As the Ebola virus continues to spread at an alarming rate, Liberia’s President, Ellen Johnson Sirleaf, issued a stern warning. Calling Ebola a “clear and present danger.” President Sirleaf said, “The scope and scale of the epidemic [and] the virulence and deadliness of the virus now exceed the capacity and statutory responsibility of any one government agency or ministry.”
Those few words underscore the need to rapidly contain the spread of the epidemic. This epidemic also draws attention to the fragility of most African countries’ public health systems, and the need to improve them.
“What we have done is to make sure we’re surging not just U.S. resources, but we have reached out to European partners and partners from other countries working with the World Health Organization (WHO),” said President Obama. He also promised to help bolster the systems that the countries already have in place.
Ebola virus disease (EVD), also called Ebola hemorrhagic fever (EHF), is the disease caused by the Ebola virus. Although no spread of the virus through the air has been documented so far, the virus may be acquired through contact with blood or bodily fluids from infected animals or people. That is why samples of bodily fluids and tissues from those infected should be handled with extreme care and protective clothing should be used.
The present one is the largest outbreak so far, affecting Guinea, Sierra Leone, Liberia, and Nigeria. Early symptoms of the infection are similar to those of malaria, dengue fever, and other tropical diseases. The infection then progresses to the bleeding phase. Because heavy bleeding is confined to the gastrointestinal tract the patients may vomit blood, have blood in the stool and also cough blood. This blood is highly infectious, so those most at risk are health care workers and those in close contact with the patients.
Since the disease is only spread by direct contact with the secretions of those infected, the potential for widespread EVD infections is considered relatively low. However, because no vaccine is effective and the disease has a mortality rate of between 50 and 90 percent, prevention efforts are most important, as is prompt treatment of those infected. Because the disease occurs typically in outbreaks in tropical regions of sub-Saharan Africa, some cultural practices that favor the spread of the infection should be addressed.
The WHO considers “burial of victims in accordance with cultural practices” one of the main factors in the spread of the disease. In that regard, traditional burial in many West African countries includes washing the dead bodies by hand and burying them in the floor of the house. However, persistent denial of the danger and resistance to change in the community are important barriers to overcome.
Early diagnosis and prompt treatment of those infected are essential. Clinical, laboratory, and support staff and supplies are much needed in the most affected African countries. Health workers are also needed to care for the patients, limit the spread of the infection, trace contacts, and engage and educate the community.
No Ebola virus-specific treatment exists. However, early supportive treatment consisting of balancing fluids, maintaining oxygen levels, managing pain, and controlling bacterial and fungal secondary infections increases the chances of survival. At present, several experimental treatments are being studied.
To limit the spread of the infection, nonessential travel to areas or countries most affected by the infection should be curtailed, and individuals returning from those countries should be closely monitored. The countries where the infection is more widespread are among the poorest countries in the world, and by themselves cannot cope with this situation. That is why outside help from industrialized countries is most important to help control this deadly infection.
Dr. César Chelala is an international public health consultant and a winner of an Overseas Press Club of America award.
