Category: Ebola Virus

Introduction

In 1976, a very fatal and dangerous Virus started to infect people in a small village in DRC (Democratic Republica of Congo) and leaded to multiple deaths. People was deteriorating very fast, all having similar symptoms of Fever, bloody vomiting, diarrhea and then deaths. This deadly new virus was called Ebola virus referring to the Ebola River where the first outbreak happened.

The Ebola Virus was thought to be transmitted from animal to humans then from human to human transmission. The Virus acquired the ability to be transmitted between humans, a characteristic mark for any virus to cause global pandemic. The Ebola through to be transmitted to humans from the barely cooked meats of infected animals.

Since 1967 until 2014, the Ebola Virus diseases or what is formally known as Ebola Hemorrhagic disease killed less than 1000 people only. The Health care [image: ]providers specialized in combating pandemics controlled the disease very well by isolating the sick people from the healthy ones. In 2014, the unexpected happened, hundreds of people went to the hospital with symptoms similar to those with Ebola virus diseases. It was then proved that Guinea and the whole world was on the brink of a newly and deadly outbreak of Ebola virus that threatened the life of 7 billion people living in this planet.

Ebola virus is a member of a virus family called Filoviridae and 6 species of this family was identified until now. They are: 1- Zaire 2- Bundibugyo 3- Sudan 4- Tai Forest 5- Reston 6- Bombali

The new outbreak that occurred in 2014 belongs to Zaire Ebola Species.

Transmission

The natural host of Ebola virus is thought to be the fruits bats which lived in west Africa. Human were infected with they have contacted with the blood, body secretions, organs and the flesh of the infected animals. Animals like chimpanzees, gorillas, monkeys and bats can be infected too and can spread the infection directly to humans.

Human-to-human infection occurs when the healthy individuals are contacted with blood, vomiting, urines, stool and secretions of infected individuals. They can even get the infection if they have contacted with the fluids of the infected dead individuals. Health workers are frequently infected when they are treating the sick people with Ebola when the precautions criteria are not followed strictly. They are also at risk of infection in burial ceremonies.

Symptoms

The symptoms of Ebola are not very specific and Ebola is highly suspected when the symptoms took place in location near of the outbreak or the person has recently visited the countries which suffers from Ebola outbreaks. The window period of Ebola virus symptoms is 2 to 21 days. This means when the person has [image: ]got the infection, the time between getting the infection and the appearance of the symptoms are ranging between 2 to 21 days maximum. 21 days are the number of days required to confirm that the individual suspected to be infected with Ebola is free from the infection. Unlike HIV, individuals with Ebola virus infection are not contagious in the window period until the [image: Image result for ebola virus]appearance of symptoms. The symptoms of Ebola virus are

• Fever
• Generalized tiredness
• Muscle ache
• Headache
• sore throat

These symptoms then followed by

• Diarrhea and bloody vomiting
• Skin rash
• Deterioration of kidney and liver function with elevation of liver enzymes, low platelets and low WBC
• External bleeding like nose and gum bleeding and internal bleeding like bloody stool.

Diagnosis

Diagnosis of Ebola virus is very tricky and difficult. it is hard to distinguish between Ebola virus symptoms and other infectious diseases like Malaria, typhoid fever and other hemorrhagic diseases. In order to diagnose Ebola we need to use one of these following methods:-

• ELISA test
• Antigen detection test
• PCR
• electron Microscopy

Viral isolation

Samples like whole blood and body fluids are preferred for the infection. These samples should be handled with extreme caution because it is highly contagious. These samples when transported internationally, should be transported with triple packaging system to insure protection.

Treatment

There is no yet a specific treatment for Ebola virus, the only treatment we have is the treatment of the symptoms occurred in Ebola infected individuals. Unfortunately Ebola is a very devastating diseases and it kills 50% to 90% of individuals infected with Ebola virus. Rehydration with Iv fluids, blood transfusion and plasma transfusion are some treatment options to control the symptoms.

