So far, the Ebola virus disease has primarily afflicted people in African nations. Although Ebola is unique, it is no anomaly. Ebola represents a dramatic version of the infectious disease phenomenon.
All infectious diseases come from somewhere, no matter how strange or unique. The vast majority have come from other animals, through a “zoonosis,” or an animal infection that’s transmissible to humans. The virus, bacteria or protozoa may inhabit harmlessly in another animal, such as a rat, bird or ape, but in a human, it could cause illness or death. When the disease finds hospitable conditions within a human, it will replicate quickly and the host will feel the effects.
Small pox for example, is not a zoonosis. It is caused by the variola virus, which only infects humans. The small pox virus can’t “hide,” because it cannot reside or reproduce anywhere but inside the human body. Therefore, we were able to isolate the disease and create a vaccine.
On the other hand, zoonotic pathogens like Ebola can “hide.” The disease may live harmlessly in another species for years, decades or longer before it is introduced to a human host.
The documented history of Ebola begins in 1976 and continues to the present, spanning the width of Africa. On average the fatality rate ranges from 60-75 percent. Ebola symptoms can take up to 21 days to develop after exposure, which is why the standard quarantine time is three weeks.
Given the widely publicized errors of healthcare officials in the United States, some are wondering if other large countries are doing enough to prepare an Ebola outbreak. China, which has a wealth of experience tackling contagious diseases, is taking steps to monitor and treat the disease. But are they better prepared to avoid some of the mistakes that occurred in the U.S?
China and infectious diseases
SARS (Severe Acute Respiratory Syndrome): Akin to Ebola, people were exposed to SARS through an intermediary species. The first case was confirmed in November 2002 and continued to spread across southern China through January 2003.
The epidemic went unnoticed outside the Chinese mainland until an infected traveler from Guangzhou stayed at a Hong Kong hotel, infecting a number of other guests. From there, the disease traveled with them to Singapore, Vietnam, Canada and elsewhere.
From mid-January to April 2003, the WHO led a battle against SARS in 29 countries. During this time, new systems for rapid global sharing of scientific and medical information were invented; however, China did not accurately report the severity of the situation. Government officials at both the national and local level underreported the number of SARS-infected patients.
Finally, in April 2003, China changed course. The Health Minister and Beijing Mayor were removed from their posts and over RMB2 billion was allocated to combat the spread of the disease. Radical measures were taken to quarantine people who had contracted the disease, enabling China to halt the epidemic.
Although poorly handled, SARS served as a wake-up call, and China overhauled their plans for dealing with threats of this caliber, organizing its own center for disease Control CDC.
Vastly improved systems for disease prevention and control included the establishment of national surveillance systems, protocols for health information management, and increased education on hygiene and hand washing.
H1N1: China’s response to the H1N1 pandemic was characterized by an aggressive containment approach that sought to establish barriers against the spread of the disease. Hospitals in Hong Kong, Guangzhou, Shanghai and Beijing all had the latest infection control equipment in place, built to contain the SARS outbreak.
H7N9: China’s reaction to H7N9 was also markedly different than its handling of SARS. China immediately notified the World Health Organization of a potential new virus and began carefully tracking all potential infections. Each new case was reported in state media outlets. Those who had come in contact with infected patients were quarantined, tested or both. As it became clear the disease was a variation of bird flu, the government began cracking down on potential breeding grounds by sacrificing poultry. Chinese scientists also worked with the U.S. Centers for Disease Control and Prevention to upload a sequence of the virus to a public database, where scientists from around the world could access the data. Instead of pleading with China to be more transparent, the WHO expressed approval of China’s response.
Ebola: “After SARS, China doesn’t want to be in the same situation again,” said Ben Cowling, an associate professor of infectious disease epidemiology at the University of Hong Kong’s School of Public Health. “In the last 10 years, they’ve built up massive capacity to respond to this kind of situation, to avoid damage to public health and prevent the socio-economic problems that arise with it.”
In Guangdong, Chinese authorities tracked 8,672 visitors from Ebola-hit countries in the two months through Oct. 21, a government release said.
According to the state-controlled broadcaster China Central Television, Guangdong screens travelers arriving from Guinea, Sierra Leone and Liberia, monitoring them for the virus’s incubation period of 21 days. China’s health ministry issued its Ebola control plan in July, laying out procedures for screening citizens, reporting cases and controlling potential infections.
China is now prepared and efficient in its response to potential threats. Recently China announced new or improved methods for controlling the spread of infectious diseases:
• The National Health and Family Planning Commission distributed a protocol for diagnosis, treatment and fast response.
• Hospitals have been assigned as specialized entities to treat suspected Ebola patients
• Customs has strengthened its checking system
• All Ebola-related experiments without government approval are banned
Through 2013 the World Health Organization (WHO) reported a total of 1,716 cases in 24 outbreaks. Centered in Guinea, Sierra Leone and Liberia, the current outbreak in West Africa is the by far the largest in history, with 14,413 reported cases resulting in 5,504 deaths (as of November 11, 2014). The Center for Disease Control and Prevention estimates that there will be 1.4 million cumulative cases and 980,000 deaths by this February 1, almost 14 percent of the total population of the infected areas.
Ebola in the U.S.
At this point, there has been one death and four confirmed cases of Ebola in the United States, not including patients brought to the U.S. for treatment. The U.S.’s response to its first Ebola patient, Thomas Duncan, surfaced many issues regarding infectious disease management. Because the majority of American hospitals and airports have not prepared for outbreaks, a number of mistakes were made.
• Airport screenings: Duncan was traveling from the Ebola-ravaged city of Monrovia to Dallas but was not flagged at any point.
• Follow-up: Potentially infectious patients, people coming to the U.S. from high-risk areas, should be monitored.
• Travel history: When Duncan arrived at the hospital with common ailments, nurses did not inquire about recent travel and therefore did not diagnose correctly.
• Lack of tracking: The two nurses infected by Duncan traveled freely after exposure.
• Slow reaction time: The ambulance used to transport Duncan to his second hospital visit, after Ebola was suspected, continued in circulation for 48 hours.
In the U.S. we rarely deal with highly infectious diseases, so in response to Ebola, health officials failed to follow basic public health practices, such as the use of protective gear and the proper disposal of patient waste. Most of the major public health debacles that have occurred in the United States happened because of unpreparedness. However, I believe that any outbreak in a developed country such as the U.S., can be properly managed with our infrastructure to isolate and treat the sick.
Since Ebola was originally discovered in 1976, there has never been a larger, more deadly or more persistent outbreak. However, the Ebola outbreak is “fragile” in that it has a short incubation period and can only be passed by direct contact, making it more difficult to spread than other infectious diseases. Every time Ebola replicates, there is a chance that it will mutate and become more dangerous. Even though the Ebola outbreak does not appear to be a major problem for developed countries, there should be a large-scale international effort to stop the disease in Africa before new strains of the virus pose yet another threat to the ongoing efforts to eradicate the lethal disease.