The current Ebola outbreak in Sierra Leone, Guinea, and Liberia has lasted almost six months. Small progress has been made in terms of control, but yesterday’s modest advance often appears offset by tomorrow’s new catastrophe.
The best news is from Nigeria, which saw a few cases related to an infected traveler. There the epidemic appears to have been halted although the recent announcement of two additional cases calls into question even this small claim. Now there is news of a second, probably unrelated group of up to 13 Ebola cases in Gara, a village in the Democratic Republic of the Congo. Gara is almost 2,000 miles away from Liberia and initial investigation has found no epidemiologic links between the Gara cases and those seen over the last 5-plus months in Liberia, Sierra Leone, and Guinea.
The appearance of Ebola in the Democratic Republic of the Congo, or DR-Congo (not to be confused with the Republic of the Congo, a separate country which sits along the northwest border of DR-Congo) is not a surprise. This is where Ebola first was identified in 1976; the 2014 cases represent the seventh time a new cluster of disease has been seen in this country. Furthermore, the Republic of the Congo, sometimes referred to simply as the Congo, itself has seen three smallish epidemics over the last 38 years.
All of this Ebola activity raises a number of questions, each of them alarming. Is something happening in Africa that is new, along the lines of various Armageddon-like predictions through the years, from the Hot Zone forward, a calamitous and permanent perturbation of the delicate balance between man, animals, and ecosystem, a tipping point, a point of no return? Though this sort of super-simple prognosticating sells lots of books, this scenario is quite doubtful—scary as Ebola feels right now, we are still talking about a relatively slow-moving (2,500 cases in six months) infection that requires intimate contact to transmit. Plus, as cruel as Homo sapiens is to the environment, the small villages such as Gara, where the disease often begins, are hardly places where McDonald’s, Big Oil, and Walmart are turning trees to parking lots.
Maybe it is really much worse—but they (whoever they are) simply aren’t telling us. Of course a grand conspiracy always feels good; it is strangely assuring in its tidiness and of course in the post-Snowden era of Totalitarian Information Awareness, anything seems game. But Ebola is far too fussy a virus to spread purposely and the disease itself makes far too dramatic a splash to creep along as some sleeper cell-type killer. So though I am all for paranoia as part of a healthy daily regimen of exercise and moderate eating, this one is just too far out there.
Perhaps we simply are diagnosing cases that always have been present. This theory makes some sense given that on the heels of the current Ebola outbreak have come better, cheaper, simpler tests as well as more inclination to consider the diagnosis. Though this almost certainly has provided a numeric worsening of case counts in the Sierra Leone-Liberia-Guinea epidemic, as various deaths and illnesses that once would have been met with a shrug now receive a highly accurate diagnostic test, it is doubtful this is occurring in the far-away village of Gara, far from the relentless maw of modern diagnostic approaches.
No, what this second 2014 Ebola epidemic likely represents yet again is the fact many countries simply do not have the health-care dollars to deal with this sort (or just about any sort) of infectious disease. The infrastructure does not exist. And infrastructure is not just masks and gowns, but rules about when to use masks and gowns, trucks to bring new supplies of masks and gowns, a stockroom guy to keep track of supplies and order when things are low, a supplier with supplies, highways that are paved and dependable so the masks and gowns can get from here to there, cash on hand to keep equipment moving and on and on—all of it is missing.
The health-care volunteers working in the 2014 hot zone(s) are true heroes, persons of remarkable strength and humanity. Once this all settles, they, like returning soldiers or reigning Super Bowl champions, should be celebrated along Broadway in a too-glitzy parade.
But what they are being asked to do is doomed to fail—at least in the long haul. It is the equivalent of having a group of firemen take on a fire with no access to piped-in water, no hose, no ladder, a single dull ax, and no fire-retardant garb. Just a few rusting pails and a nearby lake.
So their heroism is that of the line of workers moving the pail person-to-person and slowly extinguishing the fire even as they risk their own lives to save others. But all of this work, all of this courage, all of this blind commitment to each other, changes nothing at all regarding the next time Ebola comes—and come again, it surely will. For the news from the Democratic Republic of the Congo is nothing if not the ghost from the past reminding not just that country, or that continent, but the world that only a long-term strategy, aka an actual health care system, can successfully control this infection. That includes supplies and roads and buildings that function as well as smart and able people to provide the care.
The Ebola virus outbreaks of 2014 have shown us that Ebola, like HIV and many other infections with effective preventions, containments, and treatments, will remain uncontrolled as long as the world allows it. As such, it reminds us that health is a basic human right and its maintenance is not just a public health imperative—but a moral one.
