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Ebola – is this the Bubonic Plague of our generation?

I remember the first outbreak of ebola in 1979. It only killed a few poor, black people, right? Wasn’t impacting on the rich, white people, after all. So why worry about it?

Ebola virus

Here we are nearly forty years later and we have been caught with our pants down. The Plague that ravished Europe in the fourteenth century killed over 30% of the population, perhaps as high as 60%. It has been said society subsequently became more violent as the mass mortality rate cheapened life and thus increased warfare, crime, popular revolt, waves of flagellants, and persecution (Cohn, Samuel K.(2002). The Black Death: End of a Paradigm. American Historical Review, vol 107, 3, pg. 703–737).

In 2014 we are faced with a different disease with the potential for equally horrific mortality rates. In 1979 we had the skills and scientific knowledge to develop vaccines, yet we did not. Now we are faced with a race against time to control the spread.

“It is running faster than us, and it is winning the race,” Anthony Banbury told the UN Security Council. Source: BBC October 15, 2014

If you read no other references on this page, please read the extract of Paul Farmer’s diary.

Both nurses and doctors are scarce in the regions most heavily affected by Ebola. Even before the current crisis killed many of Liberia’s health professionals, there were fewer than fifty doctors working in the public health system in a country of more than four million people, most of whom live far from the capital. That’s one physician per 100,000 population, compared to 240 per 100,000 in the United States or 670 in Cuba. Properly equipped hospitals are even scarcer than staff, and this is true across the regions most affected by Ebola. Also scarce is personal protective equipment (PPE): gowns, gloves, masks, face shields etc. In Liberia there isn’t the staff, the stuff or the space to stop infections transmitted through bodily fluids, including blood, urine, breast milk, sweat, semen, vomit and diarrhoea. Ebola virus is shed during clinical illness and after death: it remains viable and infectious long after its hosts have breathed their last. Preparing the dead for burial has turned hundreds of mourners into Ebola victims.

Source: London Review of Books

More volunteers are needed to fight this battle but the reluctance to be on the front line is understandable – healthcare workers are particularly susceptible to infection. Many are willing to go, but need the support of their countries and employers to do so. The poorest communities are where ebola is spreading fastest. The communities with inadequate medical facilities, lack of education and understanding of transmission leading to a lack of trust in the concept of quarantine, hospitals and western medicine. Many believe people who go to hospitals die, rather than seeing quarantine as a means of reducing the spread of the disease.

So far Australia has not had a confirmed case of ebola, but the USA, Nigeria and Senegal have had imported cases, which in the case of the USA and Nigeria lead to other infections. Patients working in West Africa have been medically evacuated to their home countries of Germany, France, the Netherlands, Norway, Spain, the UK, and the US for treatment.

Australia, Austria, Belgium, Brazil, Canada, Czech Republic, Italy, Kenya, Macedonia, Poland, Uganda, UAE (United Arab Emirates) and Zimbabwe are all testing or have tested suspected cases. Source: International SOS

In the USA scenario, one of the nurses who treated the imported case subsequently became ill and flew on a domestic flight while feverish. While it is unlikely too many of the other passengers had contact with her body fluids during the journey, it does highlight the risks we face globally to control the spread of ebola.

In the fourteenth century travel was not as far, fast or as frequent as it is today. Yet still The Plague managed to wipe out an estimated 25 million people. The population of the world was then less than 400 million. Now we number 7 billion. The maths are mind-boggling if we extrapolate.

Despite all the countries named above, still many countries are not taking the matter seriously enough, Australia included. Brian Owler, AMA president, has expressed his concerns.

“I don’t think it is the time to put our heads in the sand and suggest that Australia should shut its doors and just pretend the problem is a west African problem and let other nations handle the problem by themselves.” Source: The Guardian

While I understand Abbott’s expressed desire to ensure our citizens could be evacuated, due to our distance, to a closer nation for treatment if infected, I am more concerned we listen to people like Brian Owler. The Plague did reach Australia in 1900 (a total of twelve outbreaks until 1925): I am not at all convinced we are guaranteed to remain ebola-free. The greater hold ebola gets, the more at risk is everyone. Better we go to it to fight, than wait until it is knocking on our door. As the SBS reports, Australians do expect Australia to make a measurable contribution to the battle.

We know the scientific aspects of ebola. My question is the nearly forty years we waited to do something about it. Why are we testing vaccines now, when we are facing the possibility of 10,000 new cases a week by December 1, 2014? Should we not have been doing this in the 1980s?

There is also collateral damage. As so many resources are poured into the battle to fight ebola, other medical cases go untreated.

Even before the Ebola outbreak, these countries had very low doctor-to-patient ratios; Liberia had one doctor for every 100,000 people prior to the outbreak.

The ripple effect of the Ebola outbreak on West Africa’s health care means many people with prevalent ailments — such as typhoid, dysentery, malaria and malnutrition — may not receive treatment.