RvS-ZEBOV is a name of a vaccine used in the countries that have high Ebola infection rate. The vaccine is available since 2015 and initial data indicated that the vaccine is highly effective in the protection of Ebola. But due to the multiple strains of Ebola and the lack of availability of the vaccine to all people, we still face some challenges.

Prevention and Control

There are multiple factors that help us to perfectly control any outbreaks. These factors relies on a good community awareness of the disease, good case management, surveillance and infection tracing and having a good laboratory services. In addition to that we need to have a very professional medical staff that handle and control the cases, and also we need good isolation system to help isolate the infected people from the healthy ones. Also we need to have a very professional burial system because as we know, dead bodies are also a source of the infection. Risk reduction should also focus on 4 important aspects

Reduce human contact with animals which causes the infection, that can be done by handling and dealing with the cadavers of these animals with protective measures like gloves. Also increasing the awareness of people to not consume the raw meat of any animal and cook it very well before consumption.

Reducing the risk of human to other human infection, this can be done by using the preventive measures when dealing with infected people like gloves and masks. In addition by isolating the infected individuals from the healthy one. Also by washing the equipment’s used in treating Ebola infected individuals.

Following the outbreak strict measurements , following any individuals who were in contact with infected people for at least 21 days. Focusing on Hygiene and isolation.

Increase the awareness of safe sexual practices, because Ebola virus are also found in the semen of infected people so using safe sexual methods like wearing condoms can reduce the infection rate.

Controlling the infection of Health Workers dealing with Ebola

Taking care of people who recovered from Ebola, people recovered from Ebola may continue having many complications from the infection including phycological and mental health issues. Ebola virus may persists in some places of the body even after the disappearance of the symptoms. it can persist in the placenta of the women and in the semen of males and even in the breast milk. People survived from Ebola infection should be encouraged to perform safe sex and use condoms until 12 months from the symptoms or when their semen tested negative twice from the infection.

Ebola and UAE

United Arab Emirates remains free from the devastating virus. This is because of the strict health measures that UAE follows in cooperation with the international health organizations. UAE was prepared with the laboratories that is equipped to detect, manage and deal with Ebola virus. UAE was working closely with the world health organization and was following every new updates about diagnosis and management of the diseases. People who travel to places near the outbreak were provided by very explained details about the protective measures needed to avoid Ebola virus. UAE also suspended all the flights to the area were the Ebola virus infection is active.

References

1. World Health Organization, (2019). Ebola Virus disease. Retrieved September 22,2019. From https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease
2. Wikipedia Writer, (2019). Ebola Virus Disease. Retrieved September 20, 2019. https://en.wikipedia.org/wiki/Ebola_virus_disease
3. CDC ,(2019). Ebola.https://www.cdc.gov/vhf/ebola/transmission/index.html
4. Adam Rizvi, (2014).Watchful UAE is free of Ebola virus.https://www.thenational.ae/uae/health/watchful-uae-is-free-of-ebola-virus-1.256056

In 1976, the Ebola virus was first exposed. It happened in the areas in northern Zaire and southern Sudan when two outbreaks of hemorrhagic fever occurred (Cenciarelli et al, 2015). Ebola Virus Disease (EVD) is the origin of hemorrhagic fever and said to be one of the most severe viral disease with 40-50% high case-fatality rate (Cenciarelli et al, 2015). According to World Health Organization, Ebola virus belongs to the virus family of Filoviridae which has a diameter of 80 nm and characteristic of pleomorphic filamentous morphology. This Filoviridae family has three genera which are Ebolavirus, Cuevavirus, and Marburgvirus. There were six species in genus Ebolavirus that have been discovered these are Zaire, Bombali, Bundibugyo, Sudan, Reston and Taï Forest (World Health Organization [WHO], 2014).

