the real number is likely much, much higher.

“Under-reporting” has been a constant feature of the world’s worst Ebola epidemic.Cases have gone missing, deaths are uncounted, and “there is widespread under-reporting of new cases,” warns the World Health Organization.

The WHO has continually said that even its current dire numbers don’t reflect the full reality. The estimated 8,000-plus Ebola cases in West Africa could just be the tip of the iceberg.

Health workers sterilize the house and prepare a body for burial in Lango village, Kenema, Sierra Leone. (Photo courtesy of Andalou Agency)

Health workers sterilize the house and prepare a body for burial in Lango village, Kenema, Sierra Leone. (Photo courtesy of Andalou Agency)

To understand how an Ebola case could be missed, you need to understand what it takes to actually find and count a case.

Often times, potential cases are communicated through dedicated hot-lines, which citizens can call in to report on themselves or their neighbors. Health workers or doctors can call in cases, too. These reports are forwarded to local surveillance response teams.

All these cases need to be followed up on and verified to be counted. To do that, a team of two to four investigators is dispatched to hunt for the suspected Ebola victim.

Actually tracking these people down isn’t straightforward, especially in areas where the roads and communication infrastructure are poor. Investigators can spend days chasing a rumor.

These health teams also work under constant stress and uncertainty. During this outbreak, they’ve faced violence, angry crowds, and blockaded roads. They can’t wear protective gear because they’ll scare off locals.

When they finally locate an Ebola victim, he or she may not always be lucid enough to talk or even still alive. So the investigators need to interview friends, family or community members to determine whether it’s Ebola that struck — always keeping a distance.

If this chase appears to have led to an Ebola patient, the health team notifies a dispatcher to have that person transported by ambulance to a nearby clinic or Ebola treatment center for testing and isolation.

If the person is already dead, they notify a burial team, which arrives in full personal protective gear. They put the body in a body bag, decontaminate the house, swab the corpse for Ebola testing, and transport the body to the morgue.

But confirming the cause of death doesn’t always happen. There have been reports that mass graves hold uncounted Ebola cases. With limited resources, too, saving people who are alive tends to take precedent over managing and testing dead bodies.

Reported cases are then communicated to the ministry of health in the country. These reports are combined with counts from NGOs and other aid organizations working in the region. The numbers come in three forms: lab-test confirmed cases, suspected cases, and probable cases. The WHO classifies a suspected case as an illness in any person, dead or alive, who had Ebola-like symptoms. A probable case is any person who had symptoms and contact with a confirmed or probable case.

The ministry of health compiles and crunches this information and sends it to the WHO country office. They then report that to the WHO’s regional Africa office in Brazzaville, Congo and that message is passed along to Geneva, home to WHO’s headquarters.

To get to this point, Dr. David Fisman, an infectious disease modeler working on Ebola, summed up: “A person needs to have recognized symptoms, seek care, be correctly diagnosed, get lab testing — if they’re going to be a confirmed case — have the clerical and bureaucratic apparatus actually transmit that information to the people doing surveillance. At each step along the way the case can fall out of the pool of ‘counteds.'”

There’s no way to know how vastly under-reported this epidemic is, but there are estimates being floated around. Comparing surveillance figures with actual hospital beds dedicated to Ebola care in West Africa, the Centers for Disease Control and Prevention suggested that under-reporting could be happening at a rate of 2.5. This means that every one case reported equals 2.5 on the ground. If true, today’s 8,000 Ebola cases could actually look more like 20,000.

One problem with treating Ebola is that Ebola treatment is draconian

Hidden in the death statistics is something a lot more human: people in this part of the world are used to being cared for by their family members when they are sick. But tending to the sick is exactly how Ebola spreads.

For this reason, many caregivers in the home, particularly women, have lost their lives. The Liberian Ministry of Health reported that 75 percent of Ebola deaths in the country have been women.

It is also this culture of care that has pitted health officials against those that they are trying to help. There have been sporadic reports of attacks on Ebola aid workers, the most disturbing being the September killing of a team of eight journalists and health professionals who had been spreading public-health messages about Ebola in Guinea.

Part of the hostility can be explained by the fact that people fear the care aid workers bring: it could mean being taken away from their families, and possibly never seen again.

Spreading public health messages has also been extremely challenging in an environment with low health literacy and public trust in officials. Since this is the first time Ebola has ever appeared in West Africa, there was little understanding about the virus and public health officials have had a difficult time getting their messages across.

These are also countries that have experienced decades of government corruption and brutal civil war.

In Liberia, distrust in the government led some people to think Ebola is a government scam to attract international aid, for example. In Sierra Leone, there have been rumors that Ebola is a government conspiracy, that the government wants to sell the blood of infected patients, or that the disinfectant being used to stave off Ebola will actually infect them.

Global health agencies were too slow in responding to the Ebola crisis

“Ebola is a very preventable disease,” said Lawrence Gostin, a health law professor at Georgetown University. “We’ve had over 20 previous outbreaks and we managed to contain all of them.”

