Ebola was once thought to be a intermittent scourge limited to the bush of Central Africa. The virus would jump from its animal hosts to a nearby community eating those animals, but these outbreaks flared up and quickly “burned out,” killing about 1,600 people over the nearly four decades since the first case was identified in a Sudanese factory worker in 1976.
But now, with easier travel and more permeable borders, an Ebola outbreak has spread from rural villages to populous hubs where it has never been before, like Guinea’s coastal capital of Conakry, a city of some 2 million, where it is likely to become endemic. “Before this outbreak, Ebola was not known to be present in Sierra Leone, in Liberia, in Conakry. But it is now present there,” says Stephen Morrison, the director of the Global Health Policy Center at the Center for Strategic and International Studies. “If it recedes, it does not mean it is not present. You will see more outbreaks. It will be recurrent.”
It’s spreading faster and farther than ever before. One American who contracted the virus, Patrick Sawyer, 40, would have boarded a plane to Minnesota had he not died in Lagos. He had flown from Liberia to Ghana to Togo before arriving at Nigeria’s largest city. That’s five countries in one trip, with countless new pathways to infection along the route. Modern borders are as porous as the number of flights, goods and people that cross them, which is to say they are extremely permeable. Viruses are along for the ride, spreading farther than they ever have.
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On August 2, an American infected with the virus was flown to the U.S. His transport was delicate—staff covered head to toe in nonporous hazmat suits placed the patient in an isolation pod for the flight. From the airport, he was transferred to Emory University in Atlanta, which has one of the country’s four specially equipped isolation wards and staff specifically trained to handle highly infectious disease. A second American patient is expected to be similarly flown from Africa to Atlanta on August 5.
The two Americans, Dr. Kent Brantly and Nancy Writebol, were both health care workers who had been volunteering in Africa. Somehow, despite wearing full hazmat suits while working with Ebola patients, they contracted the disease that, as of this writing, has killed a suspected 826 people in four countries over the past six months in the most deadly Ebola outbreak in history.
And yet, despite much hyperventilating on network news and social media about the transport of these Ebola victims, Brantly and Writebol will almost certainly not bring this deadly plague to America. And even if they did, the consequences would be minor. “If [Ebola] were to appear in the U.S., it would stop very rapidly in its tracks. The whole dynamic of transmission of this virus doesn’t exist here,” says Ian Lipkin, the epidemiologist and Columbia University professor credited for identifying West Nile virus as the cause of a 1999 encephalitis epidemic in New York City.
Unlike H1N1 swine flu, which killed as many as 575,400 people across 74 countries during a 2009 pandemic, Ebola is not airborne. It is spread only by bodily fluids. By the time people become contagious, they are extremely ill and would quickly come under medical care (at least in the U.S.). Also, with a “good culture of infection control, blood and bodily fluids would be handled in the correct manner,” says Dr. Amesh Adalja, an infectious disease physician at the University of Pittsburgh who analyzes threats and response plans for hospitals. Ebola would be contained like Lassa fever, another virally transmitted hemorrhagic fever, which has reached the U.K. eight times since 1980 and has been snuffed out without anyone becoming infected or the public even paying much mind.
News about the spread of Ebola, on the other hand, could never be buried. Nightmarish images of blood-spewing people dying horrible deaths while their internal organs are destroyed have been seared into our brains. We already have a picture of what an outbreak in the U.S. would look like: The 1995 film Outbreak imagined a monkey-hosted, Ebola-like virus spreading from a lab in California and prompting martial law. Plus, as we learned from Richard Preston’s 1994 best-selling nonfiction thriller The Hot Zone, a simple headache could be the first symptom of something much graver, and deadlier, like Ebola. Mass paranoia and gore-panic can be ignited at the mere mention of the disease.
One reason Ebola inspires so much public fear is that it is, right now, essentially untreatable. And yet a vaccine could be ready in as little as two years, according to Heinz Feldmann of the U.S. National Institute of Allergy and Infectious Diseases, a branch of the National Institutes of Health. If only the disease could generate as much funding and political will as it does panic.
Today, several vaccines and drugs are on the edge of becoming useful—they have shown promise in animal studies, and some are so far along that human clinical trials could probably have begun at any time in the past several years, Feldmann says. One promising vaccine he helped develop was shown in lab tests to fully protect rhesus macaques against contracting Ebola-Zaire, the strain now tearing through Central and West Africa. It even worked as a treatment—it saved four out of eight animals infected with the virus. For an infection that can sometimes reach a kill rate in humans of around 90 percent, those are excellent results.
