Ebola, The West African Killer

Ebola has entered the United States. Yes, the feared and seemingly unreal disease has crossed the borders of our great country. To average Americans, Ebola virus probably conjures up images of the 1995 film Outbreak, starring Dustin Hoffman, Rene Russo, and Morgan Freeman. Minus the secret cover-up plot and harboring the disease for biological warfare, the movie really hits home. Scenes of sick people in remote African villages and aid workers covered head to toe with medical protective gear are real and happening right now.

Guinea, Liberia, Sierra Leone, and Nigeria cannot manage an outbreak of this size and nature and are pleading for international aid.

The disease is spreading and people are dying. The World Health Organization has deemed the West African outbreak a global health emergency, this is only the third declaration of this kind by the WHO since permissions for such alarms were put in place in 2007. As of August 6th, the Ebola virus has killed nearly one thousand people since March and “is moving faster than we can control it," according to WHO’s director general Margaret Chan. The death rate of infected Ebola victims is fifty percent and this is the worst Ebola outbreak in history. Ebola causes a fever followed by internal bleeding.

Chan stated at a news conference at the WHO headquarters in Geneva that, “This is the largest, most severe, most complex outbreak in the nearly four-decade history of the disease.” She further stated, “I am declaring the current outbreak of the Ebola virus disease a public health emergency of international concern. Countries affected to date simply don’t have the capacity to manage an outbreak on this scale on their own.”

The WHO recently stated that, “A coordinated international response is deemed essential to stop and reverse the international spread of Ebola,” after a two day meeting of their emergency committee.

Jonathan Jennings, deputy director for Doctors Without Borders in Canada said, "We welcome today's declaration by the WHO. We very much think, though, that it needs to be translated into action on the ground.” Jennings said. He stated medical teams, epidemiologists, case detection and infection-control specialists need to be sent into the field immediately. Doctors Without Borders stated, “Lives are being lost because the response is too slow.” Nigeria declared a national emergency on Friday and the UN health agency has urged other affected countries to do the same.

In the event of a global health emergency, travel restrictions can be placed which can affect trade as well. Chan says that there isn’t a general ban for now, but countries need to be prepared to investigate and manage Ebola cases.

According to the WHO, efforts to contain the disease have been hampered by inexperience and misconceptions of the threat of the Ebola virus. The general public needs to be educated. The West African governments have set up quarantines and continue to provide hospital services, but there needs to be more education. Liberia and Sierra Leone even brought in troops to enforce the quarantines and keep infected individuals from traveling.

There are no drugs or vaccines for the disease, so only symptoms can be treated, such as, vomiting and diarrhea that cause dehydration.

According to Dr. Michael Gardam, director of infection prevention and control at Toronto’s University Health Network, more needs to be done.

"Usually, Ebola virus outbreaks burn themselves out fairly quickly and they're done. This has not burned itself out. It keeps expanding and at some point, what you would have done in the past is not enough. You have to do more and that's where this declaration is very helpful in really pushing people to now drop everything and get a handle on this."

Even the dead can infect the living. Deceased Ebola victims still carry the disease, which can be transmitted during burial preparations. There is a lack of health-care resources to trace individuals who come into contact with Ebola patients and monitor them for the full twenty-one day incubation period. Some communities in West Africa distrust the health authorities, leading to further spread of the Ebola virus. The WHO has urged all affected countries to screen all people leaving at international airports, seaports, and land crossings so that travel of anyone suspected of having the virus can be prevented.

What may be most troubling is that this disease can be contained. Dr. Keiji Fukuda is the head of health security for the WHO, “This is not a mysterious disease. This is an infectious disease that can be contained. It is not a virus that is spread through the air.”

So why is Ebola virus spreading so far and wide? Several factors play into that, as mentioned earlier: inexperience, misconceptions, and slow response. A seemingly high number of infections have occurred in health care workers, showcasing the inadequate infection control practices in the facilities. Many of the African health systems are weak in these countries, so that, coupled with lack of education and experience, paves the way for further spread of Ebola virus.

With all the hubbub surrounding the Ebola outbreak, it’s no wonder it was no small news that two infected American doctors were flown home to be cared for. The second patient arrived at Emory Hospital in Atlanta Tuesday. Critics have blasted the authorities for making this decision and bringing the disease here.

The individuals tasked with caring for the infected patients state that our country is obligated to care for the American Ebola victims and that the public worry is unfounded.

Susan Mitchell Grant is the chief nurse at Emory and has done her best to dispel arguments from public figures such as Donald Trump and Rush Limbaugh.

“We are caring for these patients because it is the right thing to do. These Americans generously went to Africa on a humanitarian mission to help eradicate a disease that is especially deadly in countries without our health-care infrastructure. They deserve the same selflessness from us."

