Excerpt: Ebola: Story of an Outbreak

Return to Ebola: Story of an Outbreak.

As I write these words Gallup has just released a poll showing that America is almost as fearful of Ebola in October 2014 as it was of the H1N1 “swine flu” in May 2009: Fourteen percent of Americans believe Ebola is likely to sicken them or someone in their family in 2014, compared to 20 percent who thought the same of swine flu in 2009. The finding is staggering—at this moment just six Americans have contracted Ebola, all of them infected while living or working in the African nations of Liberia or Sierra Leone. In contrast, by the time Gallup conducted its 2009 poll about H1N1 more than 14 million Americans were already infected with the flu, most without realizing it.

Ebola, a virus named after a Congolese river, has conjured special respect since its discovery in 1976 in Yambuku, Zaire. As I wrote in my first book, The Coming Plague, the deadly disease was utterly mysterious back then, when its first wave washed over the remote town to claim the lives of ninety percent of those infected. The small international team of virus hunters who gathered in Zaire’s capital, Kinshasa, knew little about the strange disease except its horrible toll. Yambuku could only be reached via government planes and helicopters, and communication with the outside world was all but impossible. The scientists and physicians entered villages to find entire families sprawled inside dirt-floored huts, crying out in hallucinations, moaning in pain and bleeding from every orifice—blood that was filled with contagious viruses.

After the weary Ebola-hunters isolated the new virus and stopped the epidemic, their work and the horrors they had witnessed became the stuff of epidemiology and virology legend. Among those in the infectious disease tracking community, the mere mention of “Ebola” was enough to conjure gasps of dread and nodding respect for the disease cowboys who dared in 1976 to confront the microbe.

Nineteen years later Ebola reemerged in Zaire, hundreds of miles away from Yambuku in the large southern town of Kikwit. It started over Christmastime 1994 when Gaspard Menga walked into the dense rain forest that marked the edges of Kikwit in search of wood that he could burn down to charcoal and sell as fuel. Sometime during his days camping in the forest Menga came in contact with an animal—nobody would ever know what type of beast or the nature of the contact. From that animal Menga unknowingly caught Ebola, carrying it inside his body as he trekked back into Kikwit with a lucrative haul of charcoal on his back. A few days later Menga was dead, and his family, having lovingly tended to the ailing man, surrounded his body and posed for a mournful photograph.

When I met the surviving members of the Menga Family a couple of months later the Ebola epidemic was soaring, having spread from the local hospital to far flung villages and clinics across a wide region. I stared for a long time at the faces in that photo, seeing in them loss, grief, sorrow, and the start of a grave epidemic.

As I wrote in Betrayal of Trust: The Collapse of Global Public Health, the Kikwit epidemic afflicted a town of some 450,000 people who lived crammed together, house to house in what amounted to little more than a giant village lacking electricity, running water, sewers, telephones, an airport, or more than a couple of paved roads. The battle against the virus was waged with primitive, almost fourteenth-century methods—gathering up the ailing and dead, quarantining the sick, palliative care using soap and water, and burying victims in mass graves. The fight was waged by a heroic band of local Red Cross volunteers, a handful of medical students, three European Médecins Sans Frontières (Doctors Without Borders) physicians and a group of two dozen scientists and epidemiologists from Zaire and a dozen other countries organized by the World Health Organizetion. Once the team was in place, the 1995 Kikwit epidemic was under control within three months.

By 2013 the world had witnessed twenty Ebola epidemics in Africa. The toolkit was little-augmented: No vaccine, treatment or cure was developed over the thirty-seven years since Yambuku. In each case, from Congo to Uganda, hospital infection control, quarantine, and safe burial of the dead were the key to stopping Ebola. And as deadly as Ebola remained, the world grew numb to its horrors, losing interest amid a series of isolated, remote outbreaks.

Perhaps that is why rumors of Ebola’s Christmas 2013 emergence in an area that hadn’t previously seen the virus drew little notice. Even laboratory confirmation that the original 1976 strain of the virus was infecting rural villagers in the West African nation of Guinea garnered little more than a collective shrug from the world community. By June 2014 the West African outbreak was the largest in Ebola’s history. For the first time, Ebola had reached genuine cities with international airports—Conakry, Monrovia and Freetown—and the epidemic’s pace far exceeded the collective treatment capacities of Médecins Sans Frontières, local government clinics and hospitals and an assortment of foreign missionary groups.

As of this writing humanity is battling Ebola on many fronts, the worst still in West Africa. The U.S. Centers for Disease Control and Prevention has forecast that—in the absence of a dramatic escalation in international assistance—Liberia and Sierra Leone will have at least 500,000 cumulative Ebola cases by February 1, 2015, and at worst, 1.4 million. That scale of carnage could mean the two countries would lose up to 14 percent of their populations, and the epidemic would continue to rage into 2015.

Here in America more attention had been paid to a single case—Thomas Eric Duncan, a traveler from Liberia who was diagnosed with Ebola in Dallas, Texas, on September 28, eight days after his arrival in the U.S., and who died on October 8. His case, along with subsequent isolated infections in Europe, accounts for the state of fear noted in the Gallup poll of October 5, 2014.

Americans, Canadians, Europeans are discovering the hard way that security in a globalized world cannot be bought with easy technologies or a few epidemic drills in local hospitals. There is no smart phone app that can stop Ebola. The virus does not fear Google, or disappear at border checks.

Public health is a trust, built on trust. According to Gallup, more than one third of the American people do not trust the federal government tostop Ebola from sickening them or their loved ones, and 88 percent of the respondents are sure the virus is “coming to America.” A separate poll conducted by Pew Research found 32 percent of Americans convinced the virus might infect them or their families, and the level of fear correlated with race and political party membership—black Democrats placed the greatest trust in government’s response and expressed the least fear about Ebola, whereas white Republicans expressed far greater anxiety and distrust.

There is nothing partisan about a virus. But public health and politics have always mixed—often with terrible results. Joseph Fair, an American disease-fighter advising the Sierra Leone government about Ebola, calls the current epidemic “Global Health’s Katrina moment,” a reference to the terrible Bush Administration mishandling of the 2005 Hurricane Katrina devastation of coastal Louisiana and Mississippi. The world—especially poor countries like Liberia, Guinea and Sierra Leone—placed its trust in the World Health Organizaton and the disease-fighting agencies of the wealthy world. So far the world has betrayed that trust.