10 years since the Ebola virus crisis, what have we learned?
The Ebola virus epidemic that devastated West Africa in 2014 to 2016 shows the largest and the most complex outbreak of the Ebola virus disease, or EVD. Since its first identification in 1976, it was just another unknown tropical disease. However, it peaked during 2015, and the epidemic captured quick global attention due to its unprecedented high mortality rate of 50%. Although the outbreak primarily affected countries in West Africa, the global response particularly the containment efforts in the United States shows how strong public health systems and quarantine protocols can prevent a localized outbreak from being a global catastrophe.
Characteristics of Ebola Virus Disease
Ebola virus disease is a severe and often fatal illness caused by a virus of the genus Ebolavirus. The disease attacks multiple organ systems, spreading through direct contact with bodily fluids. Key disease characteristics include transmission from direct contact with bodily fluids such as blood, vomit, sweat, saliva, or contaminated surfaces. Incubation periods typically last from 2 to 21 days depending on the individual and the virus type, and symptoms include fever, fatigue, muscle pain, vomiting. The most notable and well-known trait of EVD is extreme internal and external bleeding, which when this happens it is considered a severe case. Unlike other highly contagious diseases which are airborne, (easily transmitted through air), there are no mutations or variants of EVD currently that enable airborne transmission. However, in situations where healthcare infrastructure is weak or places with frequent contact with bodily fluids such as countries in West Africa, it spreads quickly, killing a lot during its path.
Spread of Ebola in West Africa
The 2014 to 2016 Ebola epidemic began in Guinea in late 2013, rapidly spreading to neighboring countries such as Liberia and Sierra Leone. By March 2016, the WHO reported approximately 28,000 suspected, probable, and confirmed cases and over 11,000 deaths. Several factors contributed to its rapid spread, including weak healthcare infrastructure, as many facilities in the countries which it affected lacked hospitals, protective equipment, or personnel to manage the disease. However, a more prominent cause was the culture of allowing burial rituals that involved physical contact with deceased individuals, allowing the virus to spread within the family fairly easily.
Ebola Reaches the United States.
Ebola decimated West Africa due to its weak health infrastructure and culture. Then, it is fair to question: How did a country like the United States with strong infrastructure and secure personnel react? The first diagnosed case occurred in Dallas, Texas, when a traveler from Liberia, Thomas Eric Duncan developed symptoms after arriving in the US. He was diagnosed on September 30, 2014, and died from contracting the disease. Alongside him, two nurses who treated him also became infected but recovered, making four total cases of Ebola diagnosed in the United States.
How US Quarantine and Public Health Procedures contained Ebola
The limited spread of Ebola in the US demonstrates the effectiveness of strict public health protocols. There were several strategies implemented to halt the spread: rapid isolation and quarantine of patients, contact tracing, using protective medical protocols of usage of personal protective equipment, but most importantly, monitoring of travelers returning from affected regions were rigorously screened and monitored. These measures prevented community transmission and stopped the outbreak from expanding within the United States.
What could have happened: Worst case scenario
If the response had been a bit slower or less coordinated, the consequences are severe. Several scenarios could have included infected individuals unknowingly spreading the virus through hospitals, or worse, public transportation which would have been disastrous, as it would spread to households. This could have led to public panic and economic disruption, as seen in the coronavirus pandemic in 2019. However, thanks to the effective containment of the United States, the worst case scenario never occurred.
10 Years passed. What did we learn?
One of the most important lessons from the Ebola outbreak was how much the scale of a disease can depend on its mode of transmission. Ebola spread through direct contact with infected bodily fluids rather than air transmission, which significantly limited how quickly it could spread compared to airborne diseases. The strain responsible for the West African epidemic, Zaire ebolavirus, is actually the most lethal form of the virus, mortality rates recorded as lowest from 60% to highest 90%, yet its transmission method prevented it from spreading as widely as diseases that move through the air. However, the experience of COVID-19 demonstrated how dangerous a highly transmissible airborne pathogen can be when these systems are overwhelmed or implemented too slowly. Together, these events show the need for continued investment in global disease surveillance, faster international repointing systems, stronger healthcare systems worldwide, and coordinated emergency responses so that whenever a disease that has the contagiousness of coronavirus and mortality of the Ebola virus occurs, it can be detected and controlled before they escalate into a worldwide crisis.
Sources
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e1114a5.htm
https://pmc.ncbi.nlm.nih.gov/articles/PMC5050466/
https://www.nejm.org/doi/full/10.1056/NEJMoa1404505
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