Ebola Outbreak, Discourse and Policy.
| Author | Ogbonna-McGruder, Chinyere |
Introduction
According to Jack Kerouac "The only people for me are the mad ones, the ones who are mad to live, mad to talk, mad to be saved, desirous of everything at the same time, the ones who never yawn or say a commonplace thing, but burn, burn, burn, like fabulous yellow Roman candles exploding like spiders across the stars, and in the middle, you see the blue center-light pop, and everybody goes ahh ..."
A dedication to the Ebola disease Fighters, who followed their hearts and instincts to help despite the real "mad" danger to them.
The most recent Ebola outbreak has emerged as one of the deadliest and long lasting epidemics. As of mid 2015, the outbreak has killed more than 11,000 individuals and infected more than 26, 000 people. Inherent in effective control of spread of infectious disease outbreak, is focused effort at control of the infection at the source, prior to spread. Globalization and the ease of travel especially air travel makes it easier for spread of infections from their nuclei of origin. Accordingly, diseases that were usually local infections, now have the potential to transform into global pandemics. This paper examines global actions and progress towards the management and control of the Ebola outbreak as well as USA policy discourse regarding the outbreak.
Ebola: Policy and Discourse
Ebola is an infectious high mortality rate disease. Transmission is usually by direct contact with bodily fluids of an infected person. Such bodily fluids include blood, feces, sweat, semen, saliva and vomit. The disease is usually characterized by severe flu like symptoms, such as headaches, fever, nausea, stomach pain, vomiting, coughing, muscle weakness and sore throat. In later stages the virus can lead to kidney and liver function failure as well as bleeding through the mouth, nose, ears and eyes. Sometimes a rash may occur that can result in sloughing off of the skin. It has a fatality rate ranging from 50 to 90%. This makes it, one of the most deadly viral diseases. According to Centers for Disease control (CDC) as of October 25th 2014, there were 10,114 total Ebola infection cases, of which 5666 were lab confirmed and out of those infected 4912, had died from the infection. (i)
This current outbreak is the largest outbreak and is caused by the Ebola Zaire species virus, the spread of this disease is stupefying. For comparison purposes, as of September 7th 2014, there were about 1848 suspected case deaths and 2106 laboratory confirmed cases. (ii) But by December 19th 2014, there were 19,031, cases within the 3 most affected countries (Sierra Leone, Guinea and Liberia), with 12,041 laboratory confirmed cases and 7373 total deaths. (iii) And less than a week later, on the 21st of December 2014, WHO reported that the number of global cases had risen to 19,497 confirmed cases and 7588 deaths. (iv) The virus appeared to be still spreading rapidly in Sierra Leone, up to the week of the 21st of December 2014, with 315 new confirmed cases leading up to the week. (v)
According to NPR the current outbreak has been centered mainly within Guinea, Liberia and Sierra Leone, with introduction of the Virus to Nigeria by a Liberian American (Patrick Sawyer) who flew to Lagos, Nigeria and subsequently died at one of the Lagos Hospitals. (vi) The disease was reported in two cities in Nigeria, namely Lagos and Port Harcourt. But Nigerian officials set off a vigorous process of contact tracing, which helped with stopping the spread. It must be noted that a Dr. Adadevoh at the First Consultant Hospital in Lagos where Patrick Sawyer was being treated after he collapsed at the Nigerian airport, suspected Ebola after noticing his bloodshot eyes and the fact that he was passing bloody urine. She subsequently left instructions that the patient should not be released from the hospital under any circumstances. That directive was followed and Patrick Sawyer was not released from the hospital even when he became aggressive. He eventually died at the hospital, and so did Dr. Adadevoh, but the fact that he was isolated at the hospital, helped reduce the number of individuals that he eventually infected. Further contact tracking and isolation by the Nigerian federal and state Governments in conjunction with WHO, helped ensure that the virus did not spread drastically, especially within such a populous city as Lagos. Subsequently, on Monday the 20th of October, WHO declared Nigeria Ebola free. According to BBC News Africa, "The WHO can declare an Ebola outbreak over if two incubation periods of 21 days pass with no new cases. That means if there are no reported cases of Ebola, 42 days after the last case contact. And of course there has to be active monitoring and surveillance to ensure that there is no new case within that 42 days period. For health care workers, their date of last contact is when (the day) the last patient they treated for Ebola tests negative for the virus. If that happens then WHO can declare the place Ebola free. The last reported case in Nigeria--Africa's most populous country--was discovered on 5 September. "The virus is gone for now. The outbreak in Nigeria has been defeated," WHO Nigerian representative Rui Gama Vaz said on Monday." (vii)
