A year or so after the Ebola virus was running rampant in parts of three West African countries, a look back by multiple observers is producing an almost complete story of what took place. In many respects, Ebola flared in a setting that was ripe for a runaway disease.
Liberia, Sierra Leone and Guinea are three of the poorest countries in Africa, lacking specialists and infrastructure to meet any of its citizens’ needs, including disease control and prevention. There were only a handful of doctors, not hundreds, available to respond to the disease as its ferocity became clear.
Terrain and the proximity of borders allowed Ebola to spread not just along roads and highways, but by jungle paths and river travel that linked isolated villages in all three countries. Some of the infected slipped away unknown, to infect other family members and those along their route.
Victory was called too soon at one point. While the disease looked to be contained after a few months, it was, in fact, spreading. The behavior of those likely infected had not been monitored as they mixed with family members and villagers, and traveled.
Ignorance played a role. The disease was unrecognized for a month or more, denied to exist by some government officials, and then especially spread by close contact. Some villagers believed that health workers were purposely spreading the disease and so refused care. Others refused to be quarantined. Local culture included a lot of body contact, such as hugging and touching, and the funerary service required the dead to be kept in close proximity. There could not have been a worse scenario for disease transmission.
Limited hospitals were inadequately outfitted and were quickly at capacity, with private vehicles often serving as ambulances. Church leaders and congregations were affected as well, as the sick sought succor there.
The World Health Organization, based in Geneva, Switzerland, which should have been the needed central response-control agency, was instead at arms’ length because its participation in health emergencies is historically governed via close-by medical administrators in its member countries. In this case, administrators were unschooled and overwhelmed.
It was the organization Doctors Without Borders, which looks to deserve praise for its quick, targeted and effective response.
A couple of Western countries sent medical teams, equipment and portable buildings that could be erected quickly, including units of the U.S. Army. That effort could have been critically important and was worthwhile, but by then, the incidents of disease were waning.
Last week, Liberia was deemed to be free of Ebola. Forty-two days, twice the duration of Ebola’s incubation since the burial of the last known case, without a new case surfacing. Almost 5,000 are believed to have died in Liberia alone.
Twice that many died, perhaps, in total, although the exact number will never be known.
There are a lot of moving parts associated with the 2014 Ebola outbreak in West Africa, and health organizations worldwide will be studying what took place, what might have been worse and what could have been done differently. Nature has a way of throwing up a significant event unexpectedly. Be sure there will be other such challenges.
