Ebola – The Wind That Blows; Will It Stop?

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Introduction:

The cold wind of the Ebola Virus Disease (EVD) took its first sweep in 1976. The effects of its goose bumps – very lethal, very infectious – were instantaneously felt in Nzara, a Sudanese town, and in Yambuku of the Democratic Republic of Congo. The wind blew again, very cold, in a village near the Ebola River, from which the disease took its name.

Ebola has since remained the most lethal infectious disease posing health, economic, social and security threats not only to the African continent but the world at large. The current outbreak in the three West African countries of Guinea, Sierra Leone and Liberia, detected in March 2014, unleashed the largest and most multifaceted Ebola outbreak in global history since the discovery of the virus.

The virus family, Filoviridae, includes three genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are five species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first three, Bundibugyoebolavirus, Zaire ebolavirus and Sudan ebolavirus have been associated with large outbreaks in Africa. Experts say the virus causing the 2014 West African outbreak belongs to the Zaire species.

The West Africa Ebola outbreak remains the most overwhelming outbreak of disease in world history. The number of deaths recorded unimaginably remains the highest ever to be recorded in a very short period –far higher than the records of all previous cases.

The World Health Organization estimates that the virus has killed over 11,301, mostly in West Africa. Liberia recorded a total of 4,806 deaths out of 3,151 laboratory confirmed cases, the highest recorded number of deaths. Sierra Leone recorded 3,952 deaths out of 8,697 laboratory confirmed cases while Guinea has 2,526 deaths from 3,334 laboratory confirmed cases.

15 other Ebola deaths also occurred in Mali, Nigeria and the United States. Ebola cases also emerged in Senegal while another case was later identified in Spain.

Considering the increased causalities caused by Ebola, on August 8, 2014, the WHO declared the West Africa outbreak a Public Health Emergency of International Concern under the International Health Regulations (2005). The WHO also formed a panel of international experts to assess its response – the status of this panel is still pending. On September 14, 2014, the United Nations also formed the United Nations Mission for Ebola Emergency Response (UNMEER), the first-ever UN health mission, with a core objective of scaling up the response on the ground and establishing unity of purpose among responders in support of the nationally led efforts.

However, the International Community, the UN and WHO came under heavy criticism for their snail pace response towards the epidemic from its early stage. International response scaled up when Liberia had already over 1,000 deaths.
Ebola’s impact and its potential on Africans

Since the Ebola Virus Disease (EVD) outbreak in March of 2014, West Africans have continued to be confronted with several challenges including humiliation, stigma and discrimination. Restrictions, which breached national and international laws, were imposed on
Africans, especially those from the three West African states of Guinea, Sierra Leone and Liberia due to stigma. These vices have fueled considerable amounts of damage to include shutting down borders and suspension of flights to and from the three countries. The outbreak and its aftermath sanctions crippled the economies of the affected countries in the sub-region.

According to a World Bank Report, full-year 2014 growth in Guinea collapsed to an estimated 0.5 percent from a rate of 4.5 percent expected before the crisis. Full-year growth for 2014 in Liberia fell by more than half to an estimated 2.2 percent from 5.9 percent expected before the crisis. Full-year 2014 growth in Sierra Leone fell by more than half to 4.0 percent from 11.3 percent expected before the crisis. All three of these rates imply shrinking economies in the second half of 2014. The total fiscal impact felt by the three countries in 2014 was over half a billion dollars, nearly 5 percent of their combined GDP.

West Africa as a whole may lose an average of at least US$3.6 billion per year between 2014 and 2017 due to a decrease in trade, closing of borders, flight cancellations and reduced Foreign Direct Investment and tourism activity, fuelled by stigma, says the United Nations Development Group (UNDG).

This has also had an important impact on human development. The region’s per capita income is expected to fall by US$18.00 per year between 2015 and 2017, the UNDG maintained.

In Côte d’Ivoire, the poverty rate has risen by at least 0.5 percentage points because of Ebola, while in Senegal the proportion of people living below the national poverty line could increase to 1.8 percent in 2014. In addition, food insecurity in countries such as Mali, and Guinea-Bissau is expected to increase.

