What we’re afraid to say about the epi­demic

Michael T Oster­holm

CityPress - - Voices - Oster­holm is the di­rec­tor of the Cen­ter for In­fec­tious Dis­ease Re­search and Pol­icy at the Univer­sity of Min­nesota, US

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

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