WHO Report Details Why Ebola Hit West Africa So Hard
Today, the World Health Organization issued a 14-part report on Ebola, from the moment it started until now.
We asked our team of Ebola correspondents to look at the sections and pull out the points that seemed most interesting — that may have been overlooked or forgotten, stories that show how the virus turned into an epidemic.
Where it all began
The very first human case of Ebola in this outbreak may have been due to deforestation by "foreign mining and timber operations" in Guinea, which brought residents in closer contact with bats. The first victim was an 18-month-old boy in Meliandou, a village of just 31 households. He had been seen playing near a tree infested with bats before he got sick. The child developed fever, had black stools and was vomiting on Dec. 26, 2013. He died two days later. Health officials first thought he had cholera.
Anger in Guinea
The Ministry of Health publicly described the outbreak as "nearly under control" as early as April 15. But cases were on the rise. In September, Forecariah, a mining town in western Guinea, had a case fatality rate among Ebola patients of at least 80 percent; the virus was spreading among patients and staff in a large regional hospital. As the mob in Forecariah grew to more than 3,000 heavily armed youths, WHO-led epidemiologists became the target of their anger. The epidemiologists had to flee for their lives.
The first in Sierra Leone
Ebola arrived when an infected woman seeking the services of a faith healer crossed the border from Guinea. The healer became infected and eventually died. Her funeral became ground zero for the epidemic in Sierra Leone. Epidemiologists eventually traced 365 Ebola-related deaths to that single funeral.
Not enough doctors
Before Ebola struck, the three hardest-hit countries — Guinea, Liberia and Sierra Leone — had a ratio of about one to two doctors per nearly 100,000 people.
A shocking burial connection
Funeral practices in Liberia and Sierra Leone include rinsing a corpse and having mourners bathe in that water. The assistants of socially prominent members in secret societies in these countries have also been known to sleep near a highly infectious corpses to allow "the transfer of powers." A whopping 80 percent of Ebola cases in Sierra Leone are estimated to be linked to these funeral practices. In Guinea, it's 60 percent of Ebola cases.
Ebola in the air
Never before had air travelers brought the Ebola virus to a new country. That happened twice in this outbreak, when one infected individual flew from Liberia into Lagos, Nigeria, on July 20 and another from Liberia to Texas on Sept. 30. As the report notes, every city with an international airport is, in theory, at risk of an imported case.
The littlest victims
By the end of 2014, charities in West Africa were struggling to care for more than 30,000 Ebola orphans.
No isolation
In the early summer, no hospital in Liberia had an isolation ward. Facilities lacked protective equipment, and only a few medical staff were trained in the basic principles of infection control. As a result, treatment of the first hospitalized patients actually "ignited multiple chains of transmission" and eventually led to an exponential growth in Ebola cases throughout the country.
Continuing toll on health workers
Despite progress in Liberia, infection control at health facilities is still a major problem. Six health workers were infected just in the first week of December. Health officials are investigating.
Tough laws
Sierra Leone used especially aggressive measures to try and contain the virus, though it's unclear what impact these had. Over the course of the year, the government quarantined more than half of the country's 14 districts and passed a law imposing a jail sentence of up to two years on anyone found to be hiding a patient.
Malaria builds a bridge
As part of its response, the Sierra Leonean government used an anti-malaria campaign to try and win back the public's trust in health care workers, whom they thought were possibly spreading the disease. With new Ebola cases still rising in December 2014, health facilities distributed anti-malarial medicine to tens of thousands of households in areas with the highest rates of Ebola and where fear was causing people to avoid contact with health workers. The WHO report says the program was well-received and boosted trust in the government.
The need for rapid testing
Many Ebola patients have been in a hellish limbo for days or longer while waiting for blood samples to be schlepped along rutted roads, to be tested for the virus. WHO is currently evaluating 19 different rapid blood test kits, which can be sent off to health outposts in remote areas. If a reliable one is found, that could make a big difference for patients waiting to find out if their fever is caused by Ebola, malaria or any number of common diseases in the area. Rapid results can also help doctors manage the care of sick people more easily.
