Four Reasons Why This Ebola Outbreak Is Different

A picture taken on June 28, 2014 shows a member of Doctors Without Borders (MSF) putting on protective gear at the isolation ward of the Donka Hospital in Conakry, where people infected with the Ebola virus are being treated. The World Health Organization has warned that Ebola could spread beyond hard-hit Guinea, Liberia and Sierra Leone to neighbouring nations, but insisted that travel bans were not the answer. To date, there have been 635 cases of haemorrhagic fever in Guinea, Liberia and Sierra Leone, most confirmed as Ebola. A total of 399 people have died, 280 of them in Guinea. AFP PHOTO / CELLOU BINANI 
National Journal
Sophie Novack
Aug. 8, 2014, 1:19 a.m.

West Africa is cur­rently in the midst of the largest Ebola out­break in his­tory, and it’s only get­ting worse.

Nearly 1,000 people have died and more than 1,700 have been in­fec­ted by the deadly vir­us since the out­break began in March, ac­cord­ing to the latest data from the World Health Or­gan­iz­a­tion. The death toll is already nearly four times as high as the next highest on re­cord, which oc­curred in the first doc­u­mented out­break in 1976.

And the vir­us shows no signs of let­ting up, lead­ing WHO to de­clare the out­break a “pub­lic health emer­gency of in­ter­na­tion­al con­cern” early Fri­day morn­ing. The des­ig­na­tion will re­quire the agency to make re­com­mend­a­tions for im­me­di­ate in­ter­na­tion­al ac­tion against the out­break and ramp up re­sponse, which many health ex­perts say has been lack­ing.

The an­nounce­ment was made by WHO Dir­ect­or Gen­er­al Mar­garet Chan at the con­clu­sion of a two-day emer­gency meet­ing this week on how to deal with the vir­us.

To re­ceive the des­ig­na­tion, an out­break must meet at least two of the fol­low­ing four cri­ter­ia: Is the pub­lic health im­pact of this event po­ten­tially ser­i­ous? Is this event un­usu­al or un­ex­pec­ted? Is there the po­ten­tial for in­ter­na­tion­al spread? And is there the po­ten­tial for travel and trade re­stric­tions?

There have been two cases giv­en the des­ig­na­tion since the reg­u­la­tions were put in­to place in 2005: the in­flu­enza out­break in 2009, and the polio out­break in the spring of this year.

There have been about 30 re­cor­ded out­breaks of the Ebola vir­us in the last four dec­ades, but none have come close to this mag­nitude.

“This is something we have not seen to this ex­tent be­fore,” CDC Dir­ect­or Thomas Frieden told a House sub­com­mit­tee Thursday. Frieden said this out­break is set to in­fect more people than all the pre­vi­ous out­breaks com­bined.

So why is this time so dif­fer­ent?

1. This is the first time an Ebola out­break has oc­curred in West Afric­an coun­tries.

The cur­rent Ebola out­break began in Guinea in March, then moved to Si­erra Le­one, Liber­ia, and Ni­ger­ia, none of which have ever had an Ebola out­break be­fore. Pre­vi­ous out­breaks of the vir­us have all oc­curred primar­ily in Cent­ral Afric­an coun­tries, such as the Demo­crat­ic Re­pub­lic of Congo, Uganda, and South Su­dan.

That means that this time the coun­tries were taken by sur­prise, and un­equipped to deal with the out­break—or took ac­tion too late. Health of­fi­cials were slow to re­spond, work­ers aren’t fa­mil­i­ar with the ne­ces­sary equip­ment, and health in­fra­struc­ture is lack­ing.

Fur­ther­more, the gen­er­al pub­lic does not un­der­stand what is go­ing on, and may not fol­low ne­ces­sary meas­ures to con­tain the out­break and seek med­ic­al care.

“In Cent­ral Africa there’s a his­tor­ic­al per­spect­ive,” said Mi­chael Os­ter­holm, dir­ect­or of the Cen­ter for In­fec­tious Dis­ease Re­search and Policy at the Uni­versity of Min­nesota. “When [out­breaks] hap­pen, people real­ize [aid work­ers] come in and do things and go away—they don’t have that here, be­cause it’s nev­er happened be­fore.”

“They see sick people sent to the hos­pit­al come back in a body bag. If your loved one was car­ted away alive and talk­ing and comes back in a body bag, would you send them there?”

2. There is tre­mend­ous mis­trust of non­tra­di­tion­al or West­ern medi­cine in these areas.

“The com­munit­ies have these en­trenched be­liefs and sup­port for cer­tain re­li­gions and med­ic­al prac­tices and have sought out those prac­tices and not ne­ces­sar­ily fol­lowed the dir­ec­tion of pub­lic health au­thor­it­ies,” said Josh Michaud, as­so­ci­ate dir­ect­or of glob­al health policy at the Kais­er Fam­ily Found­a­tion. “They are prone to ru­mors and fear—rather than seek out treat­ment cen­ters, they flee.”

Fear of the dis­ease has res­ul­ted in hos­til­ity to­ward aid groups such as Doc­tors Without Bor­ders and the Red Cross, be­cause people be­lieve they are bring­ing the vir­us in­to their com­munit­ies.

Fur­ther­more, tra­di­tion­al fu­ner­al prac­tices in­volve close con­tact with the de­ceased vic­tim, po­ten­tially spread­ing the dis­ease to liv­ing fam­ily mem­bers.

3. This is the first time an out­break has spread to city cen­ters.

The urb­an­iz­a­tion of the vir­us has made it more dif­fi­cult to track, trace, and con­tain.

“One of the most dis­tin­guish­ing fea­tures in this out­break is that it in­volves cit­ies,” said Daniel Lucey, ad­junct pro­fess­or of mi­cro­bi­o­logy and im­mun­o­logy at “ŽGeor­getown Uni­versity Med­ic­al Cen­ter. “When out­breaks were rur­al, they were easi­er to con­trol—you could quar­ant­ine people who were sick and stop the out­break…. When it got in­to three cap­it­al cit­ies, it be­came harder to con­trol.”

The move to urb­an cen­ters make it far easi­er for the vir­us to spread more quickly and over far great­er dis­tances, due to in­creased trans­port­a­tion ac­cess and high­er pop­u­la­tion dens­ity.

4. The re­sponse has not kept up with the vir­us.

The Ebola out­break caught on and spread quickly, while the re­sponse—par­tic­u­larly in­ter­na­tion­ally—moved more slowly.

“If you think about what used to be an ap­pro­pri­ate match in terms of a re­sponse to an out­break such that the re­sponse over­whelms it, then re­l­at­ive to the cur­rent [situ­ation], it was easi­er when in it oc­curred in one rur­al area,” Lucey said. “In this out­break the re­sponse has not matched or achieved the scope of the vir­us, and it spread over time.”

The coun­tries grap­pling with the out­break simply do not have suf­fi­cient re­sources—per­son­nel or oth­er­wise—to ef­fect­ively con­tain it, par­tic­u­larly giv­en the oth­er factors work­ing against them.

“What was a small forest fire of in­fec­tion that could been con­trolled by some good fire crews … that didn’t hap­pen,” said Os­ter­holm. “NGOs are tapped out—some people have been on the front lines for weeks and weeks. As more col­leagues get sick and die, and they are asked to do more more—it’s a re­cipe for them to get in­fec­ted [too]. They’ve got to get more re­sources.”

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