Ebola: It’s Back in the News
My, how time flies. Was it really back in 2014 that the Ebola crisis that had everyone so panic-struck? You may remember that, at the time, other alternative health websites were telling people that you could catch the disease by sitting next to someone with Ebola on a plane.1 They also chose to take a CDC report out of context and predicted over a million deaths in Africa alone2 and that the outbreak would spread to the US where it would paralyze the country, crushing social order and bringing forth martial law. And those were the saner stories. Lest we forget, others were claiming that Ebola was created in government labs or that it was a conspiracy cooked up by the pharmaceutical companies to sell vaccines or that the vaccines under development were experimental and would kill you. And many people eagerly ate it up since it fed a narrative they already believed!
Of course, as I stated at the time, none of that was true. There was little chance of Ebola spreading outside of Africa unless enough people in the West become distrustful of their own governments' intentions, and then motivated by fear, they made the same kind of misguided decisions as the people in West Africa had done and ended up turning a small outbreak into a full-blown epidemic. Truly, the only thing we had to fear was fear itself. As I said at the time:
- The number of deaths in Africa would be in the low thousands, not millions.
- The chances of the outbreak taking root in the US were about as close to zero as you could get
- You couldn't catch Ebola by sitting next to someone on a plane. It took direct contact with infected bodily fluids.
Which is pretty much how things turned out. The total number who died in Africa from Ebola was about 11,300. In the US, only two nurses contracted the disease, and both recovered. Eleven cases were reported from people who contracted Ebola outside the US and subsequently traveled to the US. Of those, two died. After all the hysteria promoted on other websites--not to mention all of the sales of "Ebola survival kits" in the US--that was the total extent of the Ebola epidemic in the US.
So, why are we talking about Ebola again? As it turns out, two reasons.
Reason 1: Ebola in the City
In fact, there have been several outbreaks of Ebola since 2014.
In 2014, there was a second outbreak that you never heard about. It started in the Democratic Republic of Congo and had a reported 69 cases with 49 deaths. An Italian healthcare worker who brought it back to Italy survived. And finally, an infected traveler brought it to Mali where eight were infected and six died. The bottom line is that you never heard about it because:
- It stayed local
- It stayed rural, never reaching a major populated city
- Mortality was low, totaling 55 people
- And finally, it never really threatened to break containment, which meant it didn't threaten large populations
In 2017, there was another outbreak in the Democratic Republic of Congo. There were 8 cases and 4 deaths. So again, for all the same reasons, you never heard about it.
And then, on May 8th of this year, an outbreak began once again in a rural area of the Democratic Republic of Congo. This one is ongoing, and it is different.
At first glance, you might wonder why.
According to government statistics, the total number of confirmed cases stands at 35-58 (depending on whose numbers you use), with at least 600 people considered at risk. And the death toll now stands at 12-27 (again, depending on whose numbers you use). Not much different than the two previous outbreaks we just talked about. So, what's different?
Unlike the previous outbreaks, this one has spread to the crossroads city of Mbandaka. Mbandaka is a densely populated provincial capital on the Congo River. The city is about 150 kilometers (93 miles) from Bikoro, the rural area where the outbreak started. It is likely it was taken there by people who attended the funeral of an Ebola victim in Bikoro before travelling to the city.
This presents two problems.
- Mbandaka has a population of more than 1 million people. This is the first time that this vast, impoverished country has encountered Ebola in an urban area. In this environment, it could easily become uncontrollable.
- Mbandaka's location on the Congo river is very concerning. It is in a busy travel corridor upstream from Congo's capital, Kinshasa, a city of about 10 million. It is just an hour's plane ride from Kinshasa, or a four- to seven-day trip by river barge. It is also close to Brazzaville, the capital of the Republic of Congo, population 1 million, as well as the Central African Republic.
As Dr. Peter Salama, the World Health Organization's deputy director-general of emergency preparedness and response said, "This is a major, major game-changer in the outbreak…This puts a whole different lens on this outbreak and gives us increased urgency to move very quickly into Mbandaka to stop this new first sign of transmission… We have urban Ebola, which is a very different animal from rural Ebola. The potential for an explosive increase in cases is now there."
As a point of reference, the 2014-16 West Africa outbreak became particularly deadly when it spread to the capitals of Guinea, Sierra Leone, and Liberia.
The problem of containment in a densely populated urban environment was brought into focus several days ago when three Ebola patients escaped from a hospital in Mbandaka, coming into contact with hundreds of people and raising fears of a widespread outbreak.
The problem of Ebola containment in an urban environment was brought into focus several days ago when three patients escaped from a hospital in the DR Congo, coming into contact with hundreds of people and raising fears of a widespread outbreak.
Two of the patients left the hospital with family members and died within the next 24 hours. One died at home while the other was brought back to the hospital before dying the next night. A third patient who was close to being discharged left briefly but later returned.
