Global coverage of the Ebola outbreak in West Africa began with (the best) courageous foreign health care workers (HCWs) being flown home by their governments in a desperate attempt to save their lives, and rapidly moved on to the sheer panic amongst the local populations experiencing the outbreak: riots, health care workers and government officials abandoning their posts (the worst). Somewhere imbetween mention was made, usually by the foreign HCWS, of their local colleagues left behind who struggled on without resources and personal protection (the best).
Misinformation, public panic and stigma
Ebola haemorrhagic fever (caused by different ebola virus strains) has been around since 1976, with regular self-limiting outbreaks, usually in remote areas of one country. Index cases always involve some contact with animal reservoirs (bushmeat (wild animal meat), bats, rodents, monkeys), and its then spread by person-to-person transmission through contact with bodily secretions or with objects contaminated with secretions. It’s infamous for its high case-fatality rate and the ease with which it spreads among contacts of the diseased.
What makes this time different is the Zaire strain has now reached West Africa: there it has spread from remote regions into highly populated urban areas, and it has crossed borders so that there are escalating outbreaks in 3 adjacent countries (Guinea, Sierra Leone and Liberia), with no end in sight. The epidemic (for that is what it is now), has resulted from sustained person-to-person transmission.
Cases have also been reported in Nigeria and Senegal but these countries seem to have contained the transmission of the virus. DR Congo has an outbreak. An up-to-date Ebola Healthmap can be found here.
Ignorance and fear, drivers of disease
Misinformation among health workers and the public fuelled panic and contributed to the spread of Ebola-zaire over the last 6 months. HCWs abandoned their posts or were the source of rumours that created riots, government officials got out whilst they could. [The index case for Nigeria, was an official who left Liberia, who knowingly had had contact with an Ebola victim].
Fear has not just caused civil breakdown. It is masking the magnitude of the outbreak, especially in Liberia and Sierra Leone. Families fear stigma so hide sick relatives or consider the hospitals as death sentences (breaking relatives out!) or indeed consider them the cause of the illness in the first place. Cases being cared for outside hospitals do not enter the statistics.
Unlike the “Black Death” in medieval Europe, it’s not lack of real clinical knowledge that’s the problem but:
- Weak health systems, lacking skilled HCWs and resources
- Lack of knowledge amongst the general public
- Lack of community involvement & mistrust of government
- Misinformation among health workers, ministries of health and the public
- Lack of effective drugs and vaccines…supportive therapy only is current medical response.