Ebola stalks West Africa

Few diseases are as terrifying as Ebola. It is a highly contagious disease, with no known cure, that induces great suffering on its victims. Symptoms include vomiting, diarrhea, and gruesome internal and external bleeding.

Most ominous is the fatality rate, which can claim as many as 90 percent of the people who catch the virus. Paradoxically the lethality of Ebola is one of the biggest constraints on its spread: So many of the victims die so quickly that outbreaks invariably burn themselves out when authorities are able to quarantine and isolate the victims.

The current outbreak of the disease in West Africa has defied that trajectory and has many officials worried as a result. The outbreak was first observed in Guinea in February; after two months, nearly 250 people had been reported infected and 59 percent had died as a result of the disease. A month later, cases were reported in Conakry, a city of 2 million people and the capital of Guinea.

Cases were recorded in Liberia in March and in Sierra Leone in May, and the disease continues to spread in all three countries. The World Health Organization reports that nearly 1,100 people have been infected and there have been 660 deaths, a fatality rate close to 60 percent.

This is the worst Ebola outbreak in history, not only in terms of infections and fatalities but also in geographic scope as well. There are more than 60 outbreak sites, and it is the first time the disease has been found in West Africa: Previous outbreaks were in Central Africa.

Even more alarming are reports that a Liberian citizen died in Nigeria after flying into the country. Ebola has an incubation period of a few days to three weeks, during which someone infected with the disease may show no symptoms. Moreover, an Ebola infection at first looks a lot like malaria.

Fortunately, however, Ebola can only spread by direct contact with the fluids of someone who has the disease. Thus, even though there is no cure for the disease, early detection can halt the spread by isolating victims. Equally important is the development of safety protocols that ensure that individuals are not exposed to those fluids.

Unfortunately medical infrastructure in much of West Africa is underdeveloped, and health care workers lack even rudimentary equipment such as full-body coveralls, gloves, goggles and face protection.

Even when they are available, the heat can make wearing the necessary equipment extremely uncomfortable. Safety practices, such as having special containers for disposal of used equipment that could transmit the disease, are often violated. Not surprisingly, dozens of health care workers have been infected in the current outbreak — as has happened during previous occurrences. Even Sierra Leone’s leading specialist in the fight against Ebola, Dr. Sheik Umar Khan, succumbed to the disease this week.

The risk of infection is heightened by poor sanitation, overcrowded living conditions in the big cities, a traditional medical culture that relies on caregivers and healers whose practices make them extremely susceptible to infection, and funeral rituals that risk spreading the disease as well.

It is reckoned that at least 35 cases were the result of infections that followed the funeral of a traditional healer whose patients handled her body during the ceremony.

The fear that inevitably surrounds appearance of the disease also makes isolation difficult. In a tragic confusion of cause and effect, medical staff are often blamed by locals for spreading the disease. The medical group Doctors Without Borders is unable to work in several villages because of local hostility.

Quarantine facilities have been attacked by angry mobs that worry that the disease will escape and infect the nearby communities. At the same time, patients have been kidnapped from those facilities by family members who prefer traditional treatments.

News that an infected man was able to fly from one country to another has raised fears that a truly global outbreak is possible. That is highly unlikely. Infection requires direct exposure to infected fluid; unlike a cold or the flu, a sneeze will not spread the disease, and the symptoms have to be active. Developed countries are more likely to have the medical facilities to both monitor the disease and treat it when it is found.

Containing Ebola will generate costs as well. Airlines are beginning to curtail travel to afflicted regions. They may not stop the spread of the disease when borders are porous and there are other modes of transportation, but it can slow economic activity especially if multinational enterprises become reluctant to send people to the region.

That part of Africa is home to several large mining companies, and their share prices have fallen significantly since the beginning of the year. The companies say their operations are far from infected areas, but there is always fear of the spread of contamination.

That fear is the biggest obstacle to dealing with the disease. Money, supplies and personnel are needed to cope with the outbreak. Terrifying though it may be, properly handled, Ebola can be contained.