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Of all of the known deadly pathogens in the world, few are as scary as the Ebola Virus Disease (EVD). With a 90% fatality rate, the hemorrhagic fever has spread to three West Africa countries since it was discovered in Guinea in February. To date, the virus has infected more than 1,400 people and killed more than 700. The United States, the European Union, and Asian nations are watching the Ebola outbreak closely and have ramped up security at their international airports to deal with the contagion. Due to the fact that medical experts believe it will take several months to bring this recent Ebola outbreak under control, extempers should be prepared to talk about it in the first few months of the 2014-2015 season.
This topic brief will provide some background information on how the Ebola virus works and spreads, discuss the course of the current West African outbreak, and highlight some areas that extempers should look into when framing impact scenarios for speeches concerning Ebola.
Readers are also encouraged to use the links below and in the related R&D to bolster their files about this topic.
What is the Ebola Virus Disease?
The Ebola Virus Disease (EVD) was first discovered in Zaire (the country now known as the Democratic Republic of the Congo) in 1976. The BBC provides an overview of Ebola on July 31 and notes that the virus, which is a hemorrhagic fever, has an incubation period of two to three weeks. During this time victims are not contagious, but they become so when they start showing symptoms. These symptoms include a gradual escalation from sudden fever, muscle pain and weakness, and sore throat to vomiting, diarrhea, and internal or external bleeding. Eventually, a victim dies of organ failure. The fatality rate of the most lethal strains of Ebola, and the current outbreak resembles this strain, is 90%. However, as with all statistics, extempers should keep in mind that the countries that have been affected by Ebola tend to have poor medical infrastructures. This leads to higher fatality rates than an Ebola strain may have in a Western nation. The current outbreak in West Africa has carried a fatality rate of over 60%.
Medical researchers are still learning about where the Ebola virus comes from and how it is transmitted. Time on July 30 points out that scientists believe fruit bats are the most likely culprit, although others have also tied Ebola with chimpanzees and forest antelope. Since West and Central Africa nations have populations that eat bushmeat, which is the meat of wild animals, this is deemed as another likely source of contagion. In the West African states that have been affected by Ebola, the bushmeat of fruit bats is deemed a delicacy, and eating the meat of an infected fruit bat is deemed as a possible source of transmission between animals and humans. An infected human can spread Ebola to others via bodily fluids that include blood, semen, vomit, mucus, and even sweat. Unlike other pathogens that tend to die quickly after killing their host, survivors of Ebola remain contagious for up to seven weeks. Therefore, it takes a great deal of time for the virus to cycle out of the human bloodstream. At present, Ebola is not an airborne virus, which scientists hope will help contain its spread.
One of the most alarming aspects of Ebola is that there is no known cure. Scientific American on July 30 reveals that treatment of Ebola sufferers currently consists of rehydration and painkillers. There is an experimental vaccine that has shown promise in monkeys, but the problem has been convincing large pharmaceutical operations that they should put their money into researching and developing a vaccine for a virus that has had very limited outbreaks in the past. Scientific American argues that the latest Ebola outbreak and the panic it has created in Western nations may spur more government funding toward the development of a vaccine, but such a vaccine is likely more than a year away. At present, the best way to prevent Ebola from spreading is to contain it in West Africa, but that has proven difficult since the outbreak began in February.
An Overview of the 2014 West African Outbreak
The current Ebola outbreak began in the West African nation of Guinea in February, with the first cases coming from the southeastern part of the country. In March, the virus spread to neighboring Liberia and in May it jumped to Sierra Leone. All of these countries have very porous borders that are poorly monitored and controlled – at least until the current outbreak – and this made it very difficult for doctors to isolate communities and keep the virus under control. The Economist on July 29 reveals that Guinea has had a mortality rate higher than any of the three West Africa nations plagued by the virus and the BBC article previously cited illustrates this by showing that of the 460 cases identified in Guinea, 339 people have died. Part of Guinea’s high mortality rate compared with Liberia and Sierra Leone may be due to the fact that it was the first country infected by the virus, so it did not have the benefit of the increased awareness and medical attention that has now been focused on West Africa. Sierra Leone now has more Ebola cases than any other country in the region, with over 500 being reported to the international media.
