The “perfect storm” analogy is often over-used when it comes to disease outbreaks–all the elements that you don’t want to see converge to make conditions ripe for a bacteria, or, in this case, a virus, to rip through a population at lightning speed: geography, society, culture, a potent virus, reluctant politicians and a weak health care system. But all those factors are contributing to history’s largest-ever Ebola outbreak, which the World Health Organization now calls a “crisis.” Since early spring, Ebola has spread to two additional countries, Sierra Leone and Liberia, infecting 635 people and claiming nearly 400 lives.
The Ebola virus causes a nasty infection that triggers an inflammatory reaction so intense, patients essentially drown in their own fluids as they bleed internally and externally — victims’ bodies are overtaken with a well-intentioned defensive system run amok. Anyone who comes into contact with the infected fluids can also get infected. As of now, there are no treatments for Ebola. The only hope is for the body to remain strong enough to overcome the initial onslaught from the virus and start to develop antibodies to fight it. As patients get sick, they stop eating and drinking, becoming too weak to develop these critical antibodies. Left alone, nine out of 10 infected people die. At treatment centers, where doctors can provide supportive care with nutrients and hydration, that figure improves to seven out of 10.
Those aren’t great odds, and social and cultural practices in west Africa may be stacking the deck even further. Dr. Michel Van Herp, a physician and epidemiologist with Doctors Without Borders who traveled to Guinea when the outbreak began, says he has been confronted by hostile villagers who did not welcome the medical help.
“I have had aggressive people in front of me in the village,” Van Herp says, as he tried to bring infected patients to treatment centers. “Most villagers are denying the existence of Ebola.”
That denial is fueled by a strong stigma against the disease. In other parts of central Africa where smaller outbreaks occurred, survivors of Ebola returned to their villages only to find their homes burned and their remaining family members ostracized for having been infected.
Such denial not only increases the risk that the close contacts of those infected by Ebola will be affected, but it also creates the ideal situation for the virus to gain an even broader foothold. A critical first step in containing any outbreak of infectious disease involves carefully tracing which people patients have been in contact with. Only then can scientists start to create barriers against the virus by keeping it contained to people known to have already been exposed. In Guinea, denial and stigma against Ebola means some patients who believe they are infected are fleeing to other villages or even crossing the border to another country.
“If you have a guy who runs away to a village 20 kilometers away, then you need to start from scratch in that village to trace his contacts,” says Van Herp.
Making things worse is the fact that in the part of western Africa where the outbreak is centered, the population is particularly mobile, often traveling to nearby Sierra Leone and Liberia in search of work.
“We’ve seen kids who travel between three or four villages, and between the countries before they are too sick and weak that they aren’t able to work any more,” says Van Herp. “In the meantime they have contaminated three or four villages.”
Cultural practices mean that the potential for transmitting Ebola is also amplified if a respected elder is affected.
“If a guy like this falls sick, then more people try to cure him,” says Van Herp. “If he dies, more people are involved in the process of the funeral–in cleaning the dead body, and preparing the body. We have seen that one patient can give disease to 15 or 20 other people.”
Van Herp plans to return to Guinea in July, but he says that so far, there hasn’t been much improvement in people’s education and acceptance about Ebola, despite the rising number of deaths. The WHO has called an emergency meeting of 11 nations next week to discuss ways of containing the outbreak. Attending will be the Minister of Health from Uganda, where the government has made efforts to address the stigma associated with Ebola by creating a survivors network to educate and inform the public about the disease–and hopefully reduce fear and misperceptions about the virus.