On August 2, Trump tweeted that bringing the American Ebola victims to the U.S. was “absolutely CRAZY-Stupid.”

Grant says the medical staff at Emory are confident in its ability to “manage and contain” the virus. She also stated that our country may benefit from seeing the disease up close.

“Ebola won’t become a threat to the general public from their presence in our facility," Grant wrote, "but the insight we gain by caring for them will prepare us to better treat emergent diseases that may confront the United States in the future."

This may already be true. The two American Ebola patients at Emory were secretly given an experimental drug called ZMapp before they even left Africa. This drug, which has never reached human clinical trials, has shown promise in monkeys. The monkeys showed improvement in small studies.

Dr. Kent Brantly is one of the Americans who contracted the disease. “I held the hands of countless individuals as this terrible disease took their lives away from them. I witnessed the horror firsthand, and I can still remember every face and name.” Dr. Brantly was ill with Ebola and sensed the end when he was given the experimental serum. By the time he reached Emory Hospital in Atlanta, he was so much improved that he was able to walk into the hospital with little assistance. Missionary Nancy Writebol also received the mysterious serum, but she required two doses before she showed improvement.

“I am writing this update from my isolation room at Emory University Hospital, where the doctors and nurses are providing the very best care possible,” he wrote from Atlanta. “I am growing stronger every day, and I thank God for His mercy as I have wrestled with this terrible disease.”

This is encouraging, but raises many questions about why this drug was only given to the white Americans, how come the drug wasn’t passed out to as many African Ebola victims as possible, and so on. It seems plain and simple, right? No, wrong. In order for researchers and scientists to give an individual an experimental drug, the patient must be fully informed of all the risks and be able to give meaningful informed consent. It would be unethical to try to explain all of the possible risks and outcomes of an experimental drug across cultural barriers and truly believe the individual can give “informed consent”. In countries with such weak health systems, informed consent would be a foreign concept and not easily and fully understood. The drug may not work at all, it may work effectively only for men and not women, it may kill children. Researchers simply do not know.

On top of that, ZMapp was administered with a special approval from the FDA called  “compassionate use exemption”. This allows an experimental drug that has not undergone full testing and research to be administered if the patient has no other way to survive but to take the experimental drug. Researchers know almost nothing about how this drug works in humans, although it seems to have helped Brantly and Writebol.

As of now, the WHO is forming a panel of ethicists to decide whether or not ZMapp should be distributed to Ebola victims and how. The situation in West Africa is very grave and action must be swift.

“You have experimental products which have never even been used in humans, in healthy volunteers. And in addition, there is very, very little of it. So what do you do with it?" Dr. Marie-Paule Kieny, the WHO's assistant director general for health systems and innovation. "Of course it should be used but for whom and how? I think you could make a case that if they are to be used, they should be used also in a condition where it is possible to learn as much as possible from their use."

Mapp Biopharmaceutical, the company that made ZMapp, has only a handful of doses left of the drug. Companies only produce very small batches of experimental medicine. It is estimated that making another batch could take upwards of three to four months. So, how would the remaining drug be distributed?

In the meantime, WHO is looking into developing a convalescent serum. Blood from Ebola survivors, which would contain Ebola antibodies, could be used as a therapy for victims. Hyperimmune globulin, a more concentrated serum, is another option. Even these treatments would take a few months to get in order.

For more information about experimental Ebola treatments, head over to the CDC website: http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa-experimental-treatments.html

As for travel, the Nigerian Civil Aviation Authority suspended Gambia Bird Airlines Ltd. until it "put in place acceptable and satisfactory measures to contain the spread of Ebola virus." There are no recorded cases of Ebola in Gambia, but they are not wanting to take the risk of bringing the disease there. The airline does fly to Guinea, Sierra Leone, and Liberia where the Ebola outbreak is concentrated.

Ivory Coast banned all flights coming from those three countries from landing in their airports.

Just over the weekend, Zambia banned all citizens of Guinea, Sierra Leone, Liberia, and Nigeria from entering the country at all. This is the biggest move against blocking travellers from Ebola afflicted countries.

Hospitals in major metropolitan areas around the world are making preparations for treating potential Ebola cases. Many countries have tested suspected individuals visiting from West African countries, but results have turned up negative.

John Rose is the chief operating officer of iJet International, which advises companies on health-related travel issues, “Panic is the bigger issue right now. We all know the chances of contracting Ebola are extraordinarily low—it's not an easily spread disease unless you're a caregiver."

In the meantime, there needs to be an influx of aid workers, government aid, education, and research to find a cure. If you are traveling, be cautious and be diligent in hand washing and basic hygiene. If you have a fever and experience vomiting and diarrhea and have just come from Africa or been exposed to someone who has, get tested. We will get through this outbreak, but it will most likely get worse before it gets better.


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