Ebola: No sign of slowing down
It's been nearly six months since the first reported case of Ebola in West Africa. Despite everyone's best efforts, we're still no closer to containing the lethal virus. In fact, the opposite is true. Now that it's spread across four African countries, it's going to be even harder to stop - and it's going to get worse before it gets better.
On Sunday, medical charity Doctors Without Borders (MSF) opened a new Ebola centre near the Liberian capital Monrovia. When it's up to full capacity, it will be able to handle 400 patients, making it the largest-ever Ebola treatment facility. And even this won't be enough.
"I think it will be very full, very fast, and the situation will continue to get worse," said Lindis Hurum, a project coordinator for MSF, speaking to the New York Times. "In general, it is a very difficult and alarming situation. I can't stress that enough."
The new facility opened at just the right time. Only the day before, on Saturday, the previous Ebola centre in the capital had been stormed and ransacked by a group of angry youths, who shouted "there is no Ebola" as they made off with contaminated mattresses and forced patients out of quarantine. Of the 29 patients in quarantine, 10 are thought to have returned home to their families while another 17 are missing. Without professional care, none of these patients are likely to beat the disease - and without safety precautions they'll probably infect dozens more people.
The first reported case of this particular outbreak was in Guinea in February. Just six months later, the virus has spread to four African countries and already killed at least 1,145, although the real death count is likely to be much higher. This is already the most severe Ebola outbreak in history - the World Health Organisation declared it an international emergency - and there is no sign that it's going to slow down any time soon.
A few factors have conspired to make this outbreak particularly difficult to deal with. Most significant is where it happened, near the triangle where the borders of Guinea, Liberia and Sierra Leone converge. Not only is this an exceptionally poor area with little in the way of government services (this situation doesn't change no matter which country you're in), but the borders are particularly fluid and porous - and where people travel, so does the virus.
Another factor is local customs and traditions, such as that dictating that bodies should be washed before burial. By now, most residents of the affected areas are probably aware that this is a dangerous practice, but this knowledge doesn't make it any easier to send off your loved ones into the great beyond without paying the proper respects. And besides, as Liberian President Ellen Johnson-Sirleaf noted, it's not so easy to simply wash your hands (both literally and metaphorically) of infected family members. The simple human urge to help take over. "In our society, it's very difficult, with a family member in the home, that they will attempt not to help," said the president. "Our culture is to shake hands, to hug, to help."
Yet another factor is the shocking state of healthcare in the region. To put the scale of this particular problem in perspective: according to Reuters, Liberia has only 50 doctors for four million citizens. No wonder it can't cope with a public health emergency on this scale. In fact, it can't really cope with any health issues.
"For many in the affected countries, Ebola is among the least of their health worries. In the eight months from when the so-called patient zero was first infected to 5 August 2014, malaria has killed nearly 30 times as many people in Guinea, Sierra Leone, and Liberia. Each week, everyday diarrheal disease claims more lives than Ebola has in eight months," writes Gwynn Guilford in Quartz.
As we've argued before, the spread of Ebola is fundamentally a failure of governance. Yes, the virus is lethal and yes, it is contagious. But containing and controlling it is not a mystery: other governments have done it before, with accurate virus tracking and aggressive information campaigns. That none of the Guinea, Liberia or Sierra Leone has the basic medical infrastructure to implement these kinds of solutions suggests that the real crisis is not the virus itself, but the inability of governments to provide even the most basic of services.
So where is a solution going to come from? Once again, African governments are looking to international organisations for assistance. MSF is out in force, the World Health Organisation is involved, America's Center for Disease Control has sent experts. But the major countermeasure is one that's been used to target highly infectious diseases for centuries - imposing a 'cordon sanitaire' to isolate entire regions of the country, preventing the movement of people. This might prevent the disease from spreading, but it's bad news for the people trapped inside - if, that is, they can be persuaded not to escape. Key to this will be providing enough food and supplies to compensate for the sudden halting of trade.
"How long will this state of siege last?" asks Laurie Garrett in New Republic. Garrett knows what she's talking about - she covered the 1995 outbreak in what was then Zaire, which was contained thanks to another cordon sanitaire imposed by dictator Mobuto Sese Seko.
"Recent statements from WHO, MSF, Samaritan's Purse, and other institutions leading the fight alongside the governments warn the world that it will be at least six months, and quite possibly a year, before Ebola can be defeated…this siege will end not with magic bullets, but smart, heroic strategies that find infected people swiftly, place them behind cordoned quarantine barriers, and bury the dead rapidly after their demise without families' contact or viewing. Yes, it is heartless and can seem cruel, but strategic isolations, coupled with vast urban campaigns of capture of the infected constitute the only hopes for ending the state of siege."
This column first appeared on _ Daily Maverick._