Internet aid
WHO was able to track possible Ebola cases in nonaffected countries with the help of a "dedicated internet search engine." The system combs through the web for rumors and hints suggesting an Ebola case and can translate from many languages. From mid-October to year's end, the system picked up more than 183,000 alerts that were then screened by epidemiologists. More than 150 required further investigation.
An unacceptable difference
More than 70 percent of Ebola patients treated in West Africa died compared to a 26 percent death rate for foreign medical staff who were evacuated to countries with specialized treatment. WHO calls this difference "unacceptable."
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Transcript
AUDIE CORNISH, HOST:
We're getting a better idea today of what has made the current Ebola outbreak the worst ever recorded. The World Health Organization has just released a 14-part assessment of the crisis, what went wrong and what needs to happen to finally stop the spread of the virus. NPR global health correspondent Jason Beaubien has been plowing through the report. And, Jason, the WHO has the benefit of hindsight here, right? I mean, what's their assessment of why this Ebola epidemic has been so severe?
JASON BEAUBIEN, BYLINE: Basically what they're describing here is a perfect storm. And they're linking it straight back to deforestation that was happening in that part of Guinea where the first case was originally found. There's some foreign mining companies, some foreign timber companies that have been working there. And the idea is there used to be these barriers between people and the bats, which are believed to be holding the virus. And this deforestation has allowed them to come into contact. The virus then jumps over to people. Once the virus gets a foothold in these countries where you've got some of the poorest countries in the world with some of these very weak health systems, it just really took off. And even though you've got weak health systems in these places, you have these reasonably decent transportation systems with buses and taxis that managed to move the virus. So they're saying that this - all of these conditions sort of contributed to it being the worst - and also just unique burial practices there. They linked back one case they found in Sierra Leone to 365 deaths from a single funeral.
CORNISH: And we should remind people that there have been more than 21,000 cases, right?
BEAUBIEN: That's right.
CORNISH: This outbreak still isn't over. What does the report say, if anything, about the organization's own role - right? - in the inability to contain the epidemic?
BEAUBIEN: It gets into this to some degree. Chapter seven is the key events in the WHO response. And then it goes into the WHO's technical support here. But all of this really casts the WHO as this sort of underfunded organization that's heroically leading the charge against the outbreak. And it is true. The WHO was there. They were on the ground. But the problem is that what they were doing clearly wasn't enough. You know, this is still going on now, as we, you know, just said. And to this day, their mandate is to support the local ministries of health in Liberia and Guinea and Sierra Leone. And so the WHO is viewed by some people in the world as supposedly this agency that's going get in there and deal with any international disease crisis or outbreak. And that's how - but it views itself very differently. It views itself as an agency that's supposed to support and provide technical advice and consultants to local ministries of health. So there's this contradiction there between its mandate and how it views itself and how some other people view it.
CORNISH: So buried further in those later chapters, anything about whether the WHO thinks its role needs to change?
BEAUBIEN: Yes. There's an awareness of this. One section right towards the end looks back to a flu outbreak that happened in 2009. And in a report written in 2010 that was quoted there, it says the world is ill-prepared to respond to a severe influenza pandemic or to any similarly global threatening public health emergency. Well, last year's Ebola outbreak again underscores the world remains ill-prepared to deal with these types of crises. The WHO's board of directors is meeting later this month in Geneva. They're going to look back at the role of the WHO in this outbreak and try to look at, you know, what should be the role of the WHO in the 21st century? Does it have the funding, the tools and, most importantly, the international mandate it needs to take on the next major disease outbreak probably more forcefully?
CORNISH: Jason, thanks so much for explaining it to us.
BEAUBIEN: You're welcome.
CORNISH: That's NPR's Jason Beaubien on a new report from the World Health Organization examining the Ebola crisis. Transcript provided by NPR, Copyright NPR.
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