Rational Paranoia: Why We All Need to Be Afraid of This Ebola Pandemic

American Dr. Kent Brantly treating a patient infected with Ebola. Dr. Bently
tested positive for the disease this past Saturday. Picture from Reuters.

              A lot has happened in the last four months. First the world was captivated by the disappearance of Malaysia Flight 370, which vanished somewhere over the Indian Ocean. Then the abduction of 276 school girls from a school in northern Nigeria caught our attention through social media. Lately flare ups in the Levant including the announcement of a Palestinian unity government, the kidnapping of three Jewish seminary students, and Israel’s subsequent military operation in Gaza, have plastered the mainstream media with news headlines and pictures. Of course the growth in strength of ISIS in Iraq and Syria has set off alarm bells throughout the Middle East and the West. And finally the downing of Malaysian Flight 17 over Ukrainian rebel airspace has brought the Ukrainian conflict back into the international spotlight.
 

                One story that has gotten little to no attention has been the rapid spread of the Ebola virus in Western Africa. This latest outbreak began in the southern region of Guinea and has spread to neighboring Sierra Leone, Senegal and Liberia. Since the beginning there have been 314 deaths in Guinea, 127 in Liberia, and 219 fatalities in Sierra Leone.

                On its face this pandemic seems like a minor scare. As of July 24^th 660 people have died over the course of four months. Compared to the current fighting in Gaza, which has left over a thousand dead in just over two weeks of violence, 660 can seem like an insignificant number. But it’s not the number of people who have died or the period of time they died in that makes this disease so deadly. Instead it’s Ebola’s potential to decimate entire communities that makes it such a public menace.

                Ebola has a fatality rate between 50 and 90%. Oh, and there’s no vaccine or cure. In addition it has an R knot of 2-7 and an incubation period of one to two weeks. That means a person infected with Ebola will transmit the disease to two to seven healthy humans. Its slow incubation period means that a subject may be infected and contagious for an estimated ten days before they even become aware that they carry the deadly contagion.

Electron micrograph of an Ebola Virus.

            
               So far the human community has been relatively lucky that this fatal disease has been confined to largely rural areas. Prior to the 2014 outbreak in Western Africa, patients who contracted Ebola were mostly limited to agrarian communities. People in agrarian communities have less frequent interaction with each other than their counterparts in urban areas. The less dense areas allow for less contact between the healthy and infected. Additionally, the inhabitants of the more impoverished farming communities of Africa are less likely to travel great distances. These factors slow the rate of transmission down to manageable levels, and isolate the disease to areas where its spread is limited to the surrounding region and community.

CDC Map of the Current Crisis, darker highlighted areas are
regions with confirmed cases, while lighter highlighted areas
have reported unconfirmed cases.

                 Even in this current crisis it has been the rural communities in the interior regions of Guinea, Sierra Leone and Liberia that were the first to identify confirmed cases. However, the metropolises of Freetown, Conakry and Monrovia have all reported confirmed cases. The impoverished densely populated areas sporting a deficient infrastructure and unsanitary conditions serve as a perfect incubator for the virus. Transmission rates have increased, and the introduction of Ebola into these urban areas have dramatically increased the number of people at risk of contracting the disease. But more importantly these cities serve as centers of domestic and international human traffic.

                 Global economic integration and technological improvements in regional and intercontinental transportation have increased the range and speed of the transmission and spread of diseases. At one time oceans and other geographical features served as protective boundaries to the spread of contagions from one region of the globe to another. Even after the age of exploration wind powered ships carried virulent diseases at a relatively slow pace. Although the age of exploration opened areas of the world to the introduction of a slew of new diseases, the invention of the seaworthy steam ship and the beginning of global integration through European colonization created the perfect conduit for the worldwide transmission of disease and the creation of the first global pandemic.
    
           Towards the end of World War 1, Spanish Influenza was unleashed upon the world. While the source of Spanish Influenza is still a hotly debated subject, at some point in 1918 it was introduced to the battlefields of Western Europe. The introduction of this virus quickly spread amongst the ranks of soldiers among the Axis and Allied powers, including the soldiers from the British and French empires. As the war wound down and soldiers returned home they carried the virus them to places such as India, the Dutch East Indies (now Indonesia), and even Oceania. An estimated 500 million people contracted Spanish Influenza in 1918, and 50 to 100 million people died from the disease around the world. With a mortality rate of 10% to 20%, an estimated 5% of the entire world's population was killed. That was 1918.

