Opinion

Ebola Outbreak: This Is Just the Prequel

Pay attention, for West Africa's crisis is the first of many we'll have to deal with.

By Crawford Kilian 31 Jul 2014 | TheTyee.ca

Crawford Kilian is a contributing editor of The Tyee.

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Ebola: a harbinger of future outbreaks and a test of how well Canada will do against worse infections. Photo: CDC.

The other day, Victoria doctor Azaria Marthyman came home from a stint at a hospital in Liberia and put himself in voluntary quarantine. He'd been working with a medical missionary group, Samaritan's Purse, as the West African Ebola outbreak worsened. Two of his American colleagues had come down with Ebola. While Dr. Marthyman had no symptoms, he wasn't taking any chances of passing Ebola on to others.

It was a sensible precaution in an age of global travel. Ebola is not, in itself, a serious threat outside West Africa. But it's a harbinger of future outbreaks and a test of how well Canada will do against worse infections.

We've already had a couple of imported-disease scares this year. Last winter, a Red Deer nurse came home to Canada from a visit to China and died here of H5N1 avian flu. And in the early stages of the current Ebola outbreak, a Canadian mining engineer came home from Liberia with a suspicious fever, giving Saskatoon an anxious day or two.

Ebola is a minor disease. On a typical day, malaria kills more people than Ebola has killed (around 2,000) since it was first identified back in 1976. But Ebola is in the news because it's a classic "McGuffin," the plot gimmick for an exciting story.

Malaria may sicken and kill far more people around the world, but we've developed psychological immunity to it. Ebola gets past our defences: it may make you bleed from all your orifices, it's most contagious when people care for the victim or the corpse, and it can kill anywhere up to 90 per cent of the people it infects. 

The present outbreak, beginning early this year, gave us an opening hook: the small beginning. In an obscure corner of an obscure country, a disease had shown up where it had no business being. But it was so lethal that if it spread countless people would be at risk. So Ebola raised the stakes, and in any worthy story high stakes are important.

A story is also anecdotal evidence for a particular view of the world: that cheaters never prosper, that the good guy gets the girl, that our side is always victorious. Sometimes we'll cling to that view even if it costs us our lives. For most of us in the west, Ebola is anecdotal evidence for the superiority of western medicine and public health principles.

For many West Africans, however, Ebola is anecdotal evidence that the west and their own ruling elites have launched another attack on them. After all, with centuries of slavery and economic exploitation to look back on, Africans can be forgiven for seeing Ebola as still more exploitation -- if not directly by westerners, then by their own western-oriented government officials. And they have their own cultural norms for health issues and treatment of the dead.

So when families with machetes invade hospitals to kidnap their ailing relatives, and young men throw stones at ambulances, they do so to try to maintain their values and therefore their identities. They are so alienated from their governments that Liberia's president and other West African officials have trouble persuading them that Ebola is a real disease instead of a scam -- like environmentalists arguing with global-warming deniers. Each side has its own story, and is sticking to it.

Tension racheting

A suspenseful plot involves a series of increasingly serious problems with unforeseeable outcomes. So we watched Ebola arise in eastern Guinea, then turn up in Conakry. Then Liberia started reporting cases. Sierra Leone seemed mysteriously exempt, but Ebola turned up there as well, and now has more cases than anyone else.

The threat to healthcare workers ratcheted up the tension: caregivers armoured themselves like warriors, and like warriors they fell anyway. Some fled their hospitals, or went on strike, or endured rock-throwing mobs. In the last few days Liberia lost its senior doctor, Samuel Brisbane, to Ebola, and Sierra Leone's lone virologist, Sheik Umar Khan, died of it after saving scores of victims.

The stakes rose again when a Liberian-American official named Patrick Sawyer caught a plane to Lagos, Nigeria, not long after his sister had died of Ebola. By the time he landed he was seriously ill, and in a couple of days he was dead.

The present hot zone is a small, poor country. Nigeria is big. If Ebola were to get into the 20+ million residents of Lagos, it might become unstoppable.

With vast oil wealth and equally vast poverty, Nigeria would undergo a severe test of its social values -- and just at a time when it has trouble enough. In the same week that Sawyer died, so did 110 people in a provincial bombing, apparently an assassination attempt against a local official. Meanwhile, Boko Haram rules in the northeast. 

Outbreaks can even cripple the healthy

That's what always worries me about any outbreak: the harm it does to those who don't catch whatever disease it might be. They lose income, and they often lose what little faith they have in the ability of their government to deal with the problem. The local politicians, like those in West Africa, just insult one another and create still more distrust in government.

West Africa is already feeling the economic impact of Ebola. Two major regional airlines have simply stopped into Sierra Leone, Guinea, and Liberia. Liberia has partially sealed its border, mostly to try to stop travel in the backwoods, where people routinely cross it to shop and trade.

The rest of the world feels the impact too. International humanitarian agencies have to get out their begging bowls for yet another Good Lost Cause; they know relief efforts will be underfunded and the problem left to fester: violence, the loss of social capital, sick and malnourished kids stunted for life, demoralized communities, and still more outbreaks of opportunistic infection exploiting the problem.

An insurance policy

But the outbreak is not going to spread around the world the way H1N1 influenza did in 2009. Ebola, like the more exotic bird flus, is actually hard to catch. It requires direct physical contact with a patient's bodily fluids, or items like bedsheets containing such fluids. It has tended to spread in African cultures that value "bush meat" like apes and bats that carry the virus. And if those cultures also value physically touching the bodies of their dead as part of funeral rituals, people are at risk.

In North America, most people can barely bring themselves to look at dead people, let alone touch them. Nor is bush meat a delicacy.

Governments around the world now have "Ebola jitters"; from Hong Kong to North Caroline, they've been testing for the disease (and getting only negative results). This is a good training experience, like the MERS cases that arrived from Saudi Arabia earlier this year. If a genuine Ebola case arrives in some distant airport, officials may get a rush of adrenaline, but they'll likely have the case in isolation within minutes. Even the false alarms will be instructive.

Equipped with such experience, countries around the world will be better prepared for the inevitable outbreaks to come. Perhaps the likeliest is yet another variation of influenza, but outbreaks of completely new diseases can't be ruled out.

As we saw in the 2003-04 SARS outbreak, Canada is highly vulnerable to such outbreaks. SARS taught us to be alert to such threats. Similarly, the first H5N1 back in 1997 led Hong Kong to set up the Centre for Health Protection, a model for both good disease surveillance and superb health communication.

Canadian-trained health experts are working around the world, from Margaret Chan, director of the World Health Organization, to any number of national officials. One way we might contribute to smothering future outbreaks would be to train still more promising African, Asian, and Latin American healthcare workers. Quite apart from the goodwill this would earn us, it would be an insurance policy against some emerging disease that might be as deadly as Ebola but as contagious as seasonal flu.

And that would be a happier ending than we are likely to see with the current Ebola story.  [Tyee]

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