Ebola's Curse

2013-2016 Outbreak in West Africa

Michael B.A. Oldstone, Madeleine R. Oldstone

• Publisher: Academic Press
• Year: 2017
• ISBN:
  9780128138892
• Topic: Scienze biologiche
• Subtopic: Biologia

Ebola's Curse: 2013-2016 Outbreak in West Africa is about hemorrhagic fever viruses, especially Ebola, its initial origin in central Africa 1976, its unprecedented appearance in West Africa in 2013. The book records in sequence and detective style how the initial outbreak of Ebola from the index case in rural Guinea traveled to Sierra Leone, the work and fate of those working in the Kenema Government Hospital (KGH) isolation ward in Sierra Leone. The book provides vignettes of the three main players involved with Ebola at KGH, Sheik Khan, Pardis Sabeti, and Robert Garry.

Khan was the head of the unit, declared a national hero by his Sierra Leone government. He died fighting Ebola and was/is recognized in the USA by American societies by awards created for his historic work and death. Pardis Sabeti, a geneticist from Harvard and Broad MIT Institute, who was honored as a "Scientist of the Year" by Time Magazine and the Smithsonian Institute. Robert Garry, head of the operation to fight hemorrhagic fevers and Ebola, shuttled between Tulane University, KGH, and The White House to make aware through the press and others the dilemma and tragedy that was unfolding, and the need to obtain additional medical and health care support and supplies. Sabeti and Garry currently work with Oldstone on Ebola at KGH and thus personal communication and knowledge was/is available to the author for the book.

• Includes perspectives from the 2013-2016 outbreak in West Africa
• Provides a detailed overview of the origins of Ebola virus through present day discoveries
• Written with an integrative approach, incorporating scientific research with insights from the field on Public Health and Medical History

Chapter 1

Ebola’s Origin

A Limited but Devastating Viral Hemorrhagic Disease of Central Africa

Abstract

Ebola’s Curse: 2013–2016 Outbreak in West Africa, a timely, needed and well-presented book by Michael Oldstone and Madeleine Rose Oldstone, unlocks the mysteries of the largest outbreak of one of the world’s most fearsome viruses. What is Ebola? Why did this happen? Here you will find the answers to these questions, while meeting fascinating people thrust into a situation as dramatic as any that could be imagined in a blockbuster novel or movie.

By reading this book you will come to understand why the world was unprepared for the outbreak of such a deadly pathogen as Ebola virus and why it still is. You will gain intimate knowledge of a pathogen that spread like a tsunami over a region of the world that lacked the resources to fight it. You will meet a group of people that by chance were already there to fight another deadly virus. You will find out how in a matter of weeks this small group of doctors, nurses, and scientists were overwhelmed and why this matters. You will meet people that fought with limited resources at hand and became heroes that put the possibility of saving their patients ahead of their own lives. In the end you will gain insights into steps that must be taken to ensure that such a horrific virus outbreak never happens again anywhere in the world.

Keywords

Ebola origin; spread; consequences; heroes

The name Ebola comes from a corruption of the French word for the river Legbala (as named in the Ngbandi language). This river is the head stream of the Mongala River, a tributary of the Congo River approximately 166 miles long, in the northern part of the Democratic Republic of the Congo (DRC). This former part of the Belgian Congo was then known as Zaire. In 1976, infection by the so-called Ebola virus was first identified in the town of Yambuku,¹ actually located 60 miles from the Ebola River. Rather than stigmatize Yambuku by naming the virus after the town, and thus hamper its economy or reputation, Dr. Peter Piot, now Director of the London School of Hygiene & Tropical Medicine, called the virus by the river’s name. This politically correct technique had been in use for naming, as shown by the outbreak of Hantavirus infection, occurring in the Four-Corners region of the United States where Colorado borders New Mexico, Utah, and Arizona.² Originally named Hanta Four-Corners virus, which depicted the geographic site where the virus was found, after disapproval by merchants and residents in the area, the pathogen underwent a change of name to Sin Nombre virus (Spanish for no-name virus) to avoid political and economic outfall. Thus Ebola virus, like Sin Nombre virus, joins the list of politically correct viruses.

In the first outbreak of Ebola virus infections, 318 victims were identified, of whom 279 died, a mortality of 88%.³ This virus was christened Ebola Zaire, basically the same virus strain as the current one in West Africa.⁴ Since 1976 all outbreaks of Ebola virus infection have occurred in Central Africa (Zaire, Sudan, Kenya, Gabon, and Uganda) except for that of one person in the Ivory Coast, West Africa in 1994.^5,6 That person was a scientist who became infected after doing an autopsy on a chimpanzee found in the Taï Forest; presumably, blood from that chimpanzee carried the infectious Ebola viruses.⁶ The Taï Forest is a national park in Cote d’Ivorie containing one of the last areas of primary rainforest in West Africa.⁷ The area was designated as a park in 1926 and promoted to national park status in 1972. In 1982, it was declared a World Heritage Site due to the breadth of its flora and fauna; five mammal species in the forest (pygmy hippopotamus, olive colobus monkeys, leopards, chimpanzees, and Jentink’s duiker) are on the Red List of threatened species. The Taï Forest is approximately 100 km from the Ivorian coast on the border of Liberia between the Cavalla and Sassandra Rivers. The size of the park is 4540 km² and altitudes vary from 80 m to 396 m. Taï Forest is believed to be a natural reservoir of the Ebola virus and is the likely source of the 2013 Ebola outbreak, which then spread through Guinea, Sierra Leone, and Liberia in West Africa during 2014–15.^4,7 None of the multiple occurrences in Central Africa, including the original 1976 outbreak, affected more than 425 individuals or caused more than 280 deaths (Fig. 1.1).⁵ Yet, by contrast, the 25th outbreak of Ebola in 2013–15 in Northwestern Africa infected over 28,000 people and killed more than 11,000.

