In this paper I am going to examine the Ebola outbreak in West Africa in 2014.
Looking back, the index case in West Africa’s Ebola epidemic proved to be an 18-month-old boy from Guinea. The child developed an illness with symptoms of fever, black stools, and emesis, and died two days later. The area he was from, Meliandou, Guinea, was mostly just forest and trees. Evidence suggests that the forest loss from timber operations brought infected animals, including infected bats, into closer contact with humans. It is possible this is how the boy contracted the virus.
According to the World Health Organization (WHO):
By the second week of January 2014, several members of the boy’s immediate family had developed a similar illness followed by rapid death. The same was true for several midwives, traditional healers, and staff at a hospital in the city of Gueckedou who treated them.
During the following week, members of the boy’s extended family, who attended funerals or took care of ill relatives, also fell sick and died. By then, the virus had spread to four sub-districts via additional transmission chains. A pattern of unprotected exposure, more cases and deaths, more funerals, and further spread had been established.
By February, the virus made it to the capital, Conakry, through an infected member of the boy’s family. He died four days later.
One of the reasons the virus spread so fast was personal protective equipment (PPE) or, the lack thereof. The Ebola virus, in its initial stages, mocks many of the signs of malaria. Malaria is so commonly treated in West Africa; hospital workers rarely wear PPE. In this instance, doctors did not suspect Ebola, so no measures were taken to protect the staff members or the other patients.
According to WHO:
As the month progressed, cases spread to the prefectures of Macenta, Baladou, Nzerekore, and Farako as well as to several villages and cities along the routes to these destinations. The Ministry of Health issued its first alert to the unidentified disease on 13 March 2014. On that same day, staff at WHO’s Regional Office for Africa (AFRO) formally opened an Emergency Management System event for a disease suspected to be Lassa fever.
A major investigation followed, which included the Ministry of Health.
On March 22, a French lab which was set up as part of this collaborative effort confirmed that the causative agent was the Zaire species, the most lethal of the Ebola viruses. When WHO made the public announcement the next day, 49 cases and 29 deaths were officially reported.
It took nearly almost three months to identify the Ebola virus as the causative agent. By that time, the virus was already out of control.
According to WHO:
By March 23, 2014, a few scattered cases had already been imported from Guinea into Liberia and Sierra Leone, but these cases were not detected, investigated, or formally reported to WHO. The outbreaks in these two countries likewise smoldered for weeks, eventually becoming visible as chains of transmission multiplied, spilled into capital cities, and became so numerous they could no longer be traced.
Ebola was thus an old disease in a new context that favored rapid and initially invisible spread. As a result of these and other factors, the Ebola virus has behaved differently in West Africa than in equatorial Africa, challenging a number of previous assumptions.
In past outbreaks, Ebola was largely confined to remote rural areas, with just a few scattered cases detected in cities. The 2014 West African outbreaks demonstrated how fast the virus could move once it reached urban settings and densely populated slums.
Also, in past outbreaks, the primary aim of rapid patient isolation was to interrupt the chains of transmission. Today, the primary aim includes aggressive supportive care, especially rehydration, which improves the chances of survival.
Life-saving supportive care is difficult to provide in the common West African health care setting, but is improving as more treatment facilities are built by MSF, the UK and US governments, WHO, and other partners.
Successful experiences in Senegal, Nigeria, and Mali demonstrated the importance of preparedness and having the capacities in place to mount a rapid and comprehensive emergency response. Given the devastation caused by Ebola virus disease in Guinea, Liberia, and Sierra Leone, countries worldwide are on high alert for imported cases and many have elaborate preparedness plans in place.
In addition, experiences in the US and Spain showed that conventional control measures, including isolation and exhaustive tracing and monitoring of contacts, can halt further spread quickly following locally-acquired infections.
While any country with an international airport was theoretically at risk of an imported case, the need for preparedness was considered greatest in countries with weak public health infrastructures and little or no diagnostic capacity to detect cases early.
The Ebola virus left many children orphaned.
Some 16,600 children are registered as having lost one or both parents, or their primary caregivers to Ebola in Guinea, Liberia and Sierra Leone, but less than 3 per cent have had to be placed outside family or community care, UNICEF said today.
Since overcoming their initial fears and misconceptions about Ebola, families have been showing incredible support, providing care and protection for children whose parents have died, said Manuel Fontaine, UNICEF’s Regional Director for West and Central Africa. This shows the strength of kinship ties and the extraordinary resilience of communities at a time of great hardship.
As a result of this tragedy, the resulting national preparedness action plans gave international development partners guidance on specific areas where support was likely to have the greatest impact on preparedness. At the end of each preparedness mission, at least one technical expert remained on site to oversee the continuity and coordination of preparedness measures.
According to WHO:
Work on preparedness has taken place in all WHO regions. Training courses, workshops, and simulation exercises have been undertaken for groups of countries, while visits have been made to more than 70 countries in all regions to review capacities first-hand, develop action plans, and provide direct support.
All regions have also developed their own Ebola task forces and have regional response plans in place. Emergency operation centers and rapid response teams are likewise in place.
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