Let Us Be Sensible About Ebola

Ebola is, of course, extremely frightening. It is like some disease physically transported to planet earth by aliens from outer space.

The television images enforce this eerie feeling. Human figures totally encased in macabre protective gear walk about hospitals attending to emaciated and miserable-looking people who, we assume, will soon become corpses.

The association of Ebola with death is unmitigated, and is constantly reinforced by newer versions of the unrelenting barrage of frightening TV images.

What to do? The first thing is to REALLY UNDERSTAND what Ebola is, and the risks it poses – or does NOT POSE – to us.

Now, we can take it for granted that the Americans and their Western partners have more information about, and do understand the outbreak, of Ebola in four West African countries – Guinea, Liberia, Sierra Leone and Nigeria – better than most other countries. So what they are telling their citizens in those countries is extremely relevant to everyone.

An American embassies in West Africa is quoted as telling US citizens this:

QUOTE “In order to help our Embassy Community better understand some of the key points about the Ebola virus, we have consulted with our medical specialists at the US State Department and assembled this list of bullet points worded in plain language for easy comprehension. Our medical specialists remind everyone that they should be following the guidelines from the Centre for Disease Control and the World Health Organization.

• The suspected reservoirs for Ebola are fruit bats.

• Transmission to humans is thought to originate from infected bats or primates that have become infected by bats.

• Undercooked infected bat and primate (bush) meat transmits the virus to humans.

• Human to human transmission is only achieved by physical contact with a person who is acutely and gravely ill from the Ebola virus, or their body fluids.

• Transmission among humans is almost exclusively among caregiver family members or health care workers tending the very ill.

• The virus is easily killed by contact with soap, bleach, sunlight, or drying. A washing machine will kill the virus [even] in clothing saturated with infected body fluids.

• A person can incubate the virus without symptoms for 2-21 days, the average being 5-8 days, before becoming. ill THEY ARE NOT CONTAGIOUS until they are acutely ill.

• Only when [a person becomes ] ill does the viral load express itself, first in the blood and then in other bodily fluids [including] vomit, faeces, urine, breast milk, semen and sweat.

• If you are walking around, you are not infectious to others.

• There are documented cases from Kikwit, Democratic Republic of Congo of an Ebola outbreak in a village that had the custom of children never touching an ill adult. Children living for days in small, one room huts with parents who died from Ebola, did not become infected. [Because they obeyed the local custom and did not touch the ill adults]

• You cannot contract Ebola by handling money, buying local bread or swimming in a pool.

• There is no medical reason to stop flights, close borders, restrict travel or close embassies, businesses or schools.

• As always, practise good hand-washing techniques and good hygiene.

You will not contract Ebola if you do not touch a a person dying from Ebola. UNQUOTE

The US Department of State must be congratulated on bringing such clarity and calm into a situation in which PANIC has arisen, not only in West Africa, but in countries to which flights depart from West Africa. Of course, any disease that kills those who are trying to use scientific best-practice to cure it must be feared – like the proverbial plague.

But acting out of ignorance of the true nature of the outbreak, or going overboard with declarations of a state of emergency, or implementing other excessively coercive measures, just because some Governments rightly have a guilty conscience over their ever-present neglect of their health sector, especially with regard to sanitation and public health generally, is unwise and dangerous.

I believe that in some parts of Liberia, the army has been deployed to prevent people from the rural areas – whether they are healthy or sick – from travelling out of their areas. Does the Government of Liberia realise that this will probably result in starving the urban areas, since most of the food the town-dwellers eat comes from the rural areas?

Secondly, does the Liberian Government realise that it will cost more to deploy troops in the rural areas and maintain them there, than in buying specially equipped ambulances to carry Ebola patients to specially-equipped mobile or makeshift health centres created on an emergency basis (with the help of the Red Cross, the Red Crescent and donor Governments)?

A practical, efficacious well-thought-out plan would serve the Liberian citizenry better than panic measures. Already riots have occurred in parts of Liberia, which should tell the Government to rethink its approach.

The Governments of Sierra Leone and Guinea would also do well to tone down the panic among their populations, whilst doing everything in their power to bring relief to the afflicted. They should remember that good psychological practices can improve the chances of survival, even among stricken communities. For instance, it has been reported that out of fear, some communities are leaving dead bodies unburied. Now, such actions can only make matters much worse, for not burying bodies does carry a risk of spreading disease, period. If this happens with Ebola-stricken corpses then serious trouble is being courted.

Nigeria, too, ought to be extremely careful in how it tackles Ebola. This is because it has some of the most crowded cities and towns in the world and any widespread panic in them could create more deaths than the disease itself. Thankfully, at the time of writing, there had been only 2 deaths and less than 20 cases, out of a population of 170 million.

Now, President Goodluck Jonathan has a history of reacting slowly to events (especially those relating to Boko Haram). But he should tread carefully on such a complicated public health issue as the Ebola case. Perhaps, it would have been more prudent of him to announce merely that $11m was being made available to beef up the health services to fight Ebola, rather than using the word “emergency”. He should know that the offer by sham Nigerian evangelists of ”blessed water” to the afflicted not helping the situation.

On the scientific front, however, there is quite encouraging news. The multi-national pharmaceutical giant, GlaxoSmithKline, is said to be ready to start trials on an Ebola drug as early as September 2014. And the World Health Organisation (WHO) has predicted that an Ebola vaccine should be available for public use by 2015.

“I think it's realistic” [to see the emergence of a vaccine] Marie-Paule Kieny, Assistant Director General of the WHO told the French news agency, AFP, on 10 August 2014. Clinical trials will get underway in the next few months.

(There is currently no vaccine or cure for Ebola.)
900 people are known to have died from it since its outbreak in West Africa in March. That means an average of 180 people have died from the disease per month – far less than die from malaria or tuberculosis each month.

GlaxoSmithKline initially started its own development of the vaccine in May 2013. The company says: “We are working with the US National Institutes of Health's Vaccine Research Centre (VRC) to advance development of an early stage vaccine candidate for Ebola..... In collaboration with VRC, we have evaluated this vaccine candidate in pre-clinical studies and we are now discussing with regulators, [how to advance] it to a Phase I clinical trial programme later this year” [2014].

The latest developments come as two US aid workers infected with the deadly virus appear to be responding well to an experimental treatment that had previously only been tested on monkeys. Dr Kent Brantly and Nancy Writebol, who were flown home to the US in a sealed tent within a modified aircraft, were said to be improving, thanks to a serum called ZMapp.

However, the administering of the drug to the Americans has puzzled health authorities in West Africa as it had not been offered to them too to try on patients.

Three of Britain's leading Ebola experts have expressed the opinion that some of the few experimental treatments currently under study, should be made available to African governments, too.

The African health authorities should be “allowed to make informed decisions about whether or not to use these products - for example to protect and treat healthcare workers, who run especially high risks of infection,” Peter Piot, who discovered Ebola in 1976, David Heymann, the Director of the Chatham House Centre on Global Health Security and Jeremy Farrar from the Wellcome Trust, said in a joint statement.

Tolbert Nyenswah, Liberia's Assistant Health Minister, said that the treatment the Americans were receiving had “made our job very difficult” with dying patients and their families in Africa requesting the same drug.