Friday 4 July 2014

At least 467 dead in West African Ebola outbreak.

At least 467 people have died in an outbreak of  Ebola Hemorrhagic Fever in West Africa that began in February this year. The disease initially appeared in the remote border area between Guinea, Sierra Leone and Liberia, and has spread widely in all three countries, severely straining their already weak public health infrastructure.

Health workers from Doctors without Borders carrying the body of an Ebola victim at a center for victims in Guekedou, Guinea, on 1 April 2014. Seyllou/AFP/Getty Images.

Ebola Hemorrhagic Fever is caused by RNA Viruses of the genus Ebolavirus. It has a reputation for being the world's deadliest viral disease, at least in part due to the 1995 film Outbreak, though this is probably slightly inaccurate as about 10% of victims survive, making it less deadly than diseases such as Rabies. However it is extremely contagious, with know known cure or vaccine, and has a tendency to rapidly overwhelm local health systems as health workers themselves are infected. 

Ebola begins with a fever similar to that caused by Influenza or Malaria, which tends to come on rapidly two-to-three weeks after infection (during at least part of which time the patient is already infectious). This tends to be followed by extreme respiratory tract infection, headaches, confusion, rashes and tissue necrosis and heavy bleeding. Death is generally caused by multiple organ failure.

The only known treatment for Ebola is intensive rehydration, which can improve the survival prospects of patients greatly, accompanied by anticoagulants and procoagulants to mange the diseases attacks on the circulatory system, analgesia to cope with the pain of the disease and antibiotics and antimycotics to prevent secondary infection. Due to the highly contagious nature of the disease it is recommended that healthcare workers wear full-body protection to maintain a barrier between them and their patients; a daunting prospect in the tropical regions of Africa where the disease is endemic.

Healthcare workers from Doctors Without Borders donning special 'Ebola-suits' before entering an isolation ward at a hospital in Guinea. AFP/Getty Images.

Ebolavirus is thought to have a non-human animal vector, since its rapid onset and high mortality rate appears to preclude a permanent residence within Human hosts. Surveys of wild animals have found Ebola infections in Rodents and Great Apes, however these were affected by the disease in a similar way to Humans, and are therefore unlikely permanent hosts. The most likely vectors are thought to be Fruit Bats or small Primates, which are endemic to the areas where the disease occurs and which are widely eaten; cooking meat probably kills the virus, but there is a distinct danger of infection while preparing carcasses. 

The area where the outbreak first occurred has suffered several decades of political instability and warfare, and many people there have a strong mistrust of both civil authorities and western healthcare. Primary healthcare in the region is often provided by traditional healers, who use principally herbal medicines. Such healers were entirely unprepared for a disease as virulent as Ebola, and many themselves became infected, first passing on then succumbing to the disease. 

The disease spread rapidly as people attempted to look after sick relatives at home, and possibly also by local customs that dictate washing and sitting vigils with the dead. Later intervention by government and NGO healthworkers was treated with extreme suspicion, as this involved taking sick relatives and holding them in isolation for treatment, going against local tradition and extremely alarming in an area with recent memories of arbitrary political detentions and kidnaping of civilians by armed militia groups, and there have been a number of reported incidents of people attacking healthworkers and even rescuing sick relatives from isolation centers. In Liberia in particular there have been persistant rumors that the disease is a hoax created by the government to cover up a series of corruption scandals.

As communities have come to realize the threat of the disease, many people have responded by fleeing, in turn spreading the illness to new areas. This has led to the disease spreading across all three countries, reaching major cities such as Bo, Conakry and Monrovia, where crowded urban dwellings have the potential for the disease to spread even more rapidly. As such neighbouring countries Guinea Bissau, Senegal, Mali and Côte d’Ivoire are in a state of high alert, and there are serious concerns about the disease spreading further via international air or shipping routes. 

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