In the West Africa, there was a tense outbreak of the Ebola virus during summer of year 2014 up until 2016 specifically in the areas of Guinea, Liberia and Sierra Leone (Hsieh, 2015). The virus that was causing the outbreak belongs to the Zaire ebolavirus species. According to numerous studies, the affected countries during 2014 epidemic in West Africa were ill-equipped to manage because they have lacked resources, inadequate funds and were poorly governed (Huynh, 2019). There was a report at the end day of December 2014 that a total of 20200 were confirmed cases of Ebola virus. According to a statistical report, there were total of 2707 infected Ebola virus cases including 1708 deaths reported in Guinea, in Liberia there were 8018 infected Ebola virus cases including 3423 deaths, and in Sierra Leone a total of 9446 infected Ebola virus cases including 2758 deaths were reported (Cenciarelli et al, 2015).

In the first weeks of Ebola virus outbreak it started in Guinea. It was unnoticeable until the serious symptoms and febrile illness appeared and observed (Ellerbrok et al, 2017). During the Ebola virus outbreak, analyses were performed on different animal species and discovered that the possible virus reservoir of Ebola virus was from the infected animals such as chimpanzees, fruit bats, monkeys, forest antelope or porcupines, and gorillas. There were several proofs that indicate Filoviruses as zoonotic, which is the virus can be transmitted from animals to human beings. This virus can be transmitted when an individual has close contact with the infected animal secretions, blood, organs or other body fluids. It can also be transmitted within person-to-person contact wherein it is contagious if there is a broken skin or wound that is directly in contact with the infected individuals’ body fluids such as their urine, semen, saliva, and feces. The transmission airborne spread through aerosols among human individuals has not been confirmed (Cenciarelli et al, 2015). The symptoms that the victims can experience are headache, sore throat, muscle and joint pain/weakness, vomiting, diarrhea, rash, and complications with the gastrointestinal tract. It is between 2 and 21 days incubation period and then after, the febrile illness starts to develop. Hemorrhagic indications can represent the major form of clinical manifestations of Ebola virus and this can be particularly observed in the complications of gastrointestinal tract (WHO, 2014).

Assessments and evaluations that the symptoms were triggered by Ebola virus infection there were diagnostic methods implemented. These diagnostic methods were the antibody-capture enzyme-linked immunosorbent essay (ELISA), serum neutralization test, antigen-capture detection tests, electron microscopy, reverse transcriptase polymerase chain reaction (RT-PCR) assay, and virus isolation by cell culture. According to World Health Organization, there was still no proven cure available for Ebola virus diseases. However, there were variety of potential treatments being evaluated such as immune remedies, blood products or transfusion, and drug analyses (WHO, 2014). On August 2014, the World Health Organization (WHO) considered the use of the experimental drugs which is the ZMapp. This drug was developed by the Mapp Biopharmaceutical Inc. and this experimental drug was given to three medical doctors who were infected with Ebola in Africa. There were signs of healing on the beginning however, there was no scientific proof that the improvement of their health was related to the administration of the experimental drugs (Cenciarelli et al, 2015). On 2015, there was a trial vaccine that proved to be highly effective against the Ebola virus. This vaccine is called rVSV-ZEBOV vaccine and this is being used up until now to treat Ebola virus disease (WHO, 2014).

The Ministry of Health (MOH) and World Health Organization (WHO) took actions to implement measures to control and prevent the advance spread of infection of the Ebola virus during the outbreak. There were plenty of difficult problems that were faced by the local and international response to eliminate the Ebola virus outbreak. Such problems that were faced during the outbreak were inadequate training of the health-care officials to manage the suspected and confirmed Ebola cases; experienced struggle to trace individuals who are contacted and probable affected by the virus; and there were new outbreaks of infection procedures that needs to be followed (Cenciarelli et al, 2015).

