If contracted, Ebola is one of the world’s most deadly diseases. It is a highly infectious virus with a mortality rate between 25 and 80 percent of people who catch it, causing terror among infected communities.
Doctors Without Borders/Médecins Sans Frontières (MSF) has treated hundreds of people with the disease and helped to contain numerous life-threatening epidemics
With the declaration of the end of the Ebola epidemic in West Africa, January 14, 2016, should be a day of celebration and relief. But lessons must be learned from the outbreak and the response.
Lessons learned must be used to improve responses to future epidemics and to neglected diseases. This Ebola response 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.
This devastating epidemic hit nearly 40 years after the first discovery of Ebola in 1976, yet the lack of research and development on Ebola meant that even today, after the medical trials and at the end of the epidemic, no specific treatment or vaccine is yet available for the disease.
This has been an unprecedented epidemic with an unprecedented response.
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 over 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. In total, the organization has spent over 96 million euros on tackling the epidemic.
But there is still a lot of room for progress. Most importantly, there still is no treatment for this deadly disease, and much about the virus remains unknown.
Steps must be taken to better prepare the world for a future outbreak.
A lot of data has been gathered during this outbreak, and a lot of it remains to be analyzed. This analysis will be of vital importance to learn as much as possible about the disease before another outbreak occurs.
We now have a promising vaccine for Ebola, but it is yet to be approved for regular administration. In order for it to be useful during a new outbreak, we must ensure that it will be accessible to those in need.
There’s no treatment for Ebola yet, but there are a few promising developments in the pipeline. In order to test these products, preparations of clinical studies of the most promising treatment products should be prepared before the next outbreak, in order to lose as little time as possible.
A sustained and well-functioning surveillance and rapid response system is essential in order to maintain zero cases of Ebola across West Africa and also to respond to cases of other diseases with epidemic potential, including measles and cholera, which have previously broken out in the region.
Finally, already weak public health systems were seriously damaged by the epidemic and their recovery must be sufficiently funded and resourced.
MSF will continue its work on Ebola.
Even though the epidemic is over, MSF’s work on Ebola is not. Ebola survivors are a particularly vulnerable group, facing continuing health challenges such as joint pain, chronic fatigue, and hearing and vision problems. They also suffer from stigmatization in their communities and need specific and tailored care. MSF has invested in setting up five Ebola survivor clinics in Liberia, Sierra Leone, and Guinea, providing a comprehensive care package, including medical and psychosocial care and protection against stigma.
Re-emergence of cases is very rare.
Evidence gathered during the epidemic shows that the virus can stay in some parts of survivors’ bodies for as long as nine months (or longer). In Sierra Leone and Liberia, there have been some cases of transmission of the disease by survivors, as well as what seems to be relapse of the disease. But these episodes are extremely rare. Only ten cases of re-emergence have been identified out of a total of 15,000 survivors. However, it is important to maintain adequate surveillance systems in order to identify and treat such cases and avoid further transmission.
Symptoms of Ebola
Early on, symptoms are nonspecific, making it difficult to diagnose.
The disease is often characterized by the sudden onset of fever, feeling weak, muscle pain, headaches, and a 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
Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.
Ebola infections can only be diagnosed definitively in the 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’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.
“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.”
Treating Ebola
No specific treatment or vaccine is yet available for Ebola.
Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure, and treating him or her 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.
MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment center.
An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.
Risk of Ebola Spreading
The risk of Ebola spreading to the US is minimal, but to minimize it even further we need more resources to bring the outbreak under control in West Africa.
Before this outbreak, MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon, and Guinea. In 2007, MSF entirely contained an epidemic of Ebola in Uganda.
I was collecting blood samples from patients. We did not have enough protective equipment to use [and] I developed the same symptoms.
On November 19, 2007, I received laboratory confirmation—I had contracted Ebola.
"MSF came to Bundibugyo and they ran a treatment center. Many patients were cared for. Thank God, I survived. After my recovery, I joined MSF."
It is estimated there have been over 1,800 cases of Ebola, with nearly 1,300 deaths.
The Ebola virus was first associated with an outbreak of 318 cases of a hemorrhagic disease in Zaire (now the Democratic Republic of Congo) 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.
MSF has treated hundreds of people affected by Ebola in Uganda, Republic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon, and Guinea. In 2014, MSF admitted 7,400 people into Ebola management centers.
