The world at large is at the brink of the great public health disaster called Ebola. The current Ebola outbreak began in December 2013,with the first case detected in Guinea in March 2014. The world is seeing more and more cases of Ebola and despite new public health measures being adopted each day, the epidemic shows no signs of abating. rom the time of its first discovery near the Ebola river in the Democratic Republic of Congo in 1976, the number of reported outbreaks of this disease has been increasing over the years. The 2014 outbreak is the largest that has been recorded in recent history in terms of numbers and geographical spread. Could the current Ebola epidemic achieve pandemic proportions? Are there routes of spread of this disease that are as yet unknown(Meredith, 2014)? Will the current outbreak “ kill itself out” as have past epidemics? Will a cure for this deadly virus be found in the near future? Continuing vigilance on Ebola with the allocation of more resources to control it is needed, because each day the number of people dying from Ebola is increasing.
This paper begins by providing a background of the Ebola situation and goes on to provide arguments where important positions in support of the thesis are supported. To provide a thorough explanation of these important positions, opposing positions are discussed. The paper concludes with a description of some of the measures taken to alleviate the situation and possible directions for future action.
Every episode of Ebola so far has killed itself out- so a few experts opine that this epidemic will end the same way. Ebola is only the third most deadly virus in the world, after HIV and rabies. A few basic public health measures have contained every Ebola of the past and can do so this time as well. These include meticulously tracing out each case and contact of an Ebola case, effective and timely response to patients in the community and some preventive interventions(Thomas R.Frieden et al 2014). Even a single member of a family or a health team can spread the disease to many others because of the nature of the spread of the Ebola virus. The CDC reports that the 2014 outbreak is the largest in history. Case counts as of October 2014 have shown a case fatality of 4922/10141 cases in countries with widespread transmission like Guinea, Liberia and Sierra Leone. The few cases of travel associated Ebola (2) have had a case fatality rate of 50%. 20 cases of localized transmission from travel associated cases have been reported, with a death seen in 9/20 cases, 4 of those cases being in the USA(CDC, 2014). Men who have recovered from Ebola can still transmit the virus in their semen for 7 weeks, after they have been cured(WHO, 2014). Since previous outbreaks have killed themselves out after a short time, resources have not been spent on studying this disease as extensively as HIV or influenza. Which patient would be asymptomatic or a highly contagious cannot be determined with the limited repertoire of laboratory tests and knowledge we have. The virus mutates fast and adapts to new environments quickly, so it is not known if it can change its mode of transmission(Joel Achenbach, 2014). What is known is that much about the Ebola virus is still unknown to man, the disease is infecting more people each day and with the world having become a global village, every citizen of the world is at risk of this disease. Hence more resources need to be set apart to study the epidemiology, the virology, the treatment and preventive measures of this disease.
The CDC predicts that there will be 550,000 cases of Ebola in Liberia and Sierra Leone by January 2015 if the disease is allowed to spread uncontrolled(Martin I.Meltzer et al, 2014). This virus spreads by direct contact with the body fluids of a sick person. While emerging information about the virus had shown that the virus might change its mode of transmission to include even fomite transmission, it becomes even more important to curb unsafe burial practices of Ebola victims. An asymptomatic Ebola patient may not transmit the disease initially and during this asymptomatic phase they may actually be developing more virus within their bodily fluids. The current outbreak has lasted longer than previous ones, which might give the virus a chance to adapt to the human body and become resistant to treatment regimens(Joel Achenbach, 2014). Even small amounts of the virus laden body fluid can transmit Ebola because “ a fifth of a teaspoon of blood contains 10 billion viral particles(Loria, 2014).”
The fast mutation of the virus- adaptive mutation and its speed and aggression in killing its victims makes it a deadly scourge. Science reported a breakthrough in understanding the Sierra Leone Ebola outbreak on August 28, 2014, when a major surveillance study reported 395 different mutations in the 99 Ebola virus genomes taken from 78 patients(Gire et al., 2014)
Scientists refer to the Ebola virus as a “hot agent” and so it is categorized as a biosafety level 4 virus even above the HIV(Stimola, 2010). If a person has a wound or a break in the skin, which has been in contact with Ebola-infected body fluid, this filovirus can enter the blood stream quickly.