In 2014, when the Ebola virus outbreak started, the isolation facilities were the first one to respond to control the spread of the virus and to provide assistance to those individuals who were suspected and have confirmed cases (Hsieh, 2015). The Global Outbreak Alert and Response Network (GOARN) sent professionals and experts to provide some of the facilities such as epidemiology and surveillance, more and advanced infection prevention and control measures, operational incident managements, medias to spread the outbreak information and to warn people living on the nearby affected areas, and social transportations (WHO, 2014). The World Health Organization (WHO) started to give more training and education to the health and community professionals to identify, notify, and manage assumed and confirmed Ebola virus cases. If there will be community engagements it will lead to success control of the outbreak. Awareness to the risk factors for Ebola infection is an efficient way to eliminate human transmission (Hsieh, 2015). The risk reductions that the community of Africa can do will be reducing the threat of the transmission between wildlife and humans, transmission between humans and human beings, outbreak containment measures, and reducing the risk of transmission during sexual intercourse (WHO, 2014). The health care workers should take standard precautions when assisting patients, nevertheless of their assumed diagnosis. These standard precautions include proper hand and respiratory sanitization, use of the personal protective equipment, safe injection protocols, and safe practices in the burial. If a health care worker or someone who has a contact within 1 meter with the infected individual, they should wear face shield, a gown and gloves. Especially the laboratory workers they are in risk so they should properly be trained so that they can handle the infected samples carefully and processed the samples accurately (WHO, 2014).

The Ebola virus outbreak was underestimated during the year 2014. West Africa was not prepared about the outbreak so the residents there only have limited knowledge or nothing at all on how to handle that certain outbreak. The health care professionals have insufficient resources during the outbreak. The resources needed to improve the critical situation like this are additional diagnostic capability, health personnel, experts, vehicle for transportation and treatment facilities (Cenciarelli et al, 2015). The health care workers trainings should also be prioritized because this is the most important essential for the response to this kind of situation. A lot of people died from the summer 2014 Ebola virus outbreak, the public communications were used so it is also the responsibility of every individual to take standard precaution on the ongoing situation. The simplest way to prevent contamination of the virus is to have a proper hand hygiene. Adults or parents must educate their children on the proper way to wash their hands. Personal protective equipment such as gloves and masks should be given to all the residents in Africa, this serves as the barrier in the continuous spread of the pathogens around the area. It was reported that another relevant crisis that has been faced was that too many cross-border movements were happening that time. So, it means that the people who are infected may spread the virus to the other countries in Africa. There have been incidents that the community did not participate and did not take seriously on what was happening and the health care teams were forced to face the aggression of the population. Hence, the government must implement a stronger and better infection control and prevention measures like night time curfew and quarantine places. Also, I believe that there should be more researchers in exerting efforts in experimenting to find more effective treatments or vaccines to fight for the Ebola virus. The Ministry of Health with collaboration with World Health Organization should seek help in other countries for new techniques and upgraded tools to improve the detection of confirmed cases and the biological agents that is causing this virus. There must be new methodologies in managing the spread of pathogens like more education to the health care workers and as well as to the residents.

Introduction

Ebola is a haemorrhagic fever that is formally known as Ebola Virus Disease. According to the Wold Health Organization, Ebola causes a severe, serious illness which is often deadly if left untreated.

Stats from WebMD show that Ebola kills up to 90% of infected people. “Ebola is a deadly disease caused by a virus. There are five strains, and four of them can make people sick. After it enters the body, it kills cells, making some of them burst. It wrecks the immune system, causes heavy bleeding inside the body, and damages almost every organ (Ambardekar, 2018).”

Symptoms

Ebola does not spread like other common viruses such as influenza and fever, it spreads through skin contact or bodily fluids of infected human, primates or animals. Other ways to get the virus is by touching Ebola-infected needles or surfaces.

A person cannot get the virus from water, air or food. An Ebola-infected person also cannot spread the virus if there are no symptoms for the virus.

Common symptoms of Ebola can feel like an influenza infection in the first two to 21 days of an infection. Some of the early symptoms are high fever, headaches, joint and muscle aches, weakness, stomach pains and loss of appetite. As the disease worsens, it causes bleeding inside the body as well as from the eyes, ears, and nose. Some people vomit, cough up blood, have a bloody diarrhea, and get a rash (Ambardekar, 2018).

