Sunday, August 31, 2014

Reap what you sow with Ebola virus

Reap what you sow with Ebola virus

The Ebola virus spreads while governments sleep on the job.

Believe it or not, there is some good news about the current outbreak of the Ebola virus. In spite of its fearsome reputation, many infected patients are recovering.

You'd expect that the two American missionaries who were flown home from Africa for special treatment would be among them. And they were.

If the top US experts couldn't save well-funded patients who'd been diagnosed early, nobody would be safe.

The two contracted the virus while working to save Ebola patients in West Africa in the biggest outbreak of the disease since it was first detected in 1976.


The Americans were evacuated to the US in a special biosecure unit in a private jet to Emory University Hospital.

There's no known vaccine or cure for Ebola. But the two were given a drug still in its experimental phase, ZMapp, described as a cocktail of antibodies, as a desperate measure.

"Today is a miraculous day," declared Kent Brantly, a 33-year-old doctor from Texas when he was pronounced cured.

So was it a triumph for the experimental drug? "The honest answer is we have no idea," said the medical director of the infectious disease unit at the hospital, Bruce Ribner.

The drug itself seems not to be a miracle. ZMapp was also given to a Spanish priest with the disease. He too was evacuated, and treated in Europe. Yet he died.

The more remarkable side of the story is that ordinary Africans in ordinary African clinics are also surviving. Patients who have not been given any experimental drugs, just basic medical care.

Not all are surviving. But, so far in this outbreak, 47 per cent of people infected with Ebola have recovered, according to the World Health Organisation.

And this is a higher survival rate than in most previous outbreaks. This is the 25th time the virus has occurred since it was first discovered in a pair of simultaneous instances in Africa, one near the Ebola River in the Democratic Republic of Congo and the other in a remote district of Sudan. It's not known but is suspected of originating in fruit bats.

Of the previous 24 outbreaks, four affected just one person. Excluding these isolated cases, the average survival rate in past Ebola eruptions was 37 per cent, and has been as low as just 10 per cent.

That is, the death rate has been as high as 90 per cent. For other notorious diseases such as typhoid or smallpox the fatality rate is 1 per cent or less.

The past ferocity of Ebola accounts for its dread reputation in Africa. And Hollywood has done the rest of the fearmongering for Ebola.

So when, for example, Victoria Yillah was pronounced cured of Ebola two months ago in Sierra Leone, it was considered miraculous. As the pregnant woman in her 30s was being interviewed on radio about her recovery, locals gathered around loudspeakers in the capital and hailed her as "miracle woman of the year."

And when Saa Sabas, an agronomist in Guinea, recovered, his village refused to believe. His clinic tested him three times to be sure, issued him a certificate of discharge, and sent staff to assure his local community that he was recovered and not infectious: "Despite this," Sabas told CNN, "I was stigmatised."

The sheer fear of the disease is one of the biggest problems in beating it. The WHO said this month that this outbreak had been "vastly" underestimated.

The WHO on August 22 set out several ways that fear has concealed the true scope of the epidemic. Because of fear of stigma, African families often hide their sick rather than take them for treatment.

And even when they seek help, they may find that frightened staff have fled: "Many treatment centres and general clinics have closed."

"An additional problem is the existence of numerous 'shadow-zones,'" said the WHO. "These are villages with rumours of cases and deaths, with a strong suspicion of Ebola as the cause, that cannot be investigated because of community resistance or lack of adequate staff and vehicles."

After fear, the biggest contributor to the spread of the disease has been complacency. From media reporting you'd have the impression that this eruption began a couple of months ago. But it actually started last December and its known reach has been accelerating.

An estimated 2615 people in West Africa have been infected, of whom 1427 have died.

Then, on the weekend, the first cases were confirmed outside West Africa, in the Democratic Republic of Congo. But this strain of the disease seems to be a different one, according to the country's health minister, Felix Numby.

So far neither strain is known to have left Africa. But globalisation is a two-way flow of risks and rewards. Terrorists can catch planes. So can people carrying Ebola.

In Australia, authorities say risk of Ebola arriving is very low. Frontline staff at airports have been told to question all people arriving from West Africa and to look for symptoms, which include fever, vomiting and diarrhoea. There is no thermal or other automatic scanning to detect the ill.   

The Australian government last week added $1 million to its funding of the WHO to help manage Ebola. The Economist magazine makes a strong case for more active management of the disease, comparing it to HIV-AIDS:

"Both were new diseases that came out of African jungles. Both took hold in countries without decent health infrastructure. Had AIDS been spotted in 1959" when it was first found but not yet comprehended, it argues, 39 million lives might have been saved.

"The story of AIDS argues for tackling such potential plagues early." Fear is counterproductive. Vigilance is priceless.

Peter Hartcher is the Sydney Morning Herald international editor.Illustration by John Shakespeare.


No comments:

Post a Comment