American soldiers from Fort Riley, Kansas suffering from
 Spanish Influenza being treated in a medical war.

               Almost one hundred years later the global integration of the world economy in addition to the technological developments in regional and intercontinental transportation has allowed for the expansion of human traffic. Today, jet airplanes guarantee that any pandemic in one part of the world will effect a larger area of the human population, at a greater speed. Whereas the mortality rate for Spanish Influenza in 1918 was 10% to 20%, the mortality rate for Ebola is between 50% to 90%.  Ebola is much deadlier and will spread much faster to a larger portion of the human population than Spanish Influenza did in 1918.

               Spanish Influenza was able to spread so far and so quickly in part due to the large congregation of soldiers from across the globe, onto the battlefields of Europe during World War 1. Such a scenario doesn't currently exist for the Ebola virus to feed off of. However, as was previously stated the introduction of the virus into urban areas in West Africa serves as a gateway for the introduction of Ebola into the rest of the world. Conakry, Freetown and Monrovia are hardly centers of international commerce or travel, but they are centers of business for their respective nations and are linked to a regional hub which serves as a gateway from West Africa to the rest of the world.

               Lagos, Nigeria is one of the most populated cities in the world, and the most populated city in Africa's wealthiest and most populated nation. It serves as a global economic and cultural hub of not only Nigeria, but of the entire West African region. The Globalization and World Cities Research Network has ranked Lagos as a Beta city, which is defined as cities that link moderate economic regions into the world economy, along with such globally significant metropolises as Seattle, Shenzhen, Rotterdam, Abu Dhabi and San Diego. Its Murtala Muhammed International Airport serves over 10 million passengers a year and has direct flights to London, Istanbul, Dubai, Atlanta, Houston, Amsterdam, Frankfurt  and Rome to name a few. If Ebola were to spread to Lagos then the airport would serve as a nexus for the spread of the contagion across the globe. And it already has.

            On July 20, a Liberian man was hospitalized in Lagos after he arrived in Nigeria via the Murtala Muhammed Airport. On the 25th, he succumbed to his illness and passed away. The World Health Organization (WHO) confirmed that the man was infected with Ebola. While this individual from Liberia might have been the first person infected with Ebola to make their way to Lagos, he won't be the last.
 

And did I mention there’s no vaccine or cure. Ebola was first discovered among the human population in the Sudan and Congo areas of Africa during the 1970s. Over the last half century there have been reoccurring epidemics in the Democratic Republic of the Congo, Sudan and Uganda. Prior to 2014 Ebola outbreaks had been confined to the central African area. The confinement of the disease to an impoverished area of the globe meant that the cost to develop a vaccine outweighed the societal benefit one would have. Pharmaceuticals lacked the financial incentive to pursue the research necessary to develop a remedy to the danger imposed by Ebola.

 Aside from the monetary aspects, the global community has taken a laissez approach to the disease because, well lets face it, it's isolated to Africa. The inherent racism that was prevalent in European attitudes towards Africa in the 18th and 19th century, from Rudyard Kipling's Jungle Book to the 1884 Berlin Conference, still exists today albeit in a subtler form. Further, the world generally just doesn't care about Africa. Since decolonization began after World War 2, the continent has lacked political stability. African nations have had to contend with constant and deadly civil wars, insurgencies and rebellions, not to mention famine and a lack of clean, drinkable water (see the current famine in South Sudan). The result has been thousands, if not millions of attributable deaths. To the developed world a few more deaths, caused by disease, added to the overall mortality rate in Africa is not an eyebrow raising event. But this outbreak needs to be.

The world cannot take a backseat to the events unfolding in West Africa this time. This pandemic has the potential of spreading like wildfire through not only Africa, but the entire human population around the globe. Ebola has the potential to devastate the human population, and unless precautions are taken now to confine and remedy the outbreak to West Africa that potential becomes a likelihood. It is ironic that about 10 million people died on the battlefield in World War I over 5 years compared to the 5 million who died around the globe due to Spanish Influenza in just one year, and yet all we remember is the war.