Diagnosis

Diagnosing the virus shortly after infection can be very difficult. It is difficult to diagnose the virus in its early stages because the symptoms are also common with malaria and typhoid fever. “To determine whether Ebola virus infection is a possible diagnosis, there must be a combination of symptoms suggestive of Ebola and a possible exposure to EVD within 21 days before the onset of symptoms. An exposure may include contact with blood or body fluids from a person sick with or who died from Ebola, objects contaminated with blood or body fluids of a person sick with or who died from the virus, infected fruit bats and primates, or semen from a man who has recovered from Ebola (CDC, 2018).”

Etiology

There are six species of Ebola virus, and four of the six species cause diseases in humans. The four species that cause diseases are Zaïre Ebola virus (EBOV), Sudan Ebola virus (SUDV), Tai Forest (TAFV) (formerly known as Ebola Ivory Coast), and Bundibugyo Ebola virus (BDBV). The fifth Ebola virus is Reston Ebola virus (RESTV), which has been proven to cause illnesses in non-human primates but not in humans. The sixth Ebola species is Bombali Ebola virus, it was discovered in bats in Sierra Leone in 2018 therefore it is not yet known if the species is pathogenic for humans (Government Publications, 2019).

Ebola first emerged in 1976, in what were almost simultaneous outbreaks in Sudan and the Democratic Republic of Congo. This disease is caused by the Ebola virus, a member of the filovirus family, which occurs in humans and other primates (Government Publications, 2019). The first outbreak occurred in the Democratic Republic of Congo in a village near the Ebola river and then later in Sudan. Theses outbreaks were thought to have been spread by a single human being who travelled from one area to another, until scientists later confirmed that the outbreaks were caused by two genetically different viruses, Zaire ebolavirus and Sudan ebolavirus. After the discovery, scientists concluded that the virus came from two different sources and spread to people in each of the areas (CDC, 2018). The general cause of this deadly virus is unknown but it has been though to have arose from bats, specifically fruit bats. Slight evidence that support the theory is that in 2005 researchers looked for a possible carrier of the virus and sampled 1 000 small animals in Central Africa. They tested 679 bats, 222 birds and 129 terrestrial vertebrates. The only animal to be found positive of carrying the virus were the bats (Rettner, 2014).

Pathogenesis

Ebola virus enters the patient through mucous membranes, breaks in the skin, or parenterally and infects many cell types, including monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, hepatocytes, adrenal cortical cells, and epithelial cells. Ebola virus then migrates from the initial infection site to regional lymph nodes and subsequently to the liver, spleen, and adrenal gland. Hepatocellular necrosis occurs and is associated with dysregulation of clotting factors and subsequent coagulopathy. Adrenocortical necrosis also can be found and is associated with hypotension and impaired steroid synthesis. Ebola virus appears to trigger a release of pro-inflammatory cytokines with subsequent vascular leak and impairment of clotting ultimately resulting in multiorgan failure and shock (CDC, Center for Disease Control and Prevention, 2014).

Pathological and clinical manifestations

After an incubation period of 2–21 days, Ebola virus disease, starts as a non-specific viral syndrome of abrupt onset. The most common symptoms are high fever, malaise, fatigue, and body aches. These symptoms are usually followed after a few days by gastrointestinal symptoms, which include nausea, vomiting, and diarrhea. Although some patients will start recovering at this stage, others will go into shock, possibly due to hypovolaemia and a systemic inflammatory response (Malvy, McElroy, Clerck, Günther, & Griensven, 2019). Neurological events are rare and include confusion, delirium, and convulsions. Late symptoms include dysphagia, throat pain, and oral ulcers and ultimately death due to cardiac arrhythmias. If patients survive the stage of shock, gradual recovery can occur. Several studies have aimed to define clinical prediction tools for Ebola virus disease, integrating discriminatory symptoms or signs (Malvy, McElroy, Clerck, Günther, & Griensven, 2019).

