In addition to fighting the virus itself, doctors must contend with misinformation, hostile relatives, and dangerous funeral practices.
Image: Sergey Uryadnikov/Shutterstock
The current Ebola outbreak in West Africa is literally the worst outbreak of the virus in history, and according to the CDC’s best case scenario, it will continue until late October. To date, more than 660 people have died from Ebola in Guinea, Sierra Leone, Liberia, and Nigeria, which reported its first death Friday. No outbreak since the virus was first discovered in 1976 has killed as many people as this one or spanned more than one country. This outbreak is in four, so it’s unprecedented and bad. Like, really bad. Various global health organizations are scrambling to send in back-up, but containing the virus has become more about education than anything else.
Ebola’s symptoms are like something out of a science-fiction horror story and involve blood coming out of every orifice in an infected individual's body. One bleeds out because the virus has ruined their white blood cells ability to clot blood. It’s scary to watch, and there is no cure or vaccine. Treatment is purely about hydration and reducing the high Ebola fever while in quarantine, which is required as the virus is highly contagious and spreads through bodily fluids like semen, saliva, and sweat, including fingerprints on cellphones.
One man in 2012 got Ebola after stealing another man’s phone, for example.This particular strain of the Ebola virus (there are five) is known as the Zaire ebolavirus and usually kills about 79 percent of the people it infects, though this time around is only killing 60 percent (for reference, the plague, aka the Black Death, kills about 11 percent). Early symptoms of the virus come across like the flu and the incubation period (before symptoms start) is 21 days.
As deadly as the virus is, many people in the current outbreak zone don’t believe Ebola is a real thing—a phenomenon CDC health communications strategist Craig Manning experienced while he was in Sierra Leone recently, including from his assigned driver. “I can understand why they don’t believe it since many diseases start with comparable symptoms and there’s half a dozen possibilities for the infectious causes,” said Manning in a phone interview. That, and the virus had previously only broken out in central African countries like Uganda and the Democratic Republic of Congo, so before this year it was more myth than reality in this part of Africa. It took Manning’s driver weeks to come around and acknowledge the virus existed, something that happened only because he accompanied Manning to labs and meetings with doctors.
Besides not believing in Ebola’s existence, health officials are fighting against misinformation, hostile relatives, and cultural practices involving funeral rites. There’s a rumor going around in Sierra Leone positing that those sick with Ebola are being killed by foreign doctors. This misinformation led family members to storm a hospital recently and make off with their Ebola-stricken relative. “In some cases, people were hiding those who were sick, or moving in order to avoid detection, and even dead bodies are being moved,” said Manning. There’s “enormous reticence from the local population,” he added.
To disprove the rumor of foreign doctors as insane killers, Manning said various health organizations have made a concerted effort to put Ebola survivors on the radio. Educating the public on Ebola has become a multimedia effort, with health officials now spending time writing non-threatening songs about Ebola for the radio, distributing flyers and posters, and setting up a text messaging systems to report those infected. The wider goal is to change cultural perception, “not by contradicting them, but allowing time to pass for the information to be absorbed,” explained Manning.
Changing the traditional way of honoring the dead, however, is their biggest challenge. Funeral rites in that region involve family members washing and touching the body of the deceased, but this leads to “onward transmissions of the virus” through sweat on both the living and dead bodies, said Manning. “It’s not going to be easy,” but it has to be done, he continued. The people of Uganda and the Democratic Republic of Congo changed their burial practices as a result of their repeated Ebola outbreaks, so Manning is confident it’s only a matter of time before Sierra Leone and Liberia do too. “It’s not a complicated process, we just need people alert at the local level,” he said.
Uganda, a country that Manning described as a “shining light as far as Ebola response goes,” is taking a “major consultative role in this response,” which has been incredibly helpful. In addition to Uganda’s assistance, the CDC is gearing up to send 50 workers to West Africa, and Manning himself is going back the first week of August with 10 people to deal with communications concerns. If all goes well in the education rumor-killing department, Manning is hopeful the outbreak will be over by the mid-fall.
In addition to the CDC, the World Health Organization (WHO) and Doctors Without Borders are also training personnel for educational purposes. According to a recent blog post by Doctors without Borders, the organization has “trained more than 200 community health workers to deliver essential health messages to people in their villages about how to protect themselves against Ebola and what action to take if someone shows any signs or symptoms of the disease.”
CDC map from July 24th, 2014, before the Nigerian case was reported
The current outbreak first began in Guinea in February, and spread to Sierra Leone and Liberia in March. Government officials were caught unprepared and unable to stop the spread of the deadly virus to neighboring nations. Five months later and the outbreak in Guinea has stabilized somewhat, but Sierra Leone is still facing rising death tolls and its top doctor contracted the virus earlier week. To make matters worse, this week Nigeria reported its first Ebola death, a Liberian government worker who had flown into the port city Lagos. Manning says its too early to tell if the death in Nigeria will manifest to additional cases, though officials have located and are monitoring everyone who was on the same flight as the dead government official for signs of infection.
As for whether or not Europeans and Americans should panic, the answer is still no. The chances of the Ebola outbreak leaving Africa are slim to none, explained University of Miami scientist Joeli Brinkman, whose area of expertise is human viruses. Spontaneous outbreaks are also impossible because “we don’t have the natural host,” which in this case is a particular species of fruit bat, she said.