The Ebola Contagion Epidemic of 2014

In late December of 2013, children of Meliandou, Guinea in West Africa found hundreds of bats nesting in a hollowed out tree. The children had no way of knowing that bats are the suspected carriers of the ebola virus. The children lit a fire and the bats scattered from the tree, allowing the children to catch and consume these bats as a source of protein. It is suspected that this is what triggered the ebola epidemic of 2014. Villagers originally thought that the illness spreading was due to witchcraft but authorities quickly identified the outbreak as ebola in an attempt to quarantine and curb the spread of the infection. Illness rapidly spread across the forest region of Guinea as those who were ill came into contact with healthcare workers whilst seeking medical attention which lead to surrounding areas becoming impacted. For 3 months, the symptoms of ebola were mistaken for cholera and malaria, which is why the contagion was unable to be controlled and halted. The problem quickly spiraled out of control with thousands becoming ill and a total of 11,315 deaths across 6 countries including Guinea, Liberia, Sierra Leone, Nigeria, Mali, and the U.S., however the U.S. faired best with only 49 of the total deaths. The government of Guinea had no idea how to respond as all previous ebola outbreaks had occurred over 1600 kilometers away, however the relief group Doctors Without Borders had decades of experience and were able to be flown in in and effort to curb the spread of the pathogen. Within 48 hours of arrival, Doctors Without Borders had setup a field hospital in the village of Guéckédou, Guinea, the epicenter of the ebola outbreak. Past outbreaks have taught physicians that the best counter attack is to isolate the ill, monitor those who have had contact with the sick, and safely bury the dead. Due to the scale of the problem and the fact that it was not isolated to a single group or village, Doctors Without Borders did not have the resources to contain this potential global threat which is why the World Health Organization became involved, a group which is part of the United Nations and has access to the best and most expensive resources in the world, with a mandate to help governments coordinate responses to outbreaks. The main problem facing the World Health Organization is that the organization itself does not take precedent nor command of any medical situation as it is the country which is dealing with a contagion that must take this lead. Due to the fact that Guinea is a poor nation with few resources, grabbing hold of the ebola outbreak was exceedingly difficult as physicians did not have proper oversight by those in power with ebola experience, the governments of affected nations were some of the poorest in the world, and the World Health Organization was in the process of downsizing, causing the entire process to become more complicated and convoluted as decision making was scattered and often conflicted. This created the perfect storm for ebola to quickly spread across the African continent and into the western world. The government of Guinea accused Doctors Without Borders of sowing panic among the public which further elevated tensions between the 3 organizations involved. Guinea’s Ministry of Health demanded that only laboratory confirmed cases be counted towards the total ebola death count which tied the hands of physicians and their governing organizations as this act downplayed the importance and severity of just how severe the ebola outbreak truly was which lead to further contamination as the public did not treat the disease with the full gravitas of what it demanded. It is believed that this single political act is what allowed ebola to jump across borders, starting with the neighboring country of Sierra Leone as residents of both states are permitted to freely cross the borderline of either nation as often as they wish, a political policy which should have been suspended during a period of mass outbreak. Rumors of foreign physicians killing impoverished residents with syringes helped inflame already growing tensions between healthcare professionals and the general public which made working with infected or potentially infected individuals exceedingly difficult for healthcare practitioners. The corpse of an ebola victim is highly infectious but in West Africa, it is customary for friends and family to spend hours with a person after death, washing and preparing them for their burial (e.g. cutting nails and braiding hair etc.). The sudden cessation of the ability to perform this ritualistic act deeply embedded within West African culture fueled even more resent from the public which caused mass rioting and chaos to ensue, endangering the lives of those who were there to help, made worse by the lack of education, language barriers, and cultural barriers already present. It is theorized that this cultural convention played a major and definitive role in the spread of the ebola virus, as mourners often touch the body during the funerary procession. It is believed by the inhabitants of West Africa that if a body is not laid to rest properly, the ghost of that person will return to haunt the people of the village which is why this ritualistic process is so deeply embedded and revered in this region of the world. The government of Guinea had no method of contact tracing, that is to say, there was no method in place to monitor those who had come in contact with ebola victims which allowed for hundreds of cases to go undetected. The World Health Organization debated whether or not to declare an international health emergency which would have acted as a global distress signal, enacting the aid and preparation for a counter attack from many of the worlds most industrialized nations (e.g. the U.S., Canada, Japan etc.). Officials worried that declaring a global emergency would create panic which would only help exacerbate the issue as many countries, particularly in Europe and the Middle East, could potentially close their borders in an effort to ensure the ebola virus remained exclusively in Africa, the worlds most impoverished continent. To exacerbate the already fevered tensions between government officials, healthcare workers, and