“What is frustrating is that we have another outbreak where potentially none of these treatment options are being used,” Feldmann says. “The thinking has to change now. We can’t just wait and wait and wait. Some of these vaccines have been stuck in this position for 10 years.”
The lack of funding is largely due to a lack of interest shown by pharmaceutical companies, for whom a rural, relatively low-kill African disease presents no lucrative market. Ebola research did gain some financial footing after anthrax attacks sent through the mail killed five and put the country on a bioterror alert in 2001. Ebola looked like a prime candidate for a future attack: Some strains have killed 90 percent of the people infected. While it can be transmitted only via bodily fluids, “once it hits, there are a lot of bodily fluids,” says Morrison. The virus causes hemorrhagic fever, which makes the blood unable to clot wherever the virus’s minute infectious agents, called virons, tear through tissue. In the worst cases, blood gushes from all orifices, which is part of why the U.S. Centers for Disease Control and Prevention (CDC) notes that the disease would likely prompt “public panic and social disruption.”
The U.S. has classified Ebola a “Category A” potential bioterror agent, listed at the highest priority level. Millions of federal dollars were put toward developing countermeasures should the virus be used as a bioterrorism agent. (In 2013, the National Institute of Allergy and Infectious Diseases reported spending $42.49 million on Ebola research.) But that hasn’t proved enough to bring even a single promising vaccine to the market. Feldmann frets that after this outbreak, the sense of threat and urgency surrounding Ebola will fade, as will the prospects for advancing Ebola pharmaceuticals. “My biggest worry is that after this outbreak is over, that everyone will go back to normal. We have to make sure that doesn’t happen.”
Were it not for a lack of funding, the death toll of this Ebola outbreak could have been much lower. “The notion that we should sit by idly while thousands die in other parts of the world is unconscionable,” Lipkin says.
Into the Wild
But what may be even more important than finding a cure for Ebola—both for the countries where it is endemic and those outside of Africa—is developing a way to prevent the next, currently unknown infectious disease from emerging from the wild. And that would take a truly global approach.
Public health experts know Ebola outbreaks begin in wild animals and jump to humans who eat them or come into contact with their feces, urine or saliva. Ebola doesn’t harm every animal host in infects; it thrives in certain animals—the “reservoir” species—for years between human outbreaks. Though no one knows for sure, bats are considered the most likely reservoir species for the Ebola virus. Bats are eaten in the West African regions where Ebola has recently erupted, as are chimpanzees, which may come into contact with fruit eaten by the bats, or bat waste.
Ebola may not pose as great a trans-Atlantic threat as H1N1, SARS or MERS, but all of them share similar zoonotic origins: They all jumped from animals to humans. SARS, it turns out, made the leap from bats as well. The 2003 SARS pandemic, which killed 774 and infected 8,098 people worldwide, emerged in China, where wildlife species were brought to urban live animal markets from regions all over the country. Scientists discovered that bats were the likely source of SARS and were transmitting it to civets (a small, farmed mammal sometimes eaten) in live animal markets in southern China.
Butchering and handling the meat in those crowded markets spread the pathogen further. Soon the government banned the sale of civets. Bats technically should not have been present in the markets anyway, based on wildlife protection laws enacted in 1989, but because there is a big demand for wildlife species in the area, there was (and still are) underground wildlife markets in various parts of China. The ongoing MERS outbreak had similar bat-related origins in the Middle East.
The link between wildlife spillover and the threat posed by major global pandemics are a growing field of inquiry, and the United States Agency for International Development (USAID) has established a dedicated Emerging Pandemic Threats (EPT) consortium of experts designed to establish an early-warning system for those connections. “We wanted to find a way to get ahead of the curve—to get beyond the traditional model of waiting until there’s an outbreak, and trying to respond, contain and trace it back to its source,” says Jonathan Epstein, an epidemiologist with the nonprofit EcoHealth Alliance, which is part of the USAID consortium. EPT works with local governments to identify viruses in wildlife hosts that have the potential to cause pandemics, as well as to conduct surveillance in high-risk activities, like wildlife markets, that bring people or livestock in closer contact with wildlife and increase the risk of viral spillover.