The global health system was completely unprepared when the 2014 Ebola outbreak began, according to a newly published report by a panel of experts from Harvard and the London School of Hygiene and Tropical Medicine.
Worse, the authors say, is that those failures exposed how unready that system is to deal with any emerging viral threats.
As Peter Piot, one of the report’s main authors said on a Lancet podcast, “we will always have emerging infections … and as we’ve seen in West Africa, things can get out of hand with global implications.”
Piot, the director of the London School of Hygiene and Tropical Medicine (LSHTM), knows what dealing with a completely unknown virus is like. As a 27-year-old doctor in 1976, he was one of the first to examine the Ebola virus. After infecting a Flemish nun, the virus was carried in a thermos to Europe, where Piot got a chance to try to identify the strange pathogen.
After a harrowing experience with the virus in the lab, Piot left his pregnant wife in Belgium and set off for the Congo, then called Zaire, to track down the source of the illness that had devastated a small village called Yambuku and the surrounding area. He joined researchers from around the world on a terrifying hunt for the origin of the disease.
Piot wrote about the experience in his book “No Time to Lose: A Life in Pursuit of Deadly Viruses.” Using photos from the CDC’s Public Health Image Library, we’ve illustrated the team’s expeditions into the Congo.
Immediately upon arrival, Piot was swept through the airport -- avoiding customs, because his passport wasn't valid -- and rushed to meet the others who planned to track down the virus' source. He's the third from the left in the middle row here, wearing the colourful shirt.
Their mission was in Yambuku, 700 miles northeast. Stories of birds dropping out of the sky, sick with fever, and of human bodies by the roadsides had terrified pilots who at first refused to fly the team to the closest airfield in Bumba, a town of 10,000 on the edge of the epidemic zone.
After some cajoling, pilots agreed to drop the team and their Land Rover off if they could immediately depart for safety. Hundreds of scared locals surrounded the plane upon arrival, hoping for a way out, but military police beat them back so the researchers could unload.
Piot says that by the time they left for Yambuku, 'my natural scepticism began to fall away, replaced by doom.' He was convinced by 'the evident fear of the pilots and the townspeople of Bumba and their desperate attempts to flee the town.'
The roads between Bumba and Yambuku were almost impossible to use, 'barely more than a sinkhole of mud and water, with entire sections washed away by the torrential equatorial rains.'
Finally in Yambuku, they found the mission and hospital. The nuns had tried to shut everything down and had posted a sign around the guesthouse they were sleeping in that warned 'anybody who passes this fence will die.'
They set out to search nearby villages for victims of the disease. Some were untouched, while others had seen entire families wiped out.
Many of the tiniest villages had built barricades at their entrances, setting up a quarantine system -- something village elders had learned to do when smallpox epidemics had torn through the region in the past.
As Piot and another doctor examined an infected couple in one small hamlet, the man died as they drew blood from his wife. Afraid that locals might think they were responsible, they departed quickly, leaving gloves and explaining that villagers should not wash the body as was common during funeral rituals.
The doctors checked mosquitoes, pigs, and cows, trying to find the source of new infections. They examined seven bats and 123 rats. Investigators even pureed 818 bedbugs from infected sites, but none carried any trace of the virus.
The hospital provided a tragic clue. Many Ebola victims seemed to be pregnant women. The nuns had been giving pregnant women unnecessary vitamin shots and reusing infected needles. 'Almost certainly,' Piot writes, 'they had unwittingly killed large numbers of people.'
They determined that Yambuku was the outbreak's center. One of the first survivors was the wife of the headmaster of the local school, one of the first casualties. Before showing signs of infection, the headmaster had returned from the forest carrying monkey and antelope carcasses. As far as anyone knows, he was 'patient zero,' potentially having caught the infection from the dead monkey. From there it spread through body fluids, including blood on the reused needles.
Later the researchers set up a clinic in the area, trying to study the disease and spreading the word to local villages that victims should not be touched without protection. One of the team members made sure they obsessively monitored their own temperatures.
While working through a handle of Kentucky bourbon one night, they looked at a poorly drawn map and saw the Ebola River -- somewhat nearby, but not as close as they thought. But that's the name they chose. They'd been calling the disease the Yambuku virus but did not want to stigmatised the village further.
It wasn't long before they had to evacuate a Peace Corps doctor in one of the first negative-pressure isolation units ever designed, designed to trap both virus and person 'for the duration of our treatment, or our few remaining days alive,' according to Piot.
Del Conn, the Peace Corps doctor, turned out to be OK. Many viruses show symptoms similar to Ebola's initial flu-like symptoms.
By flooding the area with resources, they were able to provide enough medical treatment for those infected as well as food and other essentials for those trapped in the region.
Though they didn't know what they were dealing with at the time, they were able to avert a bigger disaster.
The first Ebola outbreak killed 88% of those infected, 280 people. It's possible that the same infection was responsible for a Sudanese outbreak that year, which killed another 151 people, 53% of those infected.
The area was almost impossible to explore, and locals didn't always trust or believe the doctors, but the isolation helped contain the disease. Now that Ebola is in urban areas, it's much harder to slow the infection rate.
The CDC representative with the group thought the original outbreak could lead to 'potentially the most deadly epidemic of the century.' It didn't -- but it was the worst Ebola outbreak until the recent one, which spread much further, as you can see below.
More than 28,000 were infected between 2014 and 2015, 11,000 were killed, and the outbreak is still not quite over. Liberia just reported its first Ebola death in months.
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