the public at large, an event transpired which threw much of the West African population into a panic. In Kenema, Sierra Leone, a woman purporting herself as a nurse, began shouting in the center of the cities most populated marketplace, “there is no ebola! I say to everyone it’s not real. Ebola is not real. It’s cannibalism”. The crowd started to cry for others to come over, to hear the supposed confessions of a nurse stating that physicians are killing innocent people for the consumption of their bodies as meat. The tide quickly changed and the crowd began turning upon the healthcare staff present, throwing stones, giving chase, and threatening their lives, forcing the evacuation of virtually all physicians, nurses, and other interdisciplinary healthcare personnel. This woman was not a nurse, rather she was a person afflicted with mental illness, but her impact greatly exacerbated an already uneasy hoard of people, so much in fact that law enforcement were forced to attend and disperse tear gas to control the ire of the group. By this point, the ebola outbreak had claimed more than 800 people across 3 countries. Physicians urged the World Health Organization to declare an international emergency however organization officials refused to do so because it was believed that this act would only add fuel to an already raging and seemingly out of control inferno of illness and chaotic unrest. It was at this point that the ebola outbreak rose to a new level when an infected Liberian traveled to Nigeria, Africa’s most populous nation, and the U.S., forcing the World Health Organization to declare an international emergency, by holding a press conference given by Dr. Margaret Chan, the Director-General of the organization itself. A high ranking team was assembled and deployed to Geneva, Switzerland in response, devising and enacting a plan to employ thousands of western medical professionals in an attempt to curb an infectious outbreak which was growing by this point at an exponential rate. The outbreak was so beyond the reach of control by this time that it had spread across a broad geographical area, unlike anything ever witnessed in modern memory. The main caveat to the curated plan was that the World Health Organization did not have a standing force of physicians, nurses, laboratory technicians, and other various healthcare practitioners, ready and willing to help serve in the fight to combat such a prevalent contagion, nor did they have the budget to build one. The only option available was to appeal to the worlds wealthiest nations, persuading and to an extent pleading with trained and qualified healthcare workers who were willing and able to travel abroad and join the collective effort. This endeavor would take time as acquiring a team en mass is an extraordinarily ambitious goal to accomplish. Rioting continued to occur with some hospitals being overrun by disillusioned citizens who were angry, frightened, and frustrated enough to allow every patient under quarantine to run back into the village, allowing for the proliferation of the disease to spread even further. Governments attempted to respond by sending in military squadrons to guard sanctioned quarantined buildings in an effort to help contain an outbreak which for all intents and purposes was completely out of control and continuing to spiral into calamity. Citizens were killed both by soldiers with firearms as well as infection as those who were infected were in the streets, amongst the general populous. Doctors Without Borders began constructing ELWA 3 (pronounced “ell-wah-three”), the largest Ebola treatment center ever built, but despite their best efforts, the facility was not large enough to contain the sheer volume of people who needed medical aide. It was at this point that Doctors Without Borders made an urgent plea directed solely towards the U.S to provide thousands of soldiers immediately in order to help isolate and treat patients. Dr. Tom Frieden, Director of the Center of Disease Control, traveled to the ELWA 3 clinic in Monrovia, Liberia to see first hand, just how bad the epidemic was. Frieden recounted his experience by stating that he witnessed a “level of devastation that I have never seen” and that he was “seeing a country essentially in free fall and knowing, knowing with certainty that no matter what we did, it was going to get a lot worse before it got better”. Frieden called then President Barack Obama stating that the outbreak was expanding at an exponential pace, doubling every 3 weeks, resulting in a tripling of results with every month of delay instituted. Obama responded by implementing emergency U.S. aide, sending thousands of soldiers and medics, 10 months after the outbreak had initially begun, in an attempt to quell and eradicate the spread of this viral disease. Other industrialized nations soon followed suit and the United Nations created a new emergency mission for the World Health Organization and other related agencies to coordinate the response. Work began on the ground with the building of new treatment centers and training to teach those deployed how to properly bury affected victims. Despite these monumentous efforts, the ebola virus was still ahead of the response and threatened to spread beyond African borders. Shortly after this humanitarian response, cases in Monrovia began to sharply decline, but experts believed that the downward trajectory would bounce back in an even more dramatic resurgence as people were now staying home due to the events which had recently transpired across the African continent, allowing them to infect more people than if they had been under isolation. Fortunately, the drop in reported cases remained steadfast in its declination as Liberians stopped trying to nurse their sick and started burying the dead in an appropriate and safe manner. Liberians began to understand that the ebola virus was so drastically deadly that previous cultural customs had to be shelved for the time being so that the disease could be expunged and life could return to normal for those who had survived. Thousands more continued to die across West Africa, but the changed behavior of West Africans and the massive international response gradually turned the tide of the war