Complications and sequelae

Many short-term and long-term health problems have been reported. Some of these health problems are leucopenia, Alopecia lasting three months, loss of hearing, loss of vision, weight loss, fatigue and many other problems (Vetter, 2016). However, the clinical findings have been largely uncontrolled, making it difficult to definitively attribute causality to Ebola Virus Disease.

Prognosis

The overall prognosis of Ebola virus is relatively poor due to the virus being having such a high mortality rate of up to 90%. The 90% is without the inclusion of the Reston species of the disease. It is mostly the Zaire species, which is the deadliest of the ebolavirus (Charles, n.d.).

Epidemiology

Ebola transmission can be avoided by taking great care when nursing an infected individual. There needs to be no skin to skin contact or any contact with that person’s bodily fluids. The isolation of a patient is the best way of decreasing chances of spreading the virus and wearing gloves, gown and face masks while treating a patient reduces nurses chances of contracting the viral infection. There are no licensed vaccines at the current moment that prevent the spread of the virus. Virologists though suggest that patients require intensive supportive therapy including intravenous fluid or oral rehydration with solutions including electrolytes, maintaining their oxygen and blood pressure (Government Publications, 2019). The first opportunity that Virologists got to examine infected patients was in 1995. The most important finding was that acutely ill patients are intensely viraemic and that ELISA determination of viral antigens in serum provides a sensitive and specific way to quickly screen large numbers of suspect human samples. Virus isolation and reverse transcriptase-polymerase chain reaction are useful in a few instances as well (peter, 1999).

Conclusion

The Ebola virus first emerged in the Democratic Republic of Congo as the Zaire species then later Emerged in Sudan as the Sudan species. The incidents of the outbreak were first thought to be spread by one individual who contracted the virus in one place and moved to another. It was later discovered that the virus came from two different species with Zaire ebolavirus being the most deadly. Though the main source of the disease is unknown, it is thought to have come from fruit bats, with sample testing evidence backing that theory.

This virus starts off with common influenza and cold virus symptoms but gradually worsens during the two to 21 day inhibition period. Nasty symptoms such as bleeding from the nose and ears then follow, if patient does not get treatment soon, it then leads to death. With a mortality rate of up to 90%, the virus is as deadly as they come.

There have not been any licensed vaccines therefore there is no permanent cure for the virus at the present moment but there are ways to prevent the spread of the disease such as isolation of the infected patient, wearing masks, gloves and gown, and also preventing skin to skin contact or contact with bodily fluids of infected patient.

From a neutral standpoint, one can only hope that with the help of the latest technology and everchanging medical field, a cure for this deadly virus can be found soon to prevent the loss of so many lives in our fellow African countries.

In conclusion all patients seen to have influenza and cold like symptoms need to be tested for the virus if they feel that the symptoms are worsening. This virus is indeed one of the worst viruses an individual could contract due to its ability to spread through skin to skin contact. It is urged that patients who notice abnormal symptoms that could be related to Ebola seek medical attention as soon as possible.

Bibliography

1. Ambardekar, A. (2018, October 17). Web MD. Retrieved from Ebola Fever Virus Infection: https://www.webmd.com/a-to-z-guides/ebola-fever-virus-infection
2. CDC. (2014, March 24). Center for Disease Control and Prevention. Retrieved from CDC 24/7: saving lives, protecting People: https://www.cdc.gov/vhf/ebola/clinicians/evd/clinicians.html#targetText=Pathogenesis,cortical%20cells%2C%20and%20epithelial%20cells.
3. CDC. (2018, March 14). Centers For Disease Control And Prevention. Retrieved from Ebola (Ebola Virus Disease: https://www.cdc.gov/vhf/ebola/diagnosis/index.html#targetText=Ebola%20virus%20can%20be%20detected,that%20Ebola%20infection%20is%20confirmed.
4. Charles, P. D. (n.d.). eMedicine Health. Retrieved from Ebola Virus Disease: https://www.emedicinehealth.com/ebola_virus_disease_ebola_hemorrhagic_fever/article_em.htm#how_contagious_is_ebola_and_how_long_is_someone_with_the_disease_contagious
5. Government Publications. (2019, July 29). Retrieved from https://www.gov.uk/government/publications/ebola-origins-reservoirs-transmission-and-guidelines/ebola-overview-history-origins-and-transmission#targetText=Ebola%20virus%20disease%20(%20EVD%20)%20is,Sudan%20(now%20South%20Sudan).
6. Malvy, D., McElroy, A. K., Clerck, H. d., Günther, S., & Griensven, J. v. (2019). Ebola Virus Disease. Lancet 2019, 238-239.
7. Peter, c. j. (1999). The Journal of Infectious Diseases, Volume 179. An Introduction to Ebola: The Virus and the Disease.
8. Rettner, R. (2014, September 22). Health. Retrieved from Science live: https://www.livescience.com/47946-where-did-ebola-come-from.html
9. Vetter, P. (2016). Sequelae of Ebola virus disease: the emergency within the emergency. The Lencet, Infectious Diseases, 82-91.