In Liberia, the government reported early this year that since 2006, Liberia’s growth rate increased, reaching a level of 8.9 percent in 2012 with the potential for double digit thereafter, while in 2013, growth rate fell to 8.3 percent on account of the global economic downturn and its effect on global prices of primary commodities.

Unfortunately in 2014, the Ebola virus outbreak led to a dramatic decline in the nation’s growth rate from a projected 5.9 percent to an initial -0.4 percent. Although later revised to 1 percent, the future of economic growth is still severely challenged, the government maintained.

“If we are to achieve development goals outlined in the Agenda for Transformation, and reach the long term average growth rate of 8 percent, radical changes will be required in the structure of our economy for increased investments in the productive sector of the economy and in our governance structure and processes,” Madam Ellen Johnson-Sirleaf, President of Liberia told the country.

Will Ebola Stop?

The consequences of Ebola in Africa and its extension to the rest of the world lead one to ask many questions. An obvious question remains: “Will Ebola ever stop?”

The ordinary man would think that Ebola is soon to be over due to significant decline in new infections of the virus in the three West African nations, coupled with positive stories published on the Internet nowadays.

Internet, as well as front and back pages of most national and international newspapers’ stories since March of 2015 have become more human friendly – less fear and stress-driven – and would provide a clearer picture of communities, health practitioners and donors partnership to ‘totally’ curb the virus.

Despite the progress acknowledged the contrary is the absence of trustworthy drugs or vaccine thus making Ebola history’s impractical.

What is most interesting is that scientists are still finding it difficult to determine the infiltration or transmission of Ebola in humans due to either its complexity or recently observed ‘chameleon’ posture pinpointed in the recent outbreak that started in March of 2014.

Ebola turns ‘chameleon’ in recent outbreak

The Center for Disease Control (CDC) has alluded to the fact that because the natural reservoir of Ebola viruses has not yet been identified, the way in which the virus first appears in a human at the start of an outbreak is unknown. However, scientists believe that the first patient became infected through contact with an infected animal, such as a fruit bat or primate (apes and monkeys), which is called a spillover event. Person-to-person transmission follows and can lead to large numbers of affected people. In some past Ebola outbreaks, primates were also affected by Ebola and multiple spillover events occurred when people touched or ate infected primates.

When an infection occurs in humans, the virus can be spread to others through direct contact (through broken skin or mucous membranes, for example, the eyes, nose, or mouth) with: blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with or has died from Ebola; objects (like needles and syringes) that have been contaminated with body fluids from a person who is sick with Ebola or the body of a person who has died from Ebola; and infected fruit bats or primates (apes and monkeys).

It is widely said Ebola is not spread through the air, by water, or in general, by food and there is no evidence that mosquitoes or other insects can transmit the Ebola virus. Only a few species of mammals (e.g., humans, bats, monkeys, and apes) have shown the ability to become infected with and spread the Ebola virus.

Resurgence of the disease has made scientists to believe that the Ebola Virus Disease can possibly spread through the semen of a male survivor (for example, by having oral, vaginal, or anal sex).

Male survivors are often advised to abstain from sex for a period of 90 days or should have protected sex (use condoms) when they decide to have sex within the 90 days after being discharged from the Ebola Treatment Unit.

However, the 90 days sex abstinence is now doubtful as there have been reports of resurgence in Liberia in which the mode of transmission has been linked to sexual transmission in which the survivors had spent over 100 days.

Though it was widely believed that by sexual transmission the male survivor was the donor of the virus through the semen, most recent resurgence in Liberia in which the victim was a male has also been linked to sexual transmission. This could mean that the donor in this instance might have been a female.

Two Peculiar sexual transmission cases (resurgences) in Liberia

The first occurred following more than 10 days after Liberia released her last-but-first diagnosed Ebola patient – Beatrice Yardolo – from a Chinese run-Ebola Treatment Unit (ETU). Another woman identified as Ruth Tugbeh, 44, contracted the illness from her fiancé.

Officials reported that Ruth’s fiancé survived the virus after spending 21 days in a treatment unit. It was also reported that the pair had sexual contact over hundred days after he was discharged. Unfortunately, efforts to keep Ruth alive did not materialize.