Health officials are now searching the city to find everyone with whom the patients came into contact. That includes their relatives and those present at the church where two of the victims were taken to pray. All told, officials have put together a list of 628 people who came into contact with them. They will all need to be vaccinated, which isn't always easy as much of the population is highly distrustful of their government, fearful of vaccines and modern medicine, prone to believe in conspiracies as to how Ebola is contracted and spread, and often prefers to use prayer instead of medicine. And before you say, "Those silly Africans," doesn't that also describe a sizeable population of the United States? And keep in mind, it doesn't take many people resisting authorities and breaking containment to make an outbreak uncontrollable. In Mbandaka, just two infected patients put over 600 people at risk in less than 24 hours. How much deadlier would things be in the US where people could travel to multiple metropolitan areas in 24 hours? Very scary!
As Peter Salama said at a French press briefing, "We are on the epidemiological knife edge…The next few weeks will really tell if this outbreak is going to expand to urban areas or if we are going to be able to keep it under control."3
The primary weapon being used to keep the virus under control is an experimental vaccine from Merck. Thousands of doses have been sent to Kinshasa, with most of them earmarked for Mbandaka. The vaccine is unlicensed but was effective in limited trials during the West Africa outbreak. WHO has said it will use the "ring vaccination" method. It involves vaccinating contacts of those feared infected, contacts of those contacts, and health care and other front-line workers. As a side note: it needs to be stored at a temperature of between minus 76 and minus 112 F (-60 and -80 C). The problem is that electricity supplies are unreliable in the DR of Congo.
In any case, as Deputy Director Salama said: the next few weeks will tell.
Reason 2: Changes in US Policy
(Note: I normally scrupulously avoid politics on this website since I don't want people rejecting important health information because they feel the political content doesn't align with their view of the world. But when political decisions directly impact health--potentially in catastrophic ways--they must be addressed. And in that regard, over the years, I have called both major parties to task for ill-informed policies.)
As I said at the top of the newsletter, there are two reasons we're talking about Ebola again. The first, the new outbreak in DR Congo, which we've already discussed, is more likely than not to be contained. If it isn't, you'll be hearing a lot more about it in the weeks ahead.
The second reason, though, is nowhere near as immediate, but potentially a lot more dangerous and could ultimately bring a major Ebola outbreak to the US.
In the 2014 Ebola epidemic in West Africa (Liberia, Sierra Leone, and Guinea), over the course of the outbreak, more than 3,700 American scientists and support personnel were on the ground. In addition, the US also deployed 2,800 military personnel who built 10 Ebola treatment facilities in West Africa as well as a medical unit for infected health care workers. It was the most massive overseas mobilization of personnel in the CDC's history, with Congress ultimately approving $5.4 billion to underwrite the U.S. actions. This response is generally credited as a key factor in containing the virus that caused the Ebola outbreak in one of the poorest areas of the world.
Compare that with the current outbreak.
President Trump, in an act of almost poetic timing, asked Congress to rescind all special Ebola funding from the current federal budget and remove most of the financing for State Department emergency responses on the same day that the Ebola outbreak was declared in the Congo.4 And almost simultaneously, still National Security Advisor John Bolton removed the official in charge of pandemic response, the National Security Council's health security chief, Rear Adm. Timothy Zimmer--shutting down the entire epidemic prevention office. The move, which appears to have been part of a larger streamlining by Bolton of the entire NSC, leaves the United States with no clear line of authority for responding to any outbreak of disease, whether naturally arising or as an act of bioterrorism.5
President Trump asked Congress to rescind all special Ebola funding from the current federal budget and remove most of the financing for State Department emergency responses on the same day that the current Ebola outbreak was declared in the Congo.
Because of these and other similar White House policies, the CDC currently only has five staff permanently based in Kinshasa to advise the Congolese government's response. The CDC presence is smaller than the team of experienced Ebola fighters that arrived from West African countries that faced the disease in 2014 to support the fight in Congo's ground zero for this current outbreak. In addition, the U.S. Agency for International Development initially only promised $1 million to WHO for its Ebola efforts -- far less than has been promised by other countries. Apparently embarrassed by the response in the world press, on May 22, Alex Azar, a Trump administration cabinet member, told the World Health Assembly in Geneva that the US will contribute an additional $7 million to combat the spread of Ebola in the DR Congo.6
So, what's the big deal? That money can be better spent here in the US. We're talking America first, right?
The problem is that if the current outbreak bursts containment and spreads, dare I say it, virally, we will not have the necessary boots on the ground to mount a quick response. It will take time to marshal resources from the US and put sufficient boots on the ground to keep things from exploding out of control. At that point, it could cost us far, far, far more than we can imagine. Five billion dollars would look absurdly cheap compared to what we'd have to spend then.
During the Iraq War, the Bush administration was fond of saying, "We're fighting them over there, so we don't have to fight them here." That turned out to be a bit inaccurate as there were no Al Qaeda bases in Iraq. But what was inappropriate for the Iraq War is definitely appropriate for the fight against Ebola. If America first is your operating principle, then you want to spend a few million--even a few billion--fighting it overseas in poor countries rather than in the US. Such support, in addition to being beneficial to Africans and good foreign policy (George Bush is still hugely popular in Africa for his $15 billion African AIDS program), would also protect the US. It needs to be remembered that any Ebola outbreak that hits the US in force would be both devastating to our citizens and astonishingly costly. Again, it would make the $5.4 billion we spent in 2014 look like bingo money.