So how did West Africa states find themselves in this situation in the first place? As revealed above, West African states have very weak border controls, so it is very difficult for governments to contain infected populations. The long incubation period of the virus also works against containment, since persons may be infected, yet not show any symptoms of infection for up to twenty-one days. This may allow someone to slip across a border into another country and then become infectious in their new nation, thereby potentially spreading the virus there. Another reason that West Africa has become the site of a new Ebola outbreak, as PBS reveals on July 14, is deforestation. As West African populations grow, they have moved to frontier regions that have jungles and are home to a variety of wild animals that carry dangerous infections. With more people living closer to these jungle areas than ever before, the possibility of an outbreak becoming widespread, instead of isolated in rural areas like previous outbreaks, increases. The linking of these communities with national urban centers through better infrastructure development over the last several decades has now produced a situation where Ebola is hitting urban instead of rural areas, which is a first in the history of the virus. The Center for Strategic and International Studies in a YouTube video on July 30 also points to the lack of health infrastructures and good governance in the affected West African nations as a reason for the current outbreak. Public communications systems have been poor, governments have responded slowly to the outbreak, and there is a lack of data sharing between all three countries. International health workers are now trying to fill the void and teach proper medical practices to stop the spread of the virus, but their help was needed much sooner. And finally, cultural practices in the affected countries have worked against limiting the spread of the virus. The Chicago Tribune on July 27 reports that there are deep cultural suspicions in West Africa against modern medical practices and this led some families to pull their sick relatives out of hospitals during the outbreak. The result was that those sick relatives infected others, thereby causing the disease to spread, instead of being contained in a proper medical facility. Traditional funeral practices, which involve the manual washing of the deceased, also work to spread Ebola by putting individuals in close contact with an infected person’s bodily fluids. Therefore, the fight against Ebola in West Africa has to tackle existing political and cultural barriers to be effective.
The good news about the latest outbreak is that more international attention is being focused on the affected West African states. The World Health Organization (WHO) has set up a hub of operations in the region and the organization’s press release, published by AllAfrica on August 1, asks for $100 million in international contributions toward Ebola relief efforts. These funds will be used to provide up to 600 extra medical staff in the region, which it says are poorly needed, and better medical equipment since it is being reported that medical workers lack protective clothing like masks, gloves, and body suits. This helps to explain why hundreds of nurses have fallen ill treating Ebola patients and two of the leading Ebola doctors in the region, Liberia’s Dr. Samuel Bisbane and Sierra Leone’s Dr. Sheik Umar Khan, have died in the outbreak. International funding and work with national governments can also alleviate some of the problems in West African hospitals. The New York Times reveals on July 31 that nurses walked out of Sierra Leone hospitals on July 29 because of a dispute over their overtime pay. Such walkouts, while over valid concerns, are jeopardizing the care that patients receive. Increased international funding and attention to the problems in West Africa can help national governments cope with these issues and help medical systems that are poorly equipped to handle dangerous viruses like Ebola.
Another piece of good news is that national governments are becoming more proactive in responding to Ebola. The UK Independent reports on July 31 that Liberia and Sierra Leone have declared states of emergency to deal with the virus. These decrees enable health officials to conduct house-to-house searches for Ebola victims, close government institutions such as schools (a step Liberia has taken), and deploy security forces to protect workers from non-government organizations (NGOs) in their attempts to quarantine populations. The Washington Post adds on July 31 that the states of emergency will allow Liberia and Sierra Leone to restrict the scope of public gatherings, seal off infected towns, close border crossings, and better monitor international airports. The Monrovia Heritage on July 31 points out that Liberian forces have been empowered to seize bushmeats in local markets as well. All of these steps will help national and international medical workers to monitor and contain the spread of Ebola, but the question remains about whether these steps happened too late to keep the virus within the three West African states that it has spread to thus far.
Containing Ebola Virus
One of the biggest fears of medical professionals is that international airline traffic could spread Ebola beyond West Africa. Quartz, a digital news outlet owned by the Atlantic Media Company (publisher of The Atlantic and The National Journal) points out on July 30 that flights out of the three infected countries land at thirty-nine airports in thirty-five countries. These include six European countries (Great Britain, Belgium, Germany, France, Spain, and the Netherlands), four Middle Eastern nations, and three American cities (Houston, Atlanta, and New York City). The United States had a near-miss at the end of July when Liberian-American national Patrick Sawyer became infected with the virus and, despite showing symptoms of Ebola, was allowed to board a flight out of Liberia to Lagos, Nigeria. The Los Angeles Times on July 29 reveals that he was coming to Minnesota to celebrate the birthdays of two of his three daughters, but Sawyer never made it that far. He collapsed in the Lagos airport and was rushed to a medical facility, where he was diagnosed with Ebola and later died. Sawyer’s case shocked Nigeria, which has isolated the medical facility where he sought treatment, and thankfully, no other Ebola cases have emerged in Nigeria, which is Africa’s most populous country and home to its largest economy. However, that is not to say that more may not emerge. Quartz notes that Nigeria has no idea where all of the passengers on Sawyer’s flight are and those on the flight were allowed to leave the Lagos airport after being briefed on the virus. The infected countries have now taken steps to screen passengers for the virus and other countries are educating workers in international airports to be on the lookout for sick passengers that show Ebola symptoms. According to The Washington Post on July 30, Togo-based African airline ASKY, which was the one Sawyer flew from Liberia to Nigeria, has suspended its flights in and out of the Liberian and Sierra Leone capitals of Monrovia and Freetown. The WHO has recommended against travel restrictions to West African states, viewing the measures as unhelpful, but it would not be surprising if political pressures eventually forced developed nations to consider the possibility. Recently, Hong Kong and Britain both had Ebola scares when recent visitors to West Africa came back with Ebola-like symptoms, but those individuals tested negative for the virus. Therefore, extempers should carefully monitor how countries deal with traffic in and out of the infected nations, and they should note in their speeches that although globalization has facilitated a greater flow of people and goods throughout the world since the end of the Cold War, it brings with it the risks that a pathogen coming of the West African jungles could eventually touch much of the world.
