The World Health Organization (WHO) notes, in a website entry dated Sept 22, that this week marks six months since the Ebola outbreak in West Africa was first recognized. Three countries now have epidemic Ebola while two others have had cases but appear to have contained the disease. Over 6,200 people have contracted the viral disease and just over 2,900 have died from it.
It has been six months since Ebola was recognized in Guinea, but the origins of the outbreak date back to Dec. 2013. An article published on Sept. 19 in the New England Journal of Medicine points to a “patient zero” in Meliandou in Guéckédou prefecture dying of the disease sometime in December. A scattering of illnesses in that immediate area occurred until Feb. 2014, when it appears that an infected health care worker was responsible for Ebola illnesses in other communities. From there, the infections began to spread.
Ebola was unknown in West Africa until last December. The initial symptoms of the disease resemble malaria, which is not contagious and is endemic to the area. Guéckédou prefecture could be described as stereotypical location for an Ebola outbreak as it is very rural, with a limited road network and a primitive health care system. Until now, all Ebola outbreaks in Africa have taken place in such locations, including one still continuing in the Democratic Republic of the Congo.
Guéckédou prefecture lies very near the Guinean border with Liberia and with Sierra Leone. The three nation border region has been one of the centers for the outbreak, but the illness has also been brought into most of the cities, including the capitals, of the three countries. Conakry, Monrovia and Freetown have each become their own center of Ebola contagion.
None of the public health agencies or medical aid groups fighting the Ebola epidemic have any experience with the disease in an urban setting. It has never happened before. The poorly funded health care systems of the three countries affected have nearly collapsed under the burden. In a region short on doctors and nurses, 356 health care workers have contracted Ebola and 188 have died, according to the WHO’s Sept. 22 report.
Liberia and Sierra Leone have both issued updates to the data in the WHO report. The five nations reporting Ebola cases to the WHO, including Nigeria and Senegal, have seen 6,249 illnesses and 2,913 Ebola deaths in the last six months. The illness has killed 47 percent of infected patients, but there are several lags in the data reporting system so that death rate could be much higher.
In a Sept. 22 news release, the WHO notes that its staff is projecting 20,000 Ebola infections by early November. To date, the patients are nearly equally divided by sex. Looking at all deaths, the WHO sees a 70 percent mortality rate. That rate does drop, the agency states, when just hospitalized patients are studied. Supportive care seems to reduce mortality significantly.
The spread of the illness is due, in large measure, to the social and cultural mores of the local population, the poor health care systems in all three countries and ineffective control efforts. The WHO does not believe that the virus itself has changed to become more infectious.