That said, it's encouraging that so much is being achieved right now in the DR Congo, and in such a short a time--especially since it has happened without leadership from the United States. Quite simply, the US has, at least to this point, been missing in action from this outbreak, with only a handful of Americans on the ground and no special funding from the Trump administration. Unfortunately, that's congruent with how the U.S. government is increasingly withdrawing from global health efforts--ceding both its authority and leadership.
The Sum of All Fears
- Is the current outbreak likely to spread aggressively beyond the DR Congo?
- No. And especially, no if the vaccine works as it appeared to work in 2014.
- Are we safe from Ebola moving forward?
- Not necessarily. If the virus ever mutates and becomes transmissible in droplets from coughing and sneezing, that's a game changer. People claimed it did that in 2014. It did not--and currently still does not. But it's an easy mutation and could happen at any time.
- Are the US, Europe, and Asia at risk?
- Not now. But again, with a simple mutation or if an epidemic ever breaks containment, Ebola could rip through crowded cities in the developed and developing world with astonishing speed and devastating effect.
- Has the US given up its lead role in the fight against pandemics?
- Unfortunately, we appear to be moving rapidly in that direction.
- Is that the worst of it?
- No, sadly not. If a pandemic such as Ebola hits the US full force, defeating it will require the full resources of the medical community and the cooperation of its citizenry to save us from the worst effects. Unfortunately, large segments of the population are already highly suspicious of medical doctors and especially of vaccinations. And yes, there is a case that can be made against vaccination--but in a widespread Ebola pandemic, it might be the only effective defense available. And keep in mind we're not talking about mass vaccination, but about "ring" vaccination, which means vaccinating only those people who have come in contact with an infected person. In other words, no one gets vaccinated unless an Ebola epidemic has actually reached the United States--or wherever. Nevertheless, as things currently stand, millions of people in the US would be likely to do everything in their power to avoid this option. The result could be devastating.
- And decisions that our government is currently making are likely to greatly exacerbate the problem and put us in great jeopardy moving forward. These include:
- Reduced funding for pandemic prevention.
- Removal of knowledge-based leadership in pandemic prevention.
- Dismantlement of healthcare services to the poor--the very place where a pandemic is likely to spread the fastest--ironically putting all economic brackets at higher risk.
- Promotion of conspiracy theories and the discrediting of mainstream news media so that large segments of the population disbelieve anything that comes from the media.
The bottom line is that if a mutated Ebola virus hit the United States with a vengeance in the future, as things now stand, we will very likely be unprepared to handle it in the most expeditious manner possible. The short-term effects on the nation's health, mental well-being, societal order, and economic soundness could very well be catastrophic--costing billions of dollars at a minimum. Recovery could take a number of years.
With luck, we will rethink our priorities before it's too late and better prepare and better fund our frontline defenses against possible pandemics. It really is "better to fight Ebola over there than to fight it here."
Addendum: On May 30th, the FDA published a statement about the current Ebola outbreak in the Democratic Republic of Congo. It's useful information, but considering the reduced funding, support, and coordination from the federal government, you might want to take their statements about preparedness with a grain of salt. Also, you're going to love the section on "fraudulent products" (i.e., alternative health remedies). Considering that using FDA supported methodologies for Ebola results in a 30-70% mortality rate, that seems just a tad disingenuous.
- 1. Lena H. Sun, Brady Dennis, and Joel Achenbach. "CDC: Ebola could infect 1.4 million in Liberia and Sierra Leone by end of January." The Washington Post. September 23. (Accessed 24 May 2018.) http://www.washingtonpost.com/national/health-science/cdc-ebola-could-infect-14-million-in-west-africa-by-end-of-january-if-trends-continue/2014/09/23/fc260920-4317-11e4-9a15-137aa0153527_story.html
- 2. "CDC report predicts as many as 1.4 million cases of Ebola by January." Fox News. September 23, 204 (Accessed 24 May 2018.) http://www.foxnews.com/health/2014/09/23/who-forecasts-more-than-20000-ebola-cases-by-november-2/
- 3. "DR Congo Ebola outbreak on 'epidemiological knife edge': WHO." AFP 23 May 2018. https://www.afp.com/en/news/23/dr-congo-ebola-outbreak-epidemiological-knife-edge-who-doc-15a07t1
- 4. https://www.whitehouse.gov/wp-content/uploads/2018/05/POTUS-Rescission-Transmittal-Package-5.8.2018.pdf
- 5. "Elimination Of NSC Global Health Security Office Part Of National Security Adviser Bolton's Plans To Streamline Council." Kaiser Family Foundation. May 11, 2018. (Accessed 27 May 2018.) https://www.kff.org/news-summary/elimination-of-nsc-global-health-security-office-part-of-national-security-adviser-boltons-plans-to-streamline-council/
- 6. "US pledges 8 million dollars for Ebola outbreak in Congo." The Jamestown Sun. 22 May 2018. (Accessed 27 May 2018.) https://www.jamestownsun.com/news/world/4449657-us-pledges-8-million-dollars-ebola-outbreak-congo