Six Reasons Why You Should Still Care About Ebola

While Ebola has largely disappeared from headlines, we should not forget that this is by far the longest, most deadly Ebola outbreak the world has ever seen.

Since early 2014, Ebola has infected about 27,600 people and caused more than 11,200 deaths. And this outbreak is not over. To put this in perspective, the largest outbreak ever recorded previously was 425 cases in Uganda.

Gabrielle Fitzgerald, director of The Paul G. Allen Ebola Program, talking with staff at the national 115 Call Center in Conakry, Guinea.

Last month, I visited Sierra Leone and Guinea, and continue to be impressed at how hard people are working to try to bring the outbreak under control. Six realities stand out that remind me how far we’ve come and how far we still have to go to reach zero Ebola cases.

There is still an Ebola epidemic in West Africa — Just because the number of new Ebola cases each month is dramatically lower than at the height of the epidemic last year doesn’t mean the outbreak is over. Last week, there were 30 new cases, which is the highest we’ve seen in two months. In any other circumstance, 30 new Ebola cases would be a cause for significant alarm. Additionally, many of these cases came through unknown human contact, so we still do not have a grip on how and where the virus is moving.

It’s the time of year when Ebola cases might spike — With the onset of the rainy season this month, Sierra Leone and Guinea will receive up to 55 inches of rain on average per month, through November. This annual deluge washes out roads and diminishes sanitary conditions, making it difficult for people possibly infected with Ebola to travel to health facilities, and for response teams to reach the remote villages where Ebola may arise.

Western Area Ebola Response Center (WAERC) in Freetown, Sierra Leone, which has played a crucial role in controlling Ebola cases in the country.

New countries at risk — Liberia was declared Ebola-free in early May, allowing the country to breathe a collective sigh of relief. Unfortunately, less than two months later, five new cases have been diagnosed just outside the capital, and the response effort has geared up again.

Phone operators taking emergency calls at the national 115 Call Center in Conakry, Guinea.

In the meantime, new Ebola cases cropped up in Guinea’s Boke prefecture, which borders the country of Guinea-Bissau. International agencies have deployed health workers to this region to help the country prepare for the virus, in case it jumps the border. Complicating matters, Guinea-Bissau is another under-resourced and unprepared country, so the already stretched international response effort will be further taxed.

There are few economies of scale in an Ebola response — Managing an Ebola Treatment Unit, or ETU, is an extremely complex and dangerous task. Since the disease is highly contagious, an ETU requires the same number of staff — at least 100 people, working 24/7 in four shifts of 25 doctors, nurses, hygiene workers, cooks, etc. — whether there is only one Ebola patient or a dozen. While the lower case numbers have allowed some ETUs to close, cases could spike at any time. Thus, we must remain well-prepared until zero cases are reached globally.

Survivor tree outside the Ebola Treatment Unit (ETU) in Port Loko, Sierra Leone. Each ribbon represents one person was discharged Ebola-free.

Ebola survivors continue to suffer even after they are cured — Many ETUs have “Survivor Walls” covered with pictures or hand prints celebrating the more than 16,000 men, women and children who have survived the often-fatal disease. However, shortly after discharge, Ebola survivors have reported painful and debilitating symptoms, including fatigue, chronic muscle aches, anorexia and a devastating eye infection that can lead to blindness.

Survivor wall at a French Red Cross ETU in Forecariah, Guinea.

Studies are underway to understand the long-term effects of the virus, but it is heartbreaking to realize that survivors’ suffering goes on long after the acute illness ends.

We don’t know where Ebola originates — Despite the billions of dollars the world has poured into stopping the current West Africa Ebola outbreak, we are no closer to understanding why this outbreak started in the first place, and what may start the next one. David Quammen’s excellent piece in National Geographic debunks the common assumption that fruit bats are the source of Ebola and points to the many unanswered questions about which animal hosts the virus and what mechanism causes it to spill over to humans.

A map in the Western Area Ebola Response Center (WAERC), Freetown, Sierra Leone.

Ebola continues to be an unpredictable and devastating opponent that requires human and financial resources. What we learn about the virus today can help us stop the current outbreak and prevent future outbreaks, saving many lives.

Leaders in the Ebola response are cautiously optimistic that we can overcome the final hurdles and reach zero cases in West Africa by this fall. But there is still much more work to be done.