But this time, the international response just wasn’t there. “There was no mobilization,” Gostin said. “The World Health Organization didn’t call a public health emergency until August — five months after the first international spread [in March].”

It took three months for health officials to identify Ebola as the cause of the epidemic, another five months to declare a public health emergency, and two more months to mount a humanitarian response. In reality, a full response could take several more months still to get off the ground.

Part of the reason for the slow response can be attributed to budget cuts at the WHO that have left the agency understaffed and under-resourced. The WHO also now sees itself as a “technical agency,” providing analysis and data, and not as a first responder.

But, as an editorial in the journal Nature pointed out: “If the WHO is not the first responder to an emergency such as this, then who is?”

The International Health Regulations governing disease responses are also flawed and broken, leaving us unprepared for outbreaks. So this Ebola epidemic has served as a reminder of just how slow and poorly coordinated our global responses to outbreaks are, and this is a problem because any infectious diseases expert will tell you that the best way to stop an outbreak is to contain it early.

A Liberian health worker interviews family members of a woman suspected of dying of the Ebola virus  in Monrovia, Liberia. (John Moore/Getty Images)

A Liberian health worker interviews family members of a woman suspected of dying of the Ebola virus in Monrovia, Liberia. (John Moore/Getty Images)

Health is not free from politics, either. Sadly, the world only seemed to wake up to Ebola after two American missionaries got infected in Liberia. One of them, Dr. Kent Brantly, testified before the Senate in the US to make that point: “This unprecedented outbreak began nine months ago but received very little attention from the international community until the events of mid-July when my friend and colleague, Nancy Writebol, and I became infected.” He added: “The response, however, is still unacceptably out-of-step with the size and scope of the problem now before us.”

This awakening came too late. Preeminent disease researchers, in an article in the New England Journal of Medicine, wrote, “Ebola has reached the point where it could establish itself as an endemic infection because of a highly inadequate and late global response.”

Still, the global health community is now moving aggressively. The director of the World Health Organization called this Ebola epidemic “the greatest peacetime challenge” the world has ever faced. ZerObama called the epidemic “not just a threat to regional security… [but] a potential threat to global security.” For this reason, the United States will send more than 3,000 troops to fight Ebola and has now funded the largest international response in the history of the CDC.

The United Nations Security Council has also characterized the virus as a threat to international peace and security, holding its second-ever disease-focused meeting and setting up a special UN mission to deal with the epidemic. The Security Council unanimously passed a resolution asking countries around the world to urgently send medical workers and supplies to stop the epidemic.

The worse the outbreak in West Africa, the more global spread

The longer this epidemic rages on in West Africa, the more people get infected, the more chance there is of the virus finding new hosts to infect and spreading further around the world.

Beth Bell, director of the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, testified before the Senateon this point: “In the worst case scenario, we continue to see an exponential rise in cases that we’re currently seeing. And an important corollary to that is exportation to other countries.” The outbreak that originated in Guinea in December has already spread to seven countries as of October and the Democratic Republic of the Congo has been battling a separate outbreak.

For Ebola to continue to move, travelers are the most likely method of transport. Infectious-disease researchers recently looked at flight patterns out of West Africa and local transmission dynamics to figure out how likely it would be that an Ebola-positive person gets on a plane with the virus and brings it to a new setting.

(Graphic courtesy of PLoS Currents: Outbreaks)

(Graphic courtesy of PLoS Currents: Outbreaks)

While countries in Africa are most at risk, as the Ebola epidemic continues to over the coming the months, the risk of Ebola going international grows, too.

Unfortunately, restricting the movement of people because of Ebola, while politically expedient in a time of panic, isn’t economically viable or effective at stopping its spread. In fact, it could have the opposite of the desire effect. As Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, “To completely seal off and don’t let planes in or out of the West African countries involved, then you could paradoxically make things much worse in the sense that you can’t get supplies in, you can’t get help in, you can’t get the kinds of things in there that we need to contain the epidemic.”

There’s no cure for Ebola

Even though Ebola has known for almost 40 years, vaccine and drug development for the disease has been slow at best. Notably, most of the investment in Ebola cures has come from government agencies (such as the US Department of Defense) interested in researching potential biological terrorism weapons — not in helping Africa.

The global institutions we designed to promote health innovation, trade, and investment don’t focus on the diseases of the poor. Most all of the money for research and development in health comes from the private sector, which naturally has a singular focus — making more money.

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What’s interesting, however, is that the Ebola epidemic burning in West Africa — particularly after American missionaries were famously infected — sparked discussion and unprecedented focus on finding an Ebola cure and speeding up the drug testing and approval process for the current therapies being developed.

Some have even said that this push to discover Ebola therapies might be the silver lining of this epidemic.

The US is now frantically racing to find an Ebola treatment

In September 2014, the drug company GlaxoSmithKline announced it took the unprecedented step of starting mass production on an Ebola vaccine that has just begun being tested in humans.