After her death, Liberia had a recount surveillance schedule of 21 days which led WHO declaring the country Ebola-free on May 9, 2015.

Tactlessly, in more than six weeks after the nation was declared Ebola-free, a 17 year old boy died of Ebola in Margibi, near Monrovia, in June 2015.

The second resurgence occurred 42 days after the country was declared Ebola-free. The report that the boy died of Ebola sparked a debate marked with protest from the boy’s family who refused to accept that their son died of Ebola, instead a dead dog suspected to have been poisoned by evildoers in the county.

Preliminary report from the government unveiled that the boy may have had sex with an infected Ebola person before his demise.

Liberia’s Incident Management Team head, Mr. Tolbert Nyenswah, told local media that the virus was not imported, noting that it was the strain that Liberia fought in March. “We have conducted several investigations and are now investing sexual transmission as well because, you know that in March, issue of such was reported, so we are careful about that,” Mr. Nyenswah said in July, 2015.

With these new developments in the occurrences of Ebola, one cannot be too sure that the world can defeat Ebola in the face of mountaineering strategies, leaving out the discovery of a reliable drug or vaccine to work against the virus.

Discovering a drug or vaccine against Ebola is a wakeup call for the world and policymakers

As the World Health Organization and the United Nations continue to invest dedicated resources to the development of an effective drug or vaccine to curb and limit transmission of the Human Immuno Virus (HIV), Acquired Immuno Deficiency Syndrome (AIDS), Tuberculosis (TB), and Poliomyelitis (polio), highly infectious viral diseases, it is disturbing that an effective drug or vaccine for Ebola is yet to come to reality.

The fact remains that Ebola is awfully contagious and its fatality rate has been frequently very high. Just an infected person could cause the death of an entire family and perhaps an unimaginable number of persons in a country. However, since 1976, there has been no vaccine licensed for use in humans to guard against EVD. According to WHO, clinical trials for several candidate vaccines are in various phases and a safe and effective vaccine hasn’t been realized.

A recent trial of a vaccine to prevent the Ebola tested on 7,500 people, predominately health workers in the West African state of Guinea, where the latest and most lethal strain of the Viral Hemorrhagic Fever (VHF) originated in late 2013, is welcoming.

The vaccine is said to have 100 percent effectiveness among those that were a part of the trial. WHO told the world that additional evidence is still needed in regard to its ability to shield large populations through what is known as “herd immunity.”

As a result, the Guinean national regulatory authority and ethics review committee has given the go ahead for additional research.

The research methodology utilized in the trial is called a ring approach, Dr. Sakoba Keita, the Guinean national coordinator for the EVD response averred.

This is one of two vaccines being tested at present in the Ebola-impacted states. There is another vaccine produced by GlaxoSmithKline (GSK). The trial study used the Merck vaccine and was directed by Ana Maria Henao-Restrepo of the WHO.

Though these initial trials provide promises for containing and eradicating EVD as a major threat to human health and the overall wellbeing of the most severely-impacted states, the additional research call must be a wake-up call for policymakers locally and globally.

The devastating effect of Ebola on the African continent cannot be overemphasized as the continent yearns for affirmative action against the recurrence of the lethal infectious disease. Diplomatic speeches alone will not bring relief to the people of the continent. There is a need to galvanize more resources to catalyze the discovery of an effective drug/vaccine to guard against the humiliating disease.

If the world had discovered drug or vaccine to suppress HIV, AIDS and TB, as well as other diseases, same can be done to help eradicate Ebola, especially now that it is noted that the virus could possibly be transmitted through sexual intercourse.

This must be treated as a matter of urgency. Knowing it is not enough; we must apply the knowledge. Being willing is not enough; we must do. We must do before it is too late!

Author
The writer of this health analytical piece is a Liberian journalist, the proud winner of the 2014/2015 Health Journalist Award of the Press Union of Liberia, and a student of the African Methodist Episcopal Zion University (AMEZU), reading Public Administration and Education. He can be reached at: Email: [email protected]; Mobile phone no: (+231) 886 427 519 | 777 463 908.

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