By Staff Reporter
The latest outbreak of the lethal disease is very different – worse still, it could mutate into something even more deadly, says Tim Butcher, who knows the infected area of west Africa well
The village is nothing more than a collection of mud-walled huts tasselled with leaf frond roofs. A ”rice larder” protects the communal foodstore, a thatched chamber set high on bare lengths of timber, the bark stripped off to deter rats and other vermin that infest all human settlements hereabouts.
Life in Meliandou is hard but ”S1’’ could have been expected to play his part, growing up to work the rice fields in the annual cycle for survival, learning to cope with seasonal extremes when the Harmattan wind blows in fierce heat from the Sahara before cooling rains arrive around Easter in a tumultuous thundery climax. Or he might have left to try urban life in the sprawl of Conakry, his nation’s capital, two days’ rough road travel off to the west. Instead, he died last December, vomiting, feverous and passing blackened stool. His name was Émile.
There is some debate as to when exactly he passed away. Some say the 6th of the month, some Boxing Day, but what is not debated is that he died from Ebola, the first fatality in an outbreak of the disease that is already the world’s worst.
This status makes him ”S1’’ or ”Serial 1’’ in the eyes of epidemiologists who published a paper on the outbreak in the New England Journal of Medicine. In line with all other Ebola outbreaks the scientists did not have to look far for ”S2’’, the boy’s three-year-old sister who died a few days later, ”S3’’, his mother, ”S4’’, his grandmother, and so on as the viral infection sped through the community claiming the village nurse, ”S5’’, and local midwife, ”S6’’, who took the disease out of the village and to her own community. The spread had begun.
So far, so like other Ebola outbreaks. But the proximity to Meliandou of international borders – due south into Liberia, south west into Sierra Leone – and the nature of those countries – broken by war, hopelessly misgoverned and yet small enough to be covered by transport routes – has given this outbreak uniquely terrifying characteristics.
It is these that make it no exaggeration to say this current outbreak could lead to a health crisis of continental, even global proportions.
We have seen the first inklings of this with health workers in Spain struck down, a panic when a mortally infected Liberian man spent several days in America potentially infecting others. And this fear is going to breed like microbes in a petri dish until the special character of this outbreak is finally recognised and addressed.
It was 1976 when Ebola was first identified in that crucible for so much that is portentous about Africa, the Congo. Then known as Zaire, vials of blood from a sick Belgian nun were sent on ice in an old vacuum flask to a laboratory in Antwerp. One vial broke in transit creating a hazardous soup of melted ice, infected blood and glass shards but the skilled scientists safely recovered an intact vial and began their work.
What they found was new to science. It was a virus but by viral standards it was a whopper, much larger than normal viruses, but very long and very thin, like an unruly filament of hair. It was an example of a filovirus, a family of viral agents that are very dangerous to humans although this one, soon to be named after the Ebola river not far from the dying nun’s mission station, appears to be primus inter pares in terms of lethality.
Fruit bats are suspected of being the natural ”reservoir’’ for the Ebola virus, the animal having evolved to live with it in its system. Every so often – as happened in 1976 – the virus jumps into the human population, either when a person is bitten by an infected bat, or kills and butchers such a bat, or kills and butchers a deer or other animal recently infected by a bat.
Once inside a human the virus invades cells and replicates like fury, spewing out new copies of itself that use the blood system to spread around the body contaminating other cells. For reasons of safety, research into Ebola is far from complete, although it is known it has the ability to hijack the immune system, somehow making the body’s defences turn on themselves.
It hoodwinks blood into clotting where clotting is not needed, for example around the liver, and then it damages the lining of blood vessels to such an extent that infected blood cells, packed with replicated versions of the original virus, can smash their way through like wrecking balls.
With the body’s clotting agents already used up, the tiniest breach in skin membrane leads to heavy bleeding, sometimes from the nose, fingernails or anus, a characteristic that has Ebola categorised as a haemorrhagic fever. Victims die from multiple organ failure as their blood pressure peters away to naught.
