Ebola: diary of a global outbreak

One day in early December 2013, a two-year-old child from Guéckédou town in Guinea, West Africa, developed high fever, black stools, and vomiting. No one knew what the boy had or how he got it. He could have picked it up from a half-eaten fruit laced with the saliva of an Ebola-infected fruit bat. When we were children, I remember scooping from the ground sweet chicos and mangoes on which bats had feasted the previous night, with no regard for viruses that could be lurking in them. The Ebola virus, which was first detected in 1976, has been traced to wild animals.

In any event, that child became “patient zero”—the starting point of what the World Health Organization has now declared a “global health emergency.” The toddler died on Dec. 6, followed by his mother on Dec. 13, his three-year-old sister on Dec. 29, and his grandmother on Jan. 1. The disease quickly spread after people from the surrounding villages attended the grandmother’s funeral.

On July 23, 2014, the organization Doctors Without Borders announced that the disease was out of control. From its epicenter in Guinea, it had quickly spread to neighboring Liberia and Sierra Leone. In West Africa alone, 8,000 cases of Ebola infection have been recorded since March. More than half of the patients have died. Someone warned that there could be 10,000 additional cases every week for the next few months if the virus continues to spread at its present pace. No cure has been found, and no vaccine is yet available. Some experimental drugs are being tried, but their effectiveness remains inconclusive. The rate of survival from the disease, which has an incubation period of 21 days from infection, is at 20-40 percent.

Though the Ebola virus is not airborne, it is easily transferred through the body fluids and secretions of infected persons. It can enter through the eyes, through mucous membranes, and through breaks in the skin. Like the AIDS virus, it can also be transferred through sexual contact.

The more advanced the symptoms, the greater the saturation of the body with the virus. The remains of people who die from the disease are thus at their most infectious when they are about to be buried, which is when relatives and friends tend to gather near the diseased. But, on the bright side, this also suggests that if an infected person is strong enough to be moving around, chances are he/she may not yet be highly infectious.

Of course, this offers no assurance to international travelers. Last July 25, Patrick Sawyer, a Liberian-American, was on his way home from Liberia to Minnesota in the United States. He collapsed while waiting for his flight in Lagos, Nigeria. Sawyer never reached the United States. He was taken to a Nigerian hospital, where he died. During his brief confinement, he infected a couple of healthcare workers, who also died from the Ebola virus.

But, last September, someone like Sawyer left Liberia to visit his kin in America and managed to reach his destination in Dallas, Texas. His name was Thomas Eric Duncan, a 41-year-old personal driver from Monrovia, Liberia, who became the first Ebola virus victim to be diagnosed in the United States. How he contracted the virus is worth retelling.

On Sept. 15, Duncan helped carry an Ebola victim, Marthalene Williams, into a taxi. The girl’s family, who owned the apartment that Duncan was renting, requested him to accompany them to the hospital because there was no ambulance available. Four days later, on Sept. 19, Duncan left for America, taking a Brussels Airlines flight to Belgium, where he boarded a United Airlines flight to Washington’s Dulles Airport. Duncan did not reveal his contact with the disease in a questionnaire he filled out at the Monrovia airport. From Washington, he took another UA flight, arriving in Dallas early in the evening of Sept. 20. There he stayed with his girlfriend and her five children.

On Sept. 24, he complained of high fever and abdominal pain, prompting his partner to take him to the emergency room of the Texas Health Presbyterian Hospital. Again, when asked, he lied about his contact with the disease. He was diagnosed with a mild viral infection and sent home with a prescription of antibiotics. Four days later, he was back in the same hospital with more severe symptoms. On Sept. 30, Duncan’s Ebola diagnosis was confirmed, and he was given the experimental drug “Brincidofovir.” He, however, could not be saved. On Oct. 8, he became the first person to die from Ebola in the United States.

Unfortunately, two nurses who had attended to Duncan during his stay at the Texas hospital got infected and developed the same symptoms a few days later. One of them, 26-year-old Nina Pham, has been placed in isolation in a National Institutes of Health special facility following her Ebola diagnosis. The other, Amber Joy Vinson of Cleveland, Ohio, is now being treated at the Emory University Hospital in Atlanta. This is the same hospital where, months earlier, two missionaries who had worked with patients in Liberia, Dr. Kent Brantly and Nancy Writebol, were brought and treated with the experimental drug “ZMapp.” Both Brantly and Writebol have survived and have been discharged.

There was an early suggestion to seal Ebola-stricken Liberia, Guinea, and Sierra Leone from the rest of the world by banning travel to and from these hapless African countries. No thought could be more misguided; doing so will only make the disease impossible to track down. As Tom Frieden of the US Centers for Disease Control and Prevention put it: “We live in a world where we are all connected by the air we breathe, the water we drink, the food we eat, and by airplanes that can bring disease from anywhere in a day.”

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