Source: Huffington Post

The poorest communities in the world are the least equipped to control such an outbreak. Money can only do so much. Money can only build hospitals if there are construction workers. Drugs can be manufactured and supplied but are useless if there are no medical staff to administer the drugs. We can’t buy our way out of this, we need troops on the ground.

Death is a daily part of life in many parts of the world and in the early stages ebola can look very similar to already prevalent ailments as listed above. In down-town Melbourne, Sydney or New York we do not have to distinguish between ebola, typhoid and dysentery on a daily basis. When faced with a case of ebola in the USA, the patient was initially sent home. How many other cases around the world may have already been treated in a similar manner? Are we learning anything from the USA situation? It seems we didn’t learn the lessons in 1979, let us not make the same mistake again.

The International SOS ebola site has good information and updates. The Virology Down Under blog presents interesting data analysis and other information.

There is also an interesting historical look at the first use of quarantine by Venice during The Plague and modern resilience theory at Ebola Battlers Can Learn Much From Venice’s Response To Black Death.

It’s not the specific countermeasures Linkov and his co-authors want to highlight but the disciplined-yet-improvisatory response. (The sight of people fleeing quarantine in West Africa highlights the difficulty of enforcing rules during periods of open-ended threats.)

Let us not forget that malaria kills over half a million people a year. Where are most of those deaths?

There were an estimated 627 000 malaria deaths worldwide in 2012.

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11 comments on “Ebola – is this the Bubonic Plague of our generation?

  1. […] humans are living, breathing creatures subject to malfunctions machines are not subject to. We catch viruses, we develop cancers, body parts age. Just like our cars, we can protect our bodies by living […]

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  2. The real problem with Ebola – and with the other diseases that haven’t seized western imagination but still kill people of the developing world in distressing numbers – is that until recently it was ‘happening to someone else’. A Western response should have been mounted 10 months ago as this outbreak took hold, but that ‘not over here’ attitude’s let it get out of hand. The problem being that once such things are ‘over here’, it’s usually too late. And that’s quite apart from the colossal and unnecessary suffering in West Africa, which was preventable if the West had moved much, much earlier. How many times have we had to re-learn the ‘stitch in time’ principle?

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    • Ah, yes, Matthew – “over there” is always a great escape clause, sadly. If malaria was common in the USA or Australia, I’m sure it wouldn’t be killing 600,000 people a year.

      If ebola does take hold in any way in one of the mega cities, we will rue the day we ignored “over there”.

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  3. Robyn, you have voiced my concerns. I would have thought that by now that each state would have at least one designated hospital capable of treating a highly infectious disease outbreak.
    We need for those who are trained for treating those who have Ebola or any other disease that is capable of taking out patients so quickly, to be allowed to help. We also need to make sure that they are fully trained in all aspects of safety.
    I would much rather the money that is being spent on a war that is not winnable be spent on making sure that the citizens of this country are protected.

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  4. I was in the infectious diseases unit of a major Perth hospital on Tuesday. I asked a member of the nursing staff if there had been any discussion about ebola.
    The answer was no, nothing at all.
    It has been 6 months since the first cases were reported & the world responded by ignoring it. That now appears to have been a mistake.
    Even though it may not warrant massive resources, I would have thought it was prudent, not to mention humane, for the government to arrange support for volunteers to West Africa, and for all hospitals & government health departments to have at least cursory discussions about how to proceed BEFORE we get the first case here.

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    • Thanks for sharing your experience. I agree totally, we should be prepared to receive a few imported cases and know what we will do if that happens.

      We have such a tendency to say or think “Oh, it will never be a problem here.”

      We may not be that lucky.

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  5. If they have progressed that far that they are going to die on a flight back to Oz, no-one is going to let them on the plane any way.

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    • I don’t know how the medical evacuations to date were done, but I assume not on a commercial flight. I think the progression of the illness is highly variable and unpredictable, so it is hard to say. It does seem most of the evacuees, treated in western hospitals, have survived. The imported case in the USA may have survived too if he hadn’t originally been sent home from the hospital. We’ll never know.

      I just saw a tweet earlier comparing our willingness to send our citizens to war, but not to help a humanitarian crisis. It is an interesting comparison.

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  6. Abbott’s excuse not to send people is absurd. Aussies are in fact working in west Africa, returning periodically to rest. One of my friends does this, he works with the UN (which Australia is a part of)

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    • I was referring to his concerns as reported. The travel time to receive treatment could result in death that could have otherwise been prevented had treatment been received earlier. The travel time cited in that article was 30 hours, which is about right, depending on the route taken. However I assume patients aren’t evacuated on commercial flights, so surely the time would be less? Yes, many Aussies work in West Africa but flying home to rest is not the same as flying home for desperate medial treatment.

      My concern is more about are we even prepared to treat a case if we had one?

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