Horrible though that is, the positive thing about Ebola from a public health point of view is that the virus has to date been difficult to spread. It has not been dispersed through the air, nor transferred by insect vectors such as mosquitoes, nor carried far in water. If a victim’s infected body fluids are avoided by other humans, or neutralised using agents such as chlorine, the infection chain can be broken.
In crude terms that is what had happened since 1976 in the few dozen known eruptions of Ebola which have all happened in and around the Congo river basin. The spread of the disease has been stopped because either it has wiped out the entire human population, often small and in remote locations, or trained medical personnel, practising barrier nursing techniques, have treated patients safely until they have either died or recovered.
Just like generals who fight the last war, slow to adapt to a changing conflict situation, so world leaders have fallen into the same trap with the Meliandou outbreak. The attitude has been “don’t panic – a few doctors with biohazard gear will sort it out’’. They could not have been more catastrophically wrong.
Now is not the time for finger-pointing about the inadequacies of the world’s response. That must come later. Much more urgent is recognising how dangerously different this outbreak is and changing our response. For a start, this virus appears to be a new strain, cropping up 2,000 miles away from the only previously confirmed instances in the Congo.
Never before has Ebola spread through a significant urban population yet this is what is happening in Freetown, capital of Sierra Leone; Monrovia, capital of Liberia and Conakry, capital of Guinea.
In 2009, I walked across Liberia and Guinea from the Sierra Leone border – the ”hot zone’’ for the current outbreak – and I know from my own experience the poverty of the communities, how porous the frontiers are and how easy it is to reach the cities. I canoed across a river border away from official controls and saw how bush roads take taxi and bus traffic all the way to the big cities in a matter of hours.
And I also know how hopelessly inadequate the governments of both countries are, letting down their sterling yet long-suffering people year after year, regime after regime. Outsiders suffer from an ”illusion of normalcy’’ when applied to cities like Monrovia, the presumption being that it must have normal city-like characteristics. It does not.
It has none of the basics taken for granted in the developed ”north’’: clean water is not widely available, power is in short supply and public health is piecemeal, propped up mostly by hardworking outsiders such as aid workers or missionaries.
Like Freetown, where a cholera outbreak happened two years ago, the authorities in Monrovia have failed to improve squatter camps packed with impoverished people who have no option other than to use the sea in the city centre as their lavatory. Monrovians used to joke about what was found on the beach near the West Point slum. Few are laughing about it any more.
The arrival into these communities of a highly infectious pathogen like Ebola has meant it has reached a near-perfect site for mass replication and, more ominously, mutation.
Virologists have been able to establish that the HIV/Aids epidemic took off only after an original SIV virus jumped from primates to humans to create the forerunner of HIV. But to become a global epidemic the early HIV versions needed a large group of humans in which it could replicate, morph and develop. It found just such a population in the colonial capital of the Congo, Léopoldville, today’s Kinshasa.
Parallels with the current situation in West Africa are alarming, not alarmist: it is a place where tens of thousands of people live cheek by jowl, without decent public health infrastructure, walk the same muddy alleys, use the same open latrines, sleep in the same rooms as people who have already died of Ebola leaving infected traces of their bodily fluids.
These are the realities behind the projected figures released by the Centers for Disease Control and Prevention, America’s leading public health body, which suggest 1.4 million people could be infected by Ebola within three months of today.
They are behind the astonishing warning from Jim Yong Kim, president of the World Bank, issued this week that unless the outbreak is contained and stopped, ”the future of not only West Africa but perhaps even Africa is at stake’’.
Even getting the message out there to people distrustful of central government is not easy. In Monrovia, there have been riots by mobs spooked at the sight of health workers dressed like spacemen taking away corpses dumped on the streets. Back over the border in Guinea, not far from Meliandou, seven members of a team monitoring the spread of the disease were beaten to death.
The most worrying aspect is the longer the virus continues spreading in these communities, the greater the likelihood of a mutation that will create an even more pathogenic virus, one that might even be transferred through the air. This is not the stuff of a fiction writers, this is the sort of thing currently being talked about by virologists.
The sequence that began with Émile has already passed Serial 3,800. World leaders need to wake up and fight today’s war, not yesterday’s, to stop that number growing exponentially.