Introduction

The Ebola virus has been identified nearly 40 years during the two outbreaks in the Democratic Republic of Congo and Sudan.[footnoteRef:1] Regardless of the considerable effort to investigate, it is still arguably as obscure today to find the ecology of the filoviruses, especially, of Ebola viruses. This article is presenting some ecological factors including the behaviors and hunting habits of human and primates; the natural condition in the rainfall forest; and the transmission through chimpanzees and bats. Additionally, some social factors as the local practices, the misinterpretation of WHO, or the ignorance of some world leaders also contribute to the spread of Ebola. [1: Joseph McCormick, Ebola Virus Ecology, (New York: Oxford University Press, 2004), 1893.]

Ecological Factors

Many studies suspect that the filoviruses circulate in the central Africa rain forest and have the ability to infect humans and non-human primates due to their custom behaviors and hunting habits.[footnoteRef:2] Nevertheless, the geography distribution of filoviruses is still vague. We formerly only knew that these viruses emerge in tropical rain forest near the equator and primarily infect lethal disease to humans and monkeys.[footnoteRef:3] It has been recognized at least 4 genetic subtypes of Ebola virus.[footnoteRef:4] The outbreak of Ebola occurring in recent years was closely linked to the same virus strain that circulates in forest area in Africa. However, the occurrence of an Ebola virus subtype in the Philippines significantly inferred that Ebola group viruses can possibly carried by migratory hosts in their evolution.[footnoteRef:5] It is also noticed that antibodies are more widespread in hunter-gatherers than farmers in the Central African Republic. The prevalence of Ebola antibodies and exposure can be acquired by hunting, transferring, and preparing bush meat.[footnoteRef:6] Plus, some changes of humans’ behavior, demography and population might lead to the consumption of a larger array of animals. These changes in hunting proceeding result in the exposure of humans to virus subtypes and enzootic Ebola viruses.[footnoteRef:7] [2: McCormick, Ebola Virus, 1893.] [3: Ibid., 1893.] [4: The subtypes of Ebola virus includes Zaire (EBO-Z), Cote d’Ivoire (EBO-CI), Sudan (EBO-S), and EBO-R (from imported monkeys from the Philippines to the United States and Europe), see in Thomas Monath, Ecology of Marburg and Ebola Viruses: Speculations and Directions for Future Research, (New York: Oxford University Press, 1999), S133.] [5: Monath, Ecology of, S134.] [6: Ibid., S134.] [7: The nonselective wire snare traps contributes to the capture of nocturnal animals, including smaller species and bats.]

Thereupon the core transmission cycle of Ebola subtypes, including cyclic population changes or rainfall, intensifies virus transmission. The Ebola viruses have emerged during the rainy and short dry season in Africa. The high rainfall and environmental changes can be linked to Ebola virus transmission to hosts that have reproductive cycles or have altered behaviors. For instance, during the rainy season, non-human primates are more active due to the abundant of fruits; squirrels, insectivorous and frugivorous bats have bimodal reproductive cycles; the reproduction and activity of various arthhropods are also vigorously influenced.[footnoteRef:8] [8: Monath, Ecology of, S136.]