Once in the blood, it attacks a messenger protein that would normally have transmitted information from the interferon to the body’s immune system. The virus has 7 membrane proteins with 4 of them unidentified, and it is hypothesized that at least one of them disrupts the human immune system(Draper, 2002).So interferons cannot mount a defense reaction against the Ebola virus. Unknown to the body’s immune system, the virus multiples and spreads all over the body, after which the body mounts an attack against itself (an autoimmune reaction). Thus this virus is said to have a case fatality rate of between 50-90%(Brodwin, 2014)
Natural reservoir for the virus or the immune organism that carries it is unknown. Some studies have shown that the fruit bats may be a reservoir for the disease(Leroy et al., 2005). Monkeys might transmit the virus from its natural reservoir to humans if man eats infected monkey meat. Once a man is infected, the virus is easily transmitted through bodily secretions(Draper, 2002). The success of the smallpox eradication program has been attributed to the lack of a natural reservoir for the variola virus(Elwood, 1989). If the Ebola virus is to be eradicated or even contained, it is vital to identify its natural reservoir and study it.
The only available treatments are supportive and preventive strategies. Knowledge of how the disease is spread varies from community to community. The health care system needs to quickly identify Ebola infected patients. If the number of cases exceeds the capacity of the health care system to contain it, it could lead to a continuous cycle of cases coming for treatment to an unprepared health care system. Some of them may have to go home, without treatment, with the possibility of infecting others’. Unsafe burial practices continue to take place in the West African countries(Thomas R.Frieden, 2014). It is estimated that the cost of treating a single Ebola patient might add up to 1000$ per hour(Alex Wayne, 2014).
In the face of global uncertainty and panic about Ebola, the CDC has issued a travel warning against non essential travel to Western African countries such as Sierra Leone, Guinea and Liberia as of July, 2014. The CDC and the WHO are working with local partners within the Western African nations where the current epidemic originated to contain the disease there. They update information on their websites about the virus, its fatality rates, the number of cases detected each day and so on. In addition, they have provided detailed protocols to health care providers about identifying the disease. Local health authorities within these nations are trying to identify infected patients as they arise. Real time polymerase chain reactions (PCR tests) kits that can quickly detect the virus have been provided to the local health authorities in many of these countries. They are trying to isolate and treat patients, identify contacts through contact tracing and monitor them for fever. Personal protective equipment helps prevent spread of disease from the patient to his contact. Simple household measures like sanitation; use of soap and water or household bleach can kill this RNA virus. Infected patients can have greater chances of survival if they are provided with supportive treatments like intravenous fluids and blood. The Global Health Security Agenda has been set up to protect the world against health threats (Thomas R.Frieden, Inger Damon, Beth P.Bell, Thomas Kenyon, 2014).
Health education and health awareness measures need to be undertaken in the vernacular, in the countries of origin of the Ebola virus. Studies should be undertaken to find out cultural practices that affect the spread of the disease in the community, like burial practices and why people choose not to go to a health care facility when sick. The communities need to be supported in changing their funeral practices in order to prevent human contact with body fluids of dead persons. Consumption of bush meat of infected animals must be avoided. In areas, which are ravaged by poverty, socioeconomic changes are required to help people circumvent hunger, disease and illiteracy. Vaccines and treatment of the Ebola virus need to be developed on a war footing.
In conclusion, the world needs to work with the elements of the World Health Security Agenda to prevent newer epidemics of Ebola or other viruses. In a world, which has become smaller, no country or place is safe from a health risk that affects another. In order to detect, prevent, control, monitor and eradicate Ebola, more resources need to be allocated to keep a vigil on this virus or its mutations, newer methods of transmission of the disease, education of the community, development of vaccines, and treatment modalities to allow more patients to survive the disease. Each global outbreak needs to inspire in us a vision to prevent and watch out for the next plague that might affect humanity at huge costs.
References
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