That news followed a decision by the World Health Organization to allow unproven and experimental treatments on people in this public health emergency — which means the usual drug approvals process will be condensed or phases of clinical testing potentially skipped.

One such drug is ZMapp, an antibody therapy that was used in the two American medical missionaries infected with Ebola in Liberia. The drug was developed by several stakeholders — Mapp Biopharmaceutical, Inc. and LeafBio in San Diego, Defyrus Inc. from Toronto, the U.S. government and the Public Health Agency of Canada — to treat Ebola. It’s made up of a cocktail of monoclonal antibodies, which are essentially lab-produced molecules manufactured from tobacco plants that mimic the body’s immune response to theoretically help it attack the Ebola virus.

The report that the Americans got the drug — dubbed by CNN as a “secret serum” — led many to wonder why they skipped to the front of the line and who else might be saved with ZMapp.

But the truth is, while these patients did improve after receiving the drug, a third patient who got ZMapp died. We won’t know whether the drug worked or whether it’s harmful on the basis of data from three patients, especially since half of those infected with this strain of the virus live anyway.

Kent Brantly, one of the American medical missionaries infected with Ebola. (Photo by Jessica McGowan)

Kent Brantly, one of the American medical missionaries infected with Ebola. (Photo by Jessica McGowan)

Another experimental therapy now being tried in humans is TKM-Ebola, developed by the Canadian pharmaceutical company Tekmira (with the help of US Department of Defense funding). After being shown to reduce mortality in Ebola-infected monkeys, the FDA froze and then re-started clinical trials recently.

Whether this Ebola drug development actually turns out to be the silver lining of the worst epidemic in history remains to be seen. For every 5,000 compounds discovered at this stage, only about five are allowed to be tried in humans. These Ebola therapies are at only the earliest stage of drug testing, and they have a long way to go before proving useful. What’s more, an Ebola drug won’t fix all the health systems issues that allowed the disease to spread in Africa.

As Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, wrote in the New England Journal of Medicine: “While these interventions remain on accelerated development paths, public health measures are available today that have a proven record of controlling (Ebola) outbreaks. Premature deployment of unproven interventions could cause inadvertent harm, compromising an already strained relationship between health care professionals and patients in West Africa.”

The majority of Ebola deaths may not be from Ebola

Of this epidemic, the World Bank said Ebola may deal a “potentially catastrophic blow” to the West African countries reeling with the virus. Businesses are shutting down, people aren’t working, kids aren’t going to school.

The epidemic has also led to widespread food insecurity. “The fertile fields of Lofa County, once Liberia’s breadbasket, are now fallow. In that county alone, nearly 170 farmers and their family members have died from Ebola,” the WHO director warned. “In some areas, hunger has become an even greater concern than the virus.”

A wall bearing information about Ebola in Monrovia, Liberia. (Photo by Pascal Guyot/AFP)

A wall bearing information about Ebola in Monrovia, Liberia. (Photo by Pascal Guyot/AFP)

There’s also the fact that people are going to suffer and die more from other diseases as  the scarce health resources in the region go to Ebola. Speaking at the United Nations, Dr. Joanne Liu, international president of Médecins Sans Frontières, said, “Mounting numbers are dying of other diseases, like malaria, because health systems have collapsed.”

Jimmy Whitworth, the head of population health at Britain’s Wellcome Trust, told the Independent in an interview, “People aren’t going to hospitals or clinics because they’re frightened, there aren’t any medical or nursing staff available.”

“West Africa will see much more suffering and many more deaths during childbirth and from malaria, tuberculosis, HIV-AIDS, enteric and respiratory illnesses, diabetes, cancer, cardiovascular disease, and mental health during and after the Ebola epidemic,” wrote  disease researchers Jeremy Farrar, of the Wellcome Trust, and Peter Piot, of the London School of Hygiene and Tropical Medicine in an article in the New England Journal of Medicine.

So this virus has wreaked incalculable damage on not only the bodies of those infected, but on others who are not getting health care they need, and the health systems and economies of West Africa.

Dr. Ezie Patrick, with the World Medical Association who is based in Nigeria, focused on the simple and disquieting fact that Ebola has also taken the lives of health workers in places where the ratio of doctors per population is abysmally low. “Sadly Ebola is claiming the lives of the few doctors who have decided to work in these challenging health systems thereby worsening the dearth and also increasing the brain drain leading to far fewer doctors in the region.”

The disaster could last longer than the epidemic itself. Before the Ebola outbreak, West African nations were seeing promising signs of economic growth. Sierra Leone, for example had the second highest real GDP growth rate in the world. Liberia was 11th in 2013.

Now, there’s worry that Ebola will slam the brakes on that development. “A prolonged outbreak could undercut the growth that these countries were finally starting to experience, taking away the resources that would be necessary for improving the health and education systems,” says Jeremy Youde,  a professor of political science at the University of Minnesota Duluth.

“These countries are generally not starting from a great position as it is, so they don’t have much of a cushion to absorb long-term economic losses. If the international economy turns away from West Africa and brands it as diseased, that could be very problematic.”

Crash

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