Likewise, on October 17th, Senegal was declared Ebola virus free by WHO, after the introduction of the virus into Senegal by a young man that traveled to Dakar, Senegal by road from Guinea on August 29th 2014. Senegal in conjunction with its ministry of Health, CDC, Medecins sans Frontieres and WHO, quickly acted to stop the disease from spreading. The government identified and monitored about 74 close contacts of the patients. It also set up surveillance at the country's entry points. The patient has since recovered and tested negative for the virus on September 5th. After 42 days (double the 21 days maximum incubation period) there has been no new cases of the infection in Senegal. (viii) There was an isolated case in Mali, with the patient expiring and yet another isolated case in Spain. The infected person in Spain is a woman that helped treat a Spanish priest that had been working in Africa. The priest subsequently died despite his medical evacuation to Spain for treatment. One of his nurses in Spain got infected, but she has since recovered from the disease. In United Kingdom, there has been 2 reported cases of Ebola disease. In both instances the individuals were nurses that had travelled to Africa to help with the outbreak. (ix) One of the nurses, a William Pooley was successfully treated at Royal Free Hospital in UK with Z Mapp and released in September 2014. The other nurse, Pauline Cafferkey, was successfully treated at Royal Free Hospital and released in January 2015.
Incidentally, there was also a recent Ebola Virus Disease (EVD) outbreak in Congo which is unrelated to the current West African outbreak. According to Centers of Disease Control (CDC), as of August 26th 2014, there were 24 suspected case count with 13 suspected case deaths, and no laboratory confirmed case. (x)
Within USA there have been about 10 confirmed cases of EVD, and it is important to note that apart from the cases of the 2 nurses that got infected while treating a patient (a Mr. Duncan) that flew in from Liberia, all the other cases were journalist, missionaries or doctors that were helping out in affected countries in Africa. Upon getting infected they were medically evacuated to USA for successful treatment. A Dr Spenser, on the other hand was asymptomatic when he came back to USA, and subsequently developed symptoms after a few days in New York, he has since been treated and recovered from the infection.
There is no standard recognized care, and no approved treatment or vaccine for Ebola, though there are indications that human serum or blood transfusion from someone whom had recovered from the disease can help with recovery of infected individuals. Likewise some experimental drugs, like Z Mapp seem to proffer better prognosis for those infected with the disease. These indications were borne out in the cases of two Americans (Dr. Brantley and a missionary worker Ms Writebol) who were infected with the deadly disease in July of 2014. They were given the experimental Z Mapp, prior to being medically evacuated to Emory Hospital in Atlanta. (Z Mapp is a monoclonal antibody. Monoclonal antibodies are substances produced within the lab to target and attach to specific molecules, in this instance to the Ebola glycoprotein. This glycoprotein is one of the 7 genes of the Ebola virus and this gene is necessary for the attachment of the virus to human cells. Without the attachment of the virus to the cells the virus will die. Z Mapp is an experimental drug, thus it can only be given to Ebola patients under strict Food and Drug Administration (FDA) guidelines.) They have since recovered and been released from hospital.
The Z Mapp serum in a nutshell could possibly have been made by injecting mice with the virus and letting the mice fight off the Ebola virus and then develop antibodies within the process. The serum would ultimately be harvested, with the resultant antibodies, which were possibly used on the 2 Americans infected with the Ebola virus. Another possibility would be that, blood plasma that is separated from the red blood cells with its attendant antibodies to the virus, were taken from someone that had survived that particular species of Ebola, and given to the infected Americans. The antibodies would have been separated from the survivor's blood and concentrated prior to being given to the two patients. Dr Kent Brantley actually donated about a gallon of his blood after he successfully recovered from his Ebola infection. His blood plasma was subsequently successfully utilized in treating Nurse Vinson and Nurse Pham whom both got infected while treating Mr. Duncan at Texas Presbyterian hospital. The donor's blood has to match the recipients prior to the donation of...
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