BY ALPER ÖZKAN (MSN/PhD)
d_ozkan@ug.bilkent.edu.tr
Like most of you, I knew Ebola only as “that bleedy bat disease” before it made the headlines with the epidemic of last month. Since then, the disease has enjoyed the sort of infamy reserved for the likes of anthrax after the 2001 attacks, and, to be frank, I’m glad that it got its share of the shameless panic-mongering that media coverage of diseases invariably features. Unlike the anthrax attacks, which were treated rapidly and didn’t really pose the danger of an outbreak (anthrax is largely non-transmissible, and the transmissible, cutaneous form is largely harmless), the Ebola epidemic is a topic that is in dire need of public attention—not because we’re at any real risk of infection ourselves, but because the only reason it propagates is that many people in the affected areas live in extreme poverty and need every bit of support they can get from international sources.
Which is why I find it odd that people are making a fuss about the disease itself—worrying about contracting Ebola after the outbreak is kind of like worrying about getting hit by a tsunami after the Haiti disaster, when what you should be doing is supporting the victims. I don’t normally get all worked up about this sort of baseless panic, but somewhere in between the Stanford announcement about how the school would handle an on-campus Ebola outbreak (which, to their credit, they recognize to be about as likely as an on-campus alien invasion) and the honest-to-goodness death cult that venerates the disease, something snapped in me. So this week, I’m going to talk about how Ebola got real lucky and ended up starting a pandemic.
Prion diseases are renowned for their nastiness, and kuru is no exception. Called the laughing sickness, it is a neurodegenerative disorder not unlike mad cow disease, and invariably kills its victim about a year after its symptoms first present themselves. It is endemic to the indigenous tribes of Papua New Guinea, who hold the tradition of eating dead townsfolk to return their life energy back to the tribe—when this practice was discouraged among the inhabitants, the incidence of the disease took a sharp dive. The situation is the same for Ebola: the virus is transmitted only through contact with body fluids, and the simple advice, “Don’t touch the infected,” goes a long way in preventing its spread (Ebola is considered a rather lousy bioterrorism agent for this very reason—it doesn’t transfer readily), but burial customs in the affected areas involve handling the body for long periods of time, which courts disaster. So you have a reason for the spread of the virus, but burial customs don’t exactly change at the drop of a hat, and have probably existed for quite some time—so why didn’t we get a large-scale Ebola outbreak until now? Well, these customs are only the tip of the iceberg. The local populace is war-weary, superstitious and not at all pleased with the healthcare workers trying to assist them. Some even believe that the disease is a weapon in disguise, and that hospitals are tasked with spreading rather than curing it. These hospitals themselves are understaffed and underequipped; the doctors and nurses risk infection during the course of their efforts. Rather than being an instance of an old disease developing a new, deadly persona (as in the case of the Spanish flu during World War I—a legendary pandemic responsible for killing off around 50 to 100 million people), the Ebola pandemic was a result of late action, insufficient funds and wedges driven between the infected and the medical staff. While a miracle cure would certainly be welcome (anti-Ebola drugs and vaccines are now advancing at breakneck speeds, so hopefully this will be the last major outbreak of the disease), what the epidemic really needs is for the international community to do its duty in controlling it—but unfortunately, there are reservations about sending healthcare workers to the affected areas, since they themselves risk infection.
For these of you interested in the nature of the epidemic, and in the efforts undertaken to control it, I recommend the coverage of the outbreak by the journals Nature and Science in their news sections (as well as in their editorials and what have you). For these of you interested in Ebola biology, I recommend Wikipedia, which describes it as a filovirus that occurs naturally in fruit bats (probably) and can spread to other animals such as deer, gorillas and chimpanzees in addition to humans, with bushmeat likely being the main source of animal-to-human infections. The virus replicates in a wide array of cells, especially in the liver, the endothelium and the phagocytes of the immune system, and is found in nearly all bodily fluids this side of the cerebrospinal. As the virus reproduces in the endothelium, it damages blood vessels and causes severe fluid loss; death usually occurs from the latter. Typical care involves helping the patient gain back the fluid and electrolytes he has lost. There is no known vaccine or specific drug against the disease, but a variety of antivirals have been used with some success, and the development of antisense nucleotide and antibody treatments is underway.
For these of you interested in horrific diseases, I recommend the book “1 Litre of Tears” (or the film based on it).
Lastly, I’d like to underline the fact that Ebola is not the only disease that plagues Africa. Malaria, tuberculosis, sleeping sickness, river blindness, leishmaniasis and similar diseases run rampant in the continent—and unlike Ebola, most of these are preventable or treatable. This is why I think that the media coverage of Ebola has been a good thing: it attracts attention to how dismal the situation is in poverty-ridden regions of Africa, and may increase funding for the treatment of not just Ebola, but other widespread epidemics as well. Every little bit helps.