Figure 1.1 Upper: displays comparative sizes of several viruses including Ebola and Lassa discussed in this book. In addition, electron micrograph pictures of Ebola and Lassa are shown. Lower: map of Africa where Ebola broke out in Central Africa (yellow) and recent West African outbreak in blue.

The 1976 eruption of Ebola in Zaire in Central Africa provided lessons for how to control future outbreaks of this disease. Unfortunately, those lessons were not well learned or sufficiently applied to control the recent 2013–15 Ebola outbreak that devastated Guinea, Liberia, and Sierra Leone in Western Africa. Yet the Ebola virus that appeared in the first outbreak (called Ebola Zaire) is basically the same virus found in Western Africa in 2013–15.⁴ So what are the lessons and their consequences for those afflicted during 2013–15 and in the future?

The year 1976 marked the first recorded case of an Ebola virus infection and occurred in Central Africa. That index person (first case) was treated at Yambuku Mission Hospital for nose bleed and diarrhea, then fever and lethargy, systemic symptoms that resembled diseases such as malaria, yellow fever, and typhoid fever that are common to the region. This index patient came from a rural area and, though not proven, likely became infected initially after hunting and preparing food contaminated by the blood or saliva of an Ebola-infected monkey or fruit bat. Even when fruit bats carry evidence of Ebola virus, they can be clinically healthy and show no signs or symptoms of infection. Although the infected monkeys usually become ill and die, fruit bats do not.

The Yambuku Mission Hospital had 120 beds and the Ebola virus infection spread rapidly from the single index case to other patients in the hospital via use of unsterilized needles, syringes, scissors, and other instruments. At that time and place, hospital instruments were cleaned by simply washing and then rinsing with distilled water before reuse. These practices enabled the viral spread to not only other patients but also health care workers exposed to blood and body fluids from infected patients. Blood, body fluids, saliva, and tears are now known to contain large amounts of infectious Ebola virus. Of the Yambuku Mission Hospital’s 17 staff members, 13 became sick, and 11 died. Health care workers and ill patients infected visitors who then transmitted the infection to family members and others on return to their villages. Thus from the single index case, 318 people became infected, and 280 died. The hospital closed when the medical director and three Belgian missionaries died. Many infected individuals and their contacts fled to their home villages out of fear of disease and suspicion of the nonfunctioning Western medical system. Those fleeing often sought traditional therapies from native health healers.⁸

Concurrently, the government of Zaire contacted the United States Centers for Disease Control (CDC) in Atlanta, Georgia, for assistance. Zaire’s officials planned to join with and assist a group of international scientists and health care workers to explain and control this outbreak of a lethal hemorrhagic fever whose origin was unknown. The Zaire government of President Mobutu Sese Seko and his Council of Ministers, with the minister of health and the international community, shared information and had daily or at least frequent meetings. More than 70 health care workers were assigned to the field for surveillance and education. The government attempted to quarantine 275,000 people in the area and prohibited commercial plane and boat traffic. Orders were distributed that no one was to leave the villages, and no strangers were allowed to enter them. Four-person teams for health care surveillance, most often led by a physician or nurse, were trained to recognize Ebola hemorrhagic disease. A diagnostic test for Ebola was developed. These knowledgeable surveillance teams visited over 550 villages at least twice over a 2-month period, and a third time for the 55 villages where Ebola had been found. Of great importance were their meetings with the elders and chiefs who headed these villages to impart knowledge about the disease. Team members spoke about the infection’s spread and containment methods, the...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Biography
• Foreword
• Acknowledgments
• Introduction
• Chapter 1. Ebola’s Origin: A Limited but Devastating Viral Hemorrhagic Disease of Central Africa
• Chapter 2. Ebola’s Unanticipated Arrival in West Africa
• Chapter 3. Kenema Government Hospital: From Lassa to Ebola
• Chapter 4. Sheik Humarr Khan: Leading the Fight Against Ebola in Sierra Leone at Kenema Government Hospital
• Chapter 5. ZMapp: The Ethics of Decision Making
• Chapter 6. Robert Garry: Managing the Effort to Curtail Ebola’s Curse
• Chapter 7. Pardis Sabeti: Geneticist Tracking Ebola’s Travels and Changing Profile
• Chapter 8. Ebola’s Curse: Impact on the Economics of West Africa
• Chapter 9. Ebola’s Scorecard: Failure of the WHO and the International Community
• Addendum
• Index