By Uduak Ntuk:
The 2014 Ebola epidemic has compelled the world to see the fragility of the overall global health system. It is the worst Ebola epidemic to date with nearly 5,000 deaths reported in west Africa’s Liberia Sierra Leone and Guinea, and the death toll keeps rising1,2. Sporadic cases in Mali and the USA have also been recorded. The recent case fatalities in the United States and Spain sadly bring home the truth that viruses do not respect national territories and that ‘when danger lurks somewhere then there is danger everywhere’. It is thus imperative that in dealing with issues like this, prompt proactive global measures are taken.
Ebola Virus Disease (EVD) is characterised by a constellation of signs and symptoms beginning with fever and progressing to diarrhea, vomiting and in a subgroup of patients, hemorrhage3. Human transmission of Ebola is through direct contact with blood, secretions, organs or other bodily fluids of infected people and with surfaces and materials such as beddings, clothing contaminated with these fluids2. In addition to its health impact on society, it has an overwhelming impact on the economies of the affected countries4.
Several research studies are underway to understand the clinical illness and epidemiological impact of Ebola. A study in the New England Journal of Medicine (NEJM)5 showed that in addition to clinical characteristics and demographic factors, age is an important determinant of disease mortality. Patients under 21 years have a lower case fatality rate than those over the age of 45 years. According to the WHO, trials of Ebola vaccines are to start in December this year following discussions at a high-level meeting on accelerating testing and production, with plans to dispense vaccines in 20156. This decision comes amid a growing realisation that vaccines could play an important part in halting the current epidemic in West Africa.
There is hope that the fight against Ebola can be won. First Senegal and then Nigeria have been declared Ebola-free by the World Health Organisation1. As a Nigerian I feel proud to hear such compliments. Apart from the global respect Nigeria has won for herself in fighting Ebola, it also shows the brave leadership, commitment to ingenuity, courage and sacrifice in the line of duty of the Nigerian people. Such success helps to overcome criticisms of corruption and incompetence that West African governments are often labelled with. But the fight against Ebola in Nigeria wasn’t won with conferences or public relations talks; it took massive efforts to quarantine those infected, and monitor all of their contacts, until the spread of the virus was contained. What then are the other West African countries not doing right to combat Ebola? Guinea, Sierra Leone and Liberia have very weak health systems, lacking human and infrastructural resources and call for support has been given high priority.
The bulk of the human and financial resources being deployed across the epicentre of this outbreak come from Western nations and very few resources have been deployed from sister African countries, which is very disheartening.
The recent issue of whether to quarantine health care workers, returning to their home countries has also been a topic of huge debate. From a public health perspective, the idea of placing primary contacts under relaxed medical surveillance that depends on self-reporting and individual cooperation may comply with respect for individual rights but it appears to be difficult to manage. Perhaps it may be necessary to still adhere strictly to full quarantine even in instances where the primary contacts of index cases are minimal and manageable, and Individuals may be encouraged with different forms of incentives and remuneration for them for the period of their confinement. This may turn out to be be far cheaper and easier than frantically searching for contacts, such as passengers on flights, when a primary contact breaks self surveillance.
How do you think we can handle quarantine in a different way? Do you think treatment given to health care workers with primary contact with cases is an infringement of their human rights? I would love to hear your opinion!
- World Health Organisation. Ebola response roadmap situation report. Available from http://apps.who.int/iris/bitstream/10665/137424/1/roadmapsitrep_31Oct2014_eng.pdf?ua=1 .Accessed 4 November 2014
- Breman JG, Johnson KM. Ebola Then and Now. N Engl J Med 2014; 371:1663-1666.DOI: 10.1056/NEJMp1410540
- World Health Organisation. Ebola virus disearse. Available from http://www.who.int/mediacentre/factsheets/fs103/en/. Accessed 29 October, 2014
- BBC . Ebola crisis: The economic impact. Available from: http://www.bbc.co.uk/news/business-28865434. Accessed 27 October, 2014
- Schieffelin JS, Jeffery GS, Goba A, Gbakie M, Gire SK, Colubri A , et al . Clinical illness and outcome in patients with Ebola in Sierra Leone. N Engl J Med; October 29, 2014. DOI: 10.1056/NEJMoa1411680
- World Health Organisation. WHO convenes industry leaders and key partners to discuss trials and production of Ebola vaccine. Available at: http://www.who.int/mediacentre/news/releases/2014/ebola-vaccines-production/en/. Accessed 29 October, 2014.