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Africa's Nightmare

Ebola
Ebola
A nurse with Doctors without Borders examines a patient in the in-take area at a center for victims of the Ebola virus in Guekedou. on April 1, 2014. Ebola virus disease or Ebola hemorrhagic fever is the human disease caused by ebola viruses. | Photo: Seyllou | Link | Ebola, Virus, Disease, Epidemic, Deal, Health, Africa, Nurse,

Ebola Breaks Out

In the 1840's the western movement of white settlement in Texas had come to a halt. In fact, in some places, the movement of settlers was back toward the east, away from the Comanche Indians who had proven a fearsome adversary for the Texans and defied repeated efforts to vanquish them in battle. Then the Texans acquired an unusual ally, cholera, which spread west across the United States and into the territory controlled by the Comanche.

Cholera was a deadly menace to white settlers. To Native Americans, completely devoid of resistance to diseases from the Old World, it was an infinitely greater threat. Something like one-half of all Comanche died from cholera, and the tribe never recovered its former power. Within a generation the survivors were defeated and confined to reservations.

That Cholera epidemic, which swept across vast expanses of Texas, leaping from one Comanche camp to another, started in India, half a world a way and spread, in an age of steamships and sailing vessels, across the planet.

Imagine what the age of jet travel and mass migration means for the ability of a disease to replicate that feat today.

The deadliest Ebola outbreak in history is burning its way through the cities of West Africa right now. Ebola has long been feared for the horrific way in which it kills its victims, who ultimately bleed out through every orifice in excruciating pain, and for its lethality. Historically, something like 90% of all people who contract Ebola die.

Ebola has, however, prior to this been confined to relatively small outbreaks in remote, rural areas of Africa. While it has killed most of the people infected with it, it has not spread. It has, in essence, burned itself out, consumed its victims and lain dormant.

All that has changed. Ebola has now spread to at least three countries in West Africa, Guinea, Sierra Leone and Liberia. And within those countries it is not found primarily in the villages or countryside. It is most prevalent in the hearts of the largest cities. At least 759 individuals have been infected to date. Four hundred and sixty-seven of them are already dead, and there is no indication that the spread of the disease is slowing down.

Dr. Peter Piot, the scientist who discovered Ebola in the 1970's calls the situation 'unprecedented.'

The humanitarian group, Doctors Without Borders, has stated outright that the epidemic is out of control and that immediate and drastic action is necessary to contain it. An emergency meeting of health ministers in the region was recently convened in an attempt to get a handle on the crisis.

Why this outbreak is so much worse than those in the past, is unclear, but there seem to be a number of very worrying factors, which may be contributing to the problem.

Health care in the countries infected is poor, and basic sanitary practices are often neglected. This applies not just to the general population but to medical personnel as well.

The families of the victims of the disease, in accordance, with local religious and cultural practice, generally wash the bodies of the deceased before burial. In the process the family members themselves are often exposed to highly infectious bodily fluids and contract the disease.

Suspicion of modern medical practices and fear of the unknown often lead people in West Africa to avoid going to the hospital when they get sick. In a large number of cases, individuals who have gone to the hospital and been diagnosed with Ebola, have then left the hospital and fled back into the surrounding population, believing they will be safer. Efforts to locate them and return them to the hospital have generally been fruitless.

The population in parts of the infected area, particularly in Guinea, rather than cooperating with health workers, is actively opposing efforts to control the spread of the disease. Doctors Without Borders has, for instance, pulled all of its personnel out of at least twenty localities, because they were being threatened with physical violence by local residents. The residents blamed the medical personnel for having caused the disease. Doctors Without Borders is in many cases the only entity actually providing medical care to Ebola victims, so when their people pull out, there is no one left on the ground to treat the sick or help stop the spread of the contagion.

All of that is horrible enough, but the situation may be about to become much worse.

Ebola is generally characterized as being relatively difficult to contract, and the spread of the disease has been said to require close, often intimate contact with an infected individual. That may provide a false illusion of security however.

First, there has been research done, which has suggested that Ebola can go airborne, that is that it can spread without any physical contact at all. Canadian researchers a couple of years ago published a study in which they showed that Ebola had moved from pigs to monkeys, even though the two groups of lab animals were in separate cages and never came in contact. While the consensus seems to be that Ebola cannot move in this fashion amongst humans, the results of that study have never been fully explained nor refuted.

In any event, no one has ever denied that close contact, such as that common in passenger aircraft, significantly increases the risk of contracting Ebola from an infected individual. In fact, the Center for Disease Control's official guidance to flight crews on how to handle passengers suspected of carrying Ebola directs that the infected individual should be physically separated from other passengers and be fitted with a surgical mask to 'reduce the number of droplets expelled into the air by talking, sneezing or coughing'. The guidance also directs flight crew members to wear disposable gloves when touching the infected individual.

Conakry is the capital of Guinea, and Guinea is the epicenter of the Ebola outbreak. Direct international flights leave Conakry for a host of destinations everyday. Many of them fly direct to cities, like Dubai, Paris and Casablanca thousands of miles away. Add in connecting flights, and you can make it from Conakry to virtually anywhere on the planet in about twenty-four hours. On Air Morocco you can leave Conakry and be in JFK in New York in just over twelve hours.

That's a stark illustration of a concept researchers have come to call 'effective distance'. When thinking about the spread of disease, any disease, in the age of high-speed air travel, geographic distance is not the prime consideration. If individuals can move easily and quickly between two points, even if they are many thousands of miles apart, disease will rapidly cover the distance. A virus, for instance, will move much more easily from London to New York by air than it will move even a relatively short distance from New York City to a rural area of upstate New York.

Computer models of the spread of a pandemic in this way show not a slow spread of a disease outward from the point of origin across the planet. Instead they show the contagion leaping from point to point on the planet at ever increasing speed. A disease that begins in a major Asian city, for instance, has spread to every major city on the planet before it has spread into the interior of the country where it originated.

All of which means that what is terrifying Conakry right now may be coming to an airport near you all too soon. What is Africa's nightmare today may be ours tomorrow.

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Updated May 10, 2017 9:56 AM EDT | More details

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