What we’re afraid to say about the epidemic
Michael T Osterholm
The Ebola epidemic in west Africa has the potential to alter history. More than 3 000 people have died so far, and the World Health Organisation (WHO) has warned there might soon be thousands of new cases a week in Liberia, Sierra Leone, Guinea and Nigeria.
What is not getting said publicly is that we are in totally uncharted waters.
There are two possible future chapters to this story that should keep us up at night.
The first possibility is that the Ebola virus spreads from west Africa to megacities in other regions of the developing world.
It is much easier to control Ebola infections in isolated villages. But there has been a 300% increase in Africa’s population over the past four decades, much of it in large city slums. What happens when an infected person yet to become ill travels by plane to Lagos, Nairobi, Kinshasa or Mogadishu – or even Karachi, Jakarta, Mexico City or Dhaka?
The second possibility is one that virologists are loath to discuss openly but are definitely considering in private: that an Ebola virus could mutate to become transmissible through the air. You can now get Ebola only through direct contact with bodily fluids. But viruses like Ebola are notoriously sloppy in replicating, meaning the virus entering one person might be genetically different from the virus entering the next.
The current Ebola virus’s hyperevolution is unprecedented; there has been more humanto-human transmission in the past four months than most likely occurred in the past 500 to 1 000 years. Each new infection represents trillions of throws of the genetic dice.
If certain mutations occurred, it would mean that just breathing would put one at risk of contracting Ebola. Infections could spread quickly to every part of the globe, as the H1N1 influenza virus did from Mexico in 2009.
Why are public officials afraid to discuss this? They don’t want to be accused of screaming “Fire!” in a crowded theatre, as I’m sure some will accuse me of doing.
But the risk is real, and until we consider it, the world will not be prepared to do what is necessary to end the epidemic.
In 2012, a team of Canadian researchers proved that Ebola Zaire, the same virus that is causing the west Africa outbreak now, could be transmitted by the respiratory route from pigs to monkeys, both of whose lungs are similar to those of humans.
Richard Preston’s 1994 bestseller, The Hot Zone, chronicled a 1989 outbreak of a different strain, Ebola Reston, among monkeys at a quarantine station near Washington. The virus was transmitted through breathing, and the outbreak ended only when all the monkeys were euthanased. We must consider that such transmissions could happen between humans if the virus mutates.
First, we need someone to take over the position of “command and control”. The UN is the only international organisation that can direct the immense amount of medical, public health and humanitarian aid that must come from many different countries and nongovernmental groups to smother this epidemic. Thus far, it has, at best, played a collaborating role. A Security Council resolution could give the UN total responsibility for controlling the outbreak, while respecting west African nations’ sovereignty as much as possible.
The UN could, for instance, secure aircraft and landing rights. Many private airlines are refusing to fly into the affected countries, making it difficult to deploy critical supplies and personnel. The UN should provide whatever number of beds are needed (the WHO has recommended 1 500. It should also coordinate the recruitment and training around the world of medical and nursing staff, in particular by bringing in local residents who have survived Ebola, and are no longer at risk of infection.
Many countries are pledging medical resources but donations will not result in an effective treatment system if no single group is responsible for coordination.
Finally, we have to remember Ebola isn’t west Africa’s only problem. Tens of thousands die there each year from diseases like Aids, malaria and tuberculosis. Liberia, Sierra Leone and Guinea have among the highest maternal mortality rates in the world. Because people are now too afraid of contracting Ebola to go to the hospital, very few are getting basic medical care. In addition, many healthcare workers have been infected with Ebola, and more than 120 have died.
Liberia has only 250 doctors left, for a population of 4 million.
– The New York