Ebola outbreak: 5 questions answered

The World Health Organization just warned that Ebola cases could top 20,000, while Nigeria cited its first deadly case outside Lagos.

The Explainer

Q: What is Ebola?

Ebola is a deadly virus found in several regions of Africa. But it doesn’t spread easily: The virus is transmitted through contact with bodily fluids. (Bleach, chlorine, and soap can kill the virus.) That makes Ebola much more difficult to contract than common diseases carried by air or insect – such as tuberculosis and malaria – both of which have been linked to far more deaths than Ebola in West Africa this year. 

Q: How did this epidemic start?

Public-health experts believe “patient zero” was a 2-year-old boy who died in the village of Guéckédou, in southeastern Guinea, in early December 2013 – likely having contracted the disease from an infected local fruit bat. But it took until March of this year for the disease to be properly identified, by which time it had already killed his entire family and spread to dozens more people in both Guinea and neighboring Liberia and Sierra Leone. 

Q: What has made this outbreak so difficult to contain?

For one thing, health care in the three countries hardest hit – conflict-hobbled Guinea, Liberia, and Sierra Leone – is massively underresourced. Liberia, for instance, had fewer than 200 doctors in the entire country when the epidemic began, and Reuters estimates that fewer than 50 are still working – many stopped working out of fear, while others left the country. Only a few died as a result of working with Ebola patients.

Even more significant, however, is the lack of knowledge about Ebola specifically. Because the disease had never been seen before in West Africa, health-care workers there initially struggled to identify, treat, and, most important, quarantine patients. Patients, meanwhile, have been skeptical of health-care workers telling them to abandon deeply rooted cultural practices in caring for the sick and washing the bodies of the dead.

But the most crucial difference between present and past outbreaks is the transnational character of the disease’s spread. That Guinean village where the virus was first identified sits in a porous border zone with Liberia and Sierra Leone, allowing the disease to be transmitted easily between people in the three countries.

“If people are able to cross borders then it doesn’t matter how hard one country works if the others don’t, too,” Kim Yi Dionne, a professor of African politics at Smith College, told the Monitor. “That’s a disincentive for anyone to do anything.” 

Q: Are there any signs the tide is turning?

Yes. Although initially sluggish, the global public-health community is now reacting powerfully to the outbreak. The World Bank Group said in early August that it would provide “up to $200 million” to help halt the spread of the disease, while the World Health Organization (WHO) pledged $100 million and the African Development Bank $60 million, with several national governments promising smaller sums. Doctors Without Borders has more than 1,000 personnel working on the ground in the three most affected countries.

But the organization says that governments and international aid groups must step up their response if the epidemic is to be controlled within the next six months. Nigeria reported Aug. 28 that a doctor died of Ebola in the city of Port Harcourt, the country's first Ebola case outside of Lagos, and the World Health Organization estimates that total cases could exceed 20,000.

“We’re running behind a train that is going forward,” Joanne Liu, international president for Doctors Without Borders, told reporters in Geneva in mid-August. “And it literally is faster than what we’re bringing in terms of a response.” 

Q: What needs to be done now?

Experts warn that overreaction to the outbreak could be just as cruel as ignoring it. The WHO, for instance, has urged countries to stop instituting bans on travel and trade to the region, saying the risk of the disease spreading through air travel in particular is extremely low. “Sick persons usually feel so unwell that they cannot travel,” the organization wrote in a recent advisory.

Meanwhile, the United Nations World Food Program says that trade bans and quarantines are “increasing pressure on the most vulnerable populations” in Guinea, Sierra Leone, and Liberia, as crops are left to rot in fields and many struggle to access food and other basic supplies. In late August, the WFP began deliveries of food aid to 1.3 million people in the region who it says face potential hunger because of trade bans, restricted movement, and uncollected harvests.

From the more than 100 health-care workers who have died fighting the disease to those who continue to transport, clean, care for, and bury Ebola victims in their communities, responses to the outbreak have resulted in countless acts of everyday heroism – far more than the number of lives it has claimed.