• The message in the Ebola epidemic


    A brief story from the Agence France-Presse (AFP) wire caught my attention earlier this week: Peter Piot, a Belgian doctor who was one of the “discoverers” of the Ebola virus in 1976, described the circumstances of the epidemic rapidly spreading through West Africa as a ‘perfect storm.’

    Piot’s comments followed an uncanny admission by the World Health Organization (WHO) earlier in the month that the Ebola spread—which the WHO has sought to downplay by repeatedly admonishing the media, until now, to refer to it as an “outbreak” instead of as an epidemic—is almost certainly larger than the 2,600 cases reported so far, perhaps “by a very considerable margin.”

    The ‘perfect storm’ is that the illness, which has so far caused more than 1,400 deaths by the official count, is spreading in a region uniquely ill equipped to manage it. The two most affected countries, Liberia and Sierra Leone, have yet to recover from years of civil conflict; parts of two other countries where cases have begun to appear, Nigeria and the Democratic Republic of the Congo, are similarly affected by armed uprisings. In all the countries affected, including comparatively peaceful Guinea, public health facilities and management are spotty at best, and most residents have no access to health care at all, or if they do, receive inadequate care.

    Large parts of the population affected by Ebola are in outlying areas that are difficult to reach because of poor national infrastructures. Piot points out that the populations are deeply mistrustful of authorities as well, and that many cases of Ebola are probably not being reported.

    If all that sounds a little uncomfortably familiar, there is probably good reason for concern. The Philippines is practically a cosmopolitan wonderland compared to a country like Sierra Leone, but many of the same obstacles to dealing with a major health crisis exist. The public health system is woefully under-funded and under-manned, and if other kinds of calamities of recent years are any sort of guide, the chances that an epidemic would be met by a timely, coordinated government response seem uncertain.

    Of course, it is extremely unlikely the Philippines will have to deal with an outbreak of Ebola. It is a nasty illness but one that does not spread from person to person particularly easily, requiring direct physical contact with infected persons or contaminated bed linens, clothing, or other objects. Spend an hour in a room with a gravely ill Ebola sufferer and you probably will not become ill; spend an hour in bed with one, and you probably will.

    Despite the attention given to the epidemic, there is actually little chance of it becoming a pandemic. That’s the good news. The bad news is that there are much more common illnesses that have a very good chance of becoming a pandemic, and because they are common, we might not realize we are in the midst of an apocalypse until it is too late.

    The Spanish Flu of 1918-1919 was the H1N1 flu virus, which is not at all rare, spreads easily from person to person through the air, and can be transmitted between humans and animals. It began in the spring of 1918 in Europe—the best evidence suggests it was brought there by Chinese laborers put to work by the Allies in the last months of World War I, although the first officially recorded cases of it were in the US—and within two months appeared on every continent, in an age in which air travel did not exist. The disease did most of its damage within five months; within a year, by which time it had run its course and mutated to much less virulent forms, it killed between 50 million and 100 million, or somewhere between 3 and 5 percent of the world’s population. Here in the Philippines, there were more than 65,000 deaths recorded on Luzon alone between October and December 1918, with an unknown number throughout the rest of the country. If the Spanish Flu happened today, that figure would be closer to 640,000, out of a worldwide total of between 200 million and 350 million deaths.

    It will happen again; viruses with the potential to cause pandemics are evolving faster than medical science can keep up with them, and the high mobility of the human population means that once an infection takes hold, it will spread at lightning speed. Convincing policymakers, businesses, and the population at large to prepare to face this sort of calamity is another matter, which is why we might actually be thankful for crises like the Ebola epidemic, as grim as it is for the populations afflicted by it, for providing a small-scale object lesson.

    One of the biggest concerns for the West African countries, which are among the world’s poorest, is the huge economic toll the Ebola epidemic is taking; tourism, a major source of income, has completely dried up, and virtually all of the already-limited export business for the three most affected countries, Liberia, Sierra Leone, and Guinea, has also ground to a halt for fear of spreading the disease to other parts of the world.

    Restrictions on peoples’ movements, either imposed by the government to try to halt the spread of the disease or self-imposed by the people themselves out of fear, are wreaking havoc on local businesses. And of course, there are the direct costs of fighting the epidemic, some but not all of which are being borne by the international community.

    The nice thing about contingency plans is that they’re only harmful if they don’t exist. When even a relatively mild health crisis can push this country’s capabilities to the limit and beyond—the dengue fever outbreak of two years ago is a perfect example—responding to the reminder that a crisis like the Ebola epidemic provides with “let’s hope for the best” is probably not the best answer.



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    1 Comment

    1. Ruben V. Calip on

      Thank you for very well written warnings. I hope our government officials will heed your suggestions.