“It borders on irresponsibility when people get on television and start talking that way when they should know better. They should do their homework, and they should report in a responsible manner. Unfortunately, it’s a very competitive business, the business we’re in, and there is a perception that by hyping up this threat, you draw people’s attention.”
–PBS Science Correspondent Miles O’Brien
The World Health Organization released its 14 part report on the origin and present state of this virulent disease in January 2015. The international crisis never appeared as predicted; the few cases that traveled were taken care of with only a few mortalities. The ignorance and panic were surprising and regrettable. Albert Camus in his 1914 novel The Plague understood the fears and feelings of facing a plague:
“The evil in the world comes almost always from ignorance, and goodwill can cause as much damage as ill-will if it is not enlightened. People are more often good than bad, though in fact that is not the question. But they are more or less ignorant and this is what one calls vice or virtue, the most appalling vice being the ignorance that thinks it knows everything and which consequently authorizes itself to kill. The murderer’s soul is blind, and there is no true goodness or fine love without the greatest possible degree of clear-sightedness.”
The WHO reports the following: In Meliandou, Guinea, an 18 month old boy was afflicted by fever, black stools, and vomiting. He died two days later. The date was December 26, 2013. Guinea’s first recent case of Ebola virus had taken its first victim.
Meliandou has only 31 households and is an area known as the Forest region. The mining and timber operations have brought wildlife closer to the village. Bats, the suspected carriers, made their homes in the woods where children play.
Two weeks later, others in his family had begun to show similar symptoms. Those afflicted also died quickly. Caregivers also perished of the illness. Those attending the funerals and those caregiving to some of the caregivers were also stricken, they returned to their homes and now the illness rapidly spread.
The capital Conakry saw its first case of the illness when an extended member of the family journeyed there, dying four days later. Ebola was not suspected and few precautionary isolation practices were instituted. The cases traveled further and further.
Three months later, health officials, with assistance, identified the illness as Ebola. The disease had infected many villages and individuals by that time.
60% of Guinea’s infection can be traced to the traditional burial and funeral practices. Secret burial societies bathe and anoint the deceased. The practice of sleeping close to a (highly infectious) deceased for several nights was done to allow the transfer of powers to the living.
When these practices were discovered, health officials tried to assume the duties of burial of the dead. There was great resistance by the community who might keep the deceased above ground for up to eight days. The military performed safe and quick burials but were deemed undignified by villagers. Touching the deceased and dressing them in their finest clothes were important rituals.
Cremation of Ebola victims became mandatory in Liberia in August. This was in response to villages not allowing burials near homes and deceased victims being left unattended.
The need for medical care was overwhelming, only 240 beds were available, but Monrovia needed 1,000.
In December, the new case count was down with only 6 of the 15 counties reporting new cases.
In Grand Bassa and Grand Cape Mount, they had no trained staff to battle the illness. Personal protection equipment and proper medications were scarce. There were very few equipped ambulances, very few ambulance crews, very little fuel for the vehicles, and few burial teams.
In Sierra Leone, the first case was a woman who was guest with a family in Meliandou, Guineas. When they became ill, she went home and the infection started.
A faith healer was infected with the disease as she tried to cure others. Her funeral created more cases and up to 365 cases were reported from that funeral.
An expert on hemorrhagic diseases, Sheik Humarr Khan died of the disease in July. His work helped inform the country of its dangers and worked for the improvement of treatment facilities.
In August, the President of Sierra Leone declared a state of emergency and passed a two year jail sentence for anyone hiding a patient afflicted. Up to 30 burials a day were held.
The WHO report calls for “strengthened preparedness…and the creation of a contingency fund for public health emergencies.”
Four lessons to Learn
1. Recognize that countries with weak health systems cannot sustain this shock to their systems.
2. Preparedness for imported cases. The first case is a national emergency.
3. No single unit can bring Ebola under control. All measures and controls need to work.
4. Community engagement is the key. All parts of the community must be focused to this crisis.
“The primary cause of this enormous Ebola outbreak has been inadequate health care. The virus itself is no more transmissible or deadly than it was in any previous outbreak. In Nigeria, for example, health-care workers were able to bring the disease under control relatively quickly. They identified the problem early and got patients into hospitals equipped with protective gear and other critical supplies.”
–Editorial in the Bloomberg, (VA) View