EbolaEbola outbreak is cause for concern but there’s hope yet

By Allen Cheng

Published 5 August 2014

The current outbreak of Ebola in West Africa is now the largest recorded since the virus was first described in 1976. That this outbreak is not under control after more than four months is cause for great concern, as are the way the virus is spreading and apparent breaches in infection control. The epidemic was recognized at the outset as being unusual. It started in a region that borders Guinea, Sierra Leone and Liberia, far from where previous outbreaks had been reported. And cases spread early to a number of areas in all three countries. There are also some positive signs. Because the incubation period (the delay between contact and becoming unwell) is up to twenty-one days, current infections represent the state of control measures over that period. So the results of more recent control efforts are yet to be reflected in case numbers. The good news is that it does appear the outbreak is coming under control in some areas, particularly in Guinea where the first cases were reported.

The current outbreak of Ebola in West Africa is now the largest recorded since the virus was first described in 1976. That this outbreak is not under control after more than four months is cause for great concern, as are the way the virus is spreading and apparent breaches in infection control.

The epidemic was recognized at the outset as being unusual. It started in a region that borders Guinea, Sierra Leone and Liberia, far from where previous outbreaks had been reported. And cases spread early to a number of areas in all three countries.

New cases reported in recent weeks are causing already limited resources and health-care workers to be more thinly spread, but the tenacity of local health-care workers coupled with international support will hopefully see the end of the outbreak sooner rather than later.

Some reasons for concern
A recent development that is cause for most concern is the identification of a person who died in Lagos, Nigeria, after flying in from Liberia. The spread of Ebola to this major city of over twenty million people would represent a significant event if other cases emerge.

The case highlights the danger posed by the virus’ 21-day incubation period, which makes border screening unlikely to be effective. The futility of this measure is exacerbated by the fact that early symptoms and signs are similar to other common infections, such as malaria. This is also illustrated by reports of suspected cases in Hong Kong and the United Kingdom that have turned out to be false alarms.

Also worrying are reports of health-care workers becoming infected, and the death of a doctor.

In an Ebola outbreak, three groups of people are typically most at risk — the family and other household contacts of the patient, health-care workers, and funeral attendants and others who deal with the bodies of the dead.

A key measure to reduce the virus’ spread is to remove infected people from their families (because ongoing exposure could endanger others) to treatment centers where further measures to prevent spread can be implemented. Infection of health-care workers suggests these preventive measures may not be as tight as they should be.