The ongoing Ebola outbreak: catch-up

Since the beginning of 2014, various media outlets have produced a daily dose of “Ebola outbreak” news. Even today, as we register more new cases and more deaths, not all of us are clear on what Ebola is or why it’s spreading so fast. And that’s understandable, especially on a student schedule, but if you’ve been out of the loop too long and need to catch up, here’s the what, why, and how on the disease.

The current outbreak remains the worst yet in Ebola’s short history, but it’s certainly not the first. In 1976 we saw the first two outbreaks of Ebola: one in Congo (formerly known as Zaire) and a second in Sudan. While Ebola caused both outbreaks, each involved a different strain or distinct form of the virus. The 1976 cases lead to the classification of “Ebola-Zaire” and “Ebola-Sudan”. Today, Ebola-Zaire remains the most lethal form of the virus affecting the world.

The outbreaks didn’t stop after 1976, either. The World Health Organization contained the outbreak then, but Ebola came back again in 1995, infecting 317 patients and killing 245 of them. The next wave came in 2000, but the WHO stepped in again to stop the spread. Before 2014, the next worst outbreak was in 2007 when 247 people were infected and 183 died.

 

THE SOURCE

Scientists still don’t fully understand how Ebola first comes into contact with humans. They know that fruit bats host the virus family and infect non-human primates (like gorillas) and duiker (deer-like creatures). It’s hypothesized that the popularity of bushmeat in Africa led to the burst of Ebola outbreaks, since such meat is often infected. Once the eaters are infected and die, ceremonial customs like washing the dead increase the chances of spreading Ebola.

 

THE BLEEDING PHASE

A simple touch of infected blood or bodily fluids begins the spread of Ebola from animal to human or human to human. The virus sticks to humans like glue, so much that men who survive still retain the virus in their semen for almost two months from the date of infection.

As people become infected, more problems arise. It takes about a week for the symptoms to show up. When they do, the sufferer appears to have flu-like symptoms that gradually worsen. They lose their appetite, have trouble swallowing, and then, if these symptoms persist, enter the “bleeding phase”.

This phase begins a week after the initial symptoms, and the description is graphic. Ebola causes the blood to ooze out of puncture sites and mucus membranes—places protected by the body with mucus, like the digestive tract and nose. Patients vomit, excrete, and cough up blood, and some blood vessels break.

Once a patient enters the bleeding phase, doctors and researchers have concluded that only one end is possible: death. The blood loss affects the circulatory system, the system that delivers oxygen to different parts of the body. The severe lack of oxygen causes multiple organs to fail, and in the span of two weeks, the patient’s life ends.

 

EBOLA: TODAY

The current Ebola epidemic has countries and organizations scrambling for a cure and vaccine. As of September 17, the United States has given $35.3 million towards Ebola research, and Canada has donated $5 million. Various organizations and individuals around the world have contributed a total of $26.7 million to the cause and the African Development Bank has donated $30.1 million.

But the WHO says this is not enough, and that nearly $1 billion is required to effectively fight the virus. This cost is increasing each day as the death toll increases. The WHO broke it down in their latest report (they develop different disease reports each year, and all are accessible to the public). Direct treatment centres, burial locations, responders, and food security and provision make up the biggest part of the cost.

Many pharmaceutical companies around the world are in talks about developing vaccines and treatments. In Canada, two drugs have hopeful chances of minimizing Ebola’s damage: TKM-Ebola, developed by British Columbia’s Tekmira Pharmaceuticals, and ZMapp, developed by the National Microbiology Laboratory in Winnipeg. Around 800 to 1,000 doses of ZMapp will be donated to the WHO, according to the Ministry of Health.

Both drugs underwent Phase 1 trials at the beginning of September. Phase 1 trials let researchers test an experimental drug on small groups of volunteers or patients (usually 20 to 80 people). Researchers identify side effects, evaluate the drug’s safety, and determine the recommended dosage range.

The WHO report also mentions the potential difficulties in delivering the drugs. Many of the African nations’ healthcare systems have collapsed under the pressure of the epidemic (and others because of war or lack of funding). These drugs also need to be stored in a -70 C environment requiring a special freezing facility and liquid nitrogen. Another obstacle to administering the drugs is the method of intake. Both drugs have to be delivered intravenously, so healthcare workers require the expertise and supplies to hang an IV bag.

Another problem is the lack of supply. Right now there are fewer than 30 treatments available for TKM-Ebola and less than 100 for ZMapp. Both companies are hopeful that vaccines will be produced by the end of 2014, or at the very latest before the spring. The WHO says that “given the very limited quantities available, it is anticipated that the first treatment or vaccine doses will be allocated according to a transparent process”. This process has yet to be discussed.

 

STOP THE SPREAD

As of now, the Ebola virus has infected over 5,000 people (more than half of whom are dead). The WHO and other health organizations urge those living in high-risk countries to thoroughly wash their hands and properly handle and cook bushmeat. National governments have stepped in. Countries like Guinea banned bushmeat distribution and ceremonial washing of the dead, and have shut down their borders.