Ebola is one of the world’s deadliest diseases. It is a highly infectious virus with a mortality rate between 25 and 80 percent of people who contract it, causing terror among infected communities.
Doctors Without Borders/Médecins Sans Frontières (MSF) has treated thousands of people with Ebola and helped to contain numerous life-threatening epidemics, including one currently affecting North Kivu and Ituri provinces in the Democratic Republic of Congo (DRC).
The declaration of the end of the Ebola epidemic in West Africa on January 14, 2016, was a day of celebration and relief, but lessons learned must be used to improve responses to future outbreaks and to neglected diseases more broadly. The Ebola response in West Africa was not limited by a lack of international resources, but by a lack of political will to rapidly deploy assistance to help communities. The needs of patients and affected communities must remain at the heart of any response and outweigh political interests.
The devastating West Africa epidemic, which resulted in more than 11,000 deaths, hit nearly 40 years after the first discovery of Ebola in 1976. From the very beginning of the epidemic, MSF responded in the worst-affected countries—Guinea, Liberia, and Sierra Leone—by setting up Ebola treatment centers and providing services such as psychological support, health promotion, surveillance, and contact tracing. At its peak, MSF employed nearly 4,000 national staff and more than 325 international staff to combat the epidemic across these three countries. MSF admitted a total of 10,376 patients to its Ebola treatment centers, of which 5,226 turned out to be confirmed Ebola cases.
Yet the lack of research and development on Ebola meant that until this year, no specific treatment or vaccine was available to fight the disease. In 2018, a trial for a new vaccine was conducted during an outbreak in Equateur province in northwestern DRC, which was declared over in July. This vaccine is also currently being used in response to the ongoing Ebola outbreak in the northeastern part of the country.
Symptoms of Ebola
Early on, symptoms are nonspecific, making it difficult to diagnose.
The disease is often characterized by the sudden onset of fever, weakness, muscle pain, headaches, and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and, in some cases, internal and external bleeding.
Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, and difficulty breathing and swallowing.
Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.
Ebola infections can only be definitively diagnosed in a laboratory by five different tests.
Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing.
“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease while caring for patients,” said Henry Gray, MSF emergency coordinator, during an outbreak of Ebola in Uganda in 2012. Gray also served in this role during the 2018 outbreak in Equateur province, DRC.
“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus—through contaminated material from patients or medical waste infected with Ebola,” Gray said.
No specific treatment or vaccine is widely available for Ebola. However, developmental treatments were approved for use and are currently being administered in DRC as part of the response to the ongoing outbreak in North Kivu and Ituri provinces.
Generally, standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure, and treating them for any complicating infections.
Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.
An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.
History of Ebola
Before the West Africa outbreak, MSF treated hundreds of people affected by Ebola in Uganda, Republic of Congo, DRC, Sudan, Gabon, and Guinea. In 2007, MSF entirely contained an epidemic in Uganda.
The Ebola virus was first associated with an outbreak of 318 cases of a hemorrhagic disease in Zaire (now DRC) in 1976. Of the 318 cases, 280 died—and died quickly. That same year, 284 people in Sudan also became infected with the virus, killing 156.
The Ebola virus is made up of five species: Bundibugyo, Ivory Coast, Reston, Sudan, and Zaire, named after their places of origin. Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.