Why the Worst Ebola Outbreak May Be Worse Than We Thought

By Michael Ferguson
Thursday, September 4, 2014

The current Ebola epidemic is the most lethal episode of the disease since its discovery in 1976. And yet, even while more than tripling the number of deaths from any previous outbreak, the Ebola crisis may be vastly underestimated, according to the World Health Organization (WHO).

News of the Ebola Virus Disease (EVD) outbreak — the first in West Africa — surfaced in March, when the Ministry of Health of Guinea reported 49 cases. Subsequently, the outbreak spread to Sierra Leone, Liberia and Nigeria. On Aug. 30, a patient in Senegal presented with symptoms consistent with EVD. All told, the disease is known to have affected more than 3,000 people.

Recent confirmed cases of EVD in the Democratic Republic of Congo, in Central Africa, are not virologically linked to the strain of the disease present in West Africa.

Mortality rates ranging between 55 and 60 percent — and as high as 90 percent in some areas — demonstrate the disease’s virulence and punctuate calls for a larger global response.

WHO recently released the Ebola Response Roadmap, offering guidance for preventing the international spread of EVD and curtailing transmission in affected countries within six to nine months. But along with recommending prophylactic strategies, WHO suggests the epidemic is still proliferating and may have affected nearly 20,000 people

Bending and Breaking

The outbreak still spreads unchecked and, in fact, continues to accelerate. That highlights the macrocosmic problem of global healthcare disparity.

In Liberia, newly opened EVD treatment facilities have been immediately overwhelmed by patients who were not previously reported as having the disease, reinforcing the probability that the outbreak extends beyond what official statistics show.

Rumored infections and deaths in remote villages often go unconfirmed because of their location and inadequate transportation. In such cases, epidemiologists estimate EVD’s toll by counting fresh graves. Meanwhile, residents of some communities don’t allow scientists access because of distrust of outside medical providers.

Misperceptions Drive Hostility

But perceptual problems aren’t limited to rural areas. In urban centers, there’s deep suspicion of medical efforts to treat people with suspected or confirmed EVD.

On Aug. 16, a mob looted an EVD quarantine center in the West Point district of Monrovia, Liberia, resulting in the disappearance of 17 suspected EVD patients. The mob purportedly stole bloodstained sheets and other items from the facility

There are conflicting reports as to why the armed men broke into the facility, but Liberia’s Assistant Health Minister, Tolbert Nyenswah, says residents were outraged that patients from across the country were being transported to their community. By contrast, witnesses to the attack reported hearing anti-government protests and shouts that there was no Ebola in Liberia.

Preparedness at Home

Transcontinental propagation of EVD may be likely, as the disease crops up in more urban areas where diverse populations have ready access to multiple means of travel

However, CDC officials have suggested a similarly large-scale outbreak in the United States is unlikely because medical facilities in this country are designed with safeguards against disease transmission and preventive equipment is readily available to healthcare providers.

Hope for Help

This week, GlaxoSmithKline (GSK) begins human trials on an EVD vaccination at the National Institutes of Health. The vaccine, which has been expeditiously researched and developed, showed promise in trials on chimpanzees. If successful in human trials, the vaccine could be available as early as this month, according to the company. Funding provided by an international consortium will allow GSK to manufacture 10,000 doses of the vaccine in conjunction with the clinical trials.

But with the degree of mistrust demonstrated in the Monrovia looting, strategies to educate the public in affected regions about the virus and to foster greater confidence in medical institutions, providers and practices will have to be fruitful to quell the outbreak.

Whether those efforts will prove effective is uncertain. The recent past has evidenced how fear mongering can provide a foothold to an all-but-eradicated scourge