Since panic is growing in the West about Ebola due to the fact that medical professionals have yet to bring the virus under control, extempers should expect questions about whether the United States or Western nations are prepared to deal with an Ebola outbreak. Questions of this sort are not unusual and they have been asked about previous lethal contagions like Severe Acute Respiratory Syndrome (SARS), swine flu, and bird flu. To calm fears, the United States and the European Union (EU) have publicly pronounced that they are equipped to handle an Ebola outbreak and that the public should not be worried. ABC News on July 30 points out that twenty American airports have quarantine teams from the Centers of Disease Control and Prevention (CDC) that are ready to isolate and treat passengers with Ebola symptoms. The UK Independent on July 30 adds that Great Britain’s National Health Service (NHS) has the facilities on hand to quickly deal with an infection and that Ebola would be stopped by its third generation were it to land on British soil because of the quality of British medical facilities relative to their West African counterparts. However, in an era when suspicion of government is at an all-time high it should come as no surprise that not everyone trusts this rhetoric. After all, Doctors Without Borders, according to the Sydney Morning Herald on July 31, has said that the Ebola outbreak is “out of control.” The CDC also ignited a social media firestorm by its decision last week to bring two American charity workers infected with Ebola back to the United States. These individuals will be treated at Emory University Hospital in Atlanta, Georgia, and although the CDC has handled more infectious diseases like SARS at that facility in the past, the American public questioned the CDC’s wisdom of bringing Ebola into the United States and into a major metropolitan area. While it is highly unlikely that Ebola is going to spread out of Emory University’s facilities, extempers should still monitor the situation and the steps the U.S., EU, China, and other nations take to thwart the spread of Ebola to their shores.
Bringing Ebola under control will require extensive international cooperation with West African states. It will also require a large scale education campaign to overcome the fears and traditional practices of West Africans. As discussed earlier in this brief, distrust of Western medicine and traditional burial practices have thwarted efforts to quarantine the virus thus far. Some of this distrust stems from the lack of educational institutions in these countries, which have been plagued by political violence in recent decades, and from suspicions of the West that date back to the continent’s subjugation by European powers. The New York Times on July 27 discusses how West Africans have obstructed medical personnel from visiting villages with stones, clubs, and machetes. Villagers fear that if their loved ones are taken to medical facilities that they will not come out alive, which has sadly been the case for a large percentage of those infected by the virus. Rumors have spread that the reason people are not leaving medical facilities alive is because doctors and nurses are cannibals and this disinformation has made villagers reluctant to cooperate with medical personnel. The Chicago Tribune article cited earlier points out that tear gas has had to be used in Sierra Leone against those congregating outside of medical facilities. Those protesters demanded to take their infected love ones home with them. CAJ News in Nigeria on July 31 noted that disinformation campaigns have spread into nations that are not yet affected by Ebola, as the Nigerian government has warned against people selling “cures” for the virus and citizens sending panicky text messages. Therefore, overcoming cultural differences is one of the essential building blocks to containing the spread of Ebola in West Africa. Extempers should make sure to properly explain why African villagers are suspicious of the West and not merely write off residents there as “ignorant.” Much of what we know about modern medicine had to be taught to us from previous generations and some of this learning has yet to permeate West African societies. Awareness and education campaigns are sorely needed, which is why public officials such as Liberian President Ellen Johnson Sirleaf have demonstrated how to properly wash one’s hands. It is through these campaigns, which must be long-term and not short-term, that the Ebola virus will be brought under control and the scale of future outbreaks can be reduced.
The Economist article previously cited in this brief notes that an outbreak is considered to be over when forty-two days have elapsed and no new confirmed cases have been reported. Since Guinea and other nations continue to have new Ebola cases, the best case scenario envisions that the Ebola outbreak will end by October. However, getting to that point will require vigilance by the international community and the leaders of the affected West African states to tackle the virus at its source. If that fails, the world will have a public health nightmare on its hands.