One of the most direct clues to the origination of Ebola viruses in nature is that humans get infection from chimpanzees butchered for meat. The transmission of viruses may be during contact behaviors and social grooming. Chimpanzees are believed to get infected by physically contacting or consuming infected prey.[footnoteRef:9] Due to their omnivorous habits and vertical distribution, chimpanzees prey upon various birds, insects, and mammals that they are responsible for a wide range of exposures. In addition, other interactions of chimpanzees with other species should also be considered. Those interactions can be from handling or sniffing dead rodents; competing and contacting with frugivorous birds; or entangling with nocturnal arthropods and mammals including bats, arboreal mice, anomalure squirrels, and mongooses.[footnoteRef:10] Thus, predation of chimpanzees and other game animals results in the acquisition of human infection of Ebola. [9: Ibid., S135. ] [10: Ibid.]

Additionally, there are evidences implicating that the transcontinental geography and association between infection and roosting sites of bats in caves distribute Ebola virus subtypes (EBO-S virus; cotton factory, Nzara, Sudan).[footnoteRef:11] A number of species assembling in communal roosts, sought by humans for food, or flying in low strata of the forest or near human habitations can be the transmission of enzootic Ebola viruses. On the contrary, virulent strains of Ebola viruses apparently more involve transmission between species at low density with nocturnal flying species in the higher strata of the forest and with solitary roosting habitats.[footnoteRef:12] The emergence of virulent Ebola strains arises by stepwise or gradual mutation from an “enzootic” virus. [11: Ibid.] [12: Ibid.]

Social Factors

The transmission of Ebola can be through direct contact with the body fluids or corpse of an infected person, specifically during traditional funeral ceremonies. Kissidougou (a prefecture in southeastern Guinea) was first reported of Ebola in March 2014, and the largest record of increasing since the beginning of the epidemic during mid-December.[footnoteRef:13] As a result, the Centers for Disease Control & Prevention (CDC) and World Health Organization (WHO) are requested to investigate the local outbreak. The result found out that 85 confirmed Ebola cases were related to a traditional funeral ceremony.[footnoteRef:14] In Guinea and other west African countries, traditional burial practices involve washing, touching, and kissing the body of the dead person.[footnoteRef:15] Hence, it is inevitable that attendees have direct contact with the body and body fluids of the deceased. Of the 85 confirmed Ebola cases, 21% confirmed to attend and contact directly with the corpse in the funeral, meanwhile 79% verified to have direct contact with attendee of the funeral.[footnoteRef:16] Although the community leaders tried to enhance public health interventions and control Ebola transmission in Kissidougou and other remote communities in Guinea, the transportations in rural areas remained a major problem. While the patients were transferred to the nearest Ebola treatment center (ETC) in Kissidougou, the delayed time from isolation, diagnosis, and treatment at an ETC, could create potential exposure to additional persons.[footnoteRef:17] [13: Kerton Victory et al., Ebola Transmission Linked to a Single Traditional Funeral Ceremony — Kissidougou, Guinea, December, 2014–January 201, (Atlanta: Centers for Disease Control & Prevention, 2015), 386.] [14: Victory et al., Ebola Transmission, 386.] [15: Ibid., 387.] [16: Victory et al., Ebola Transmission, 387.] [17: Ibid., 387.]

Despite the seriousness of the situation, the ignorance and loss of vigilance due to the misinterpretation of WHO causes the spread of Ebola epidemic wider. The epidemic was first occurred in 1976, with an outbreak in Yambuku, Zair, and surrounding areas. In 1995, Ebola again broke out in Kikwit.[footnoteRef:18] Yet another 19 years on, little had improved that the world had not developed medical tools or new technical to for addressing the Ebola viruses. For two decades, same old story as the AIDS pandemic and other lethal outbreaks, the general population and governments always proved more fonded of attacking the subpopulation at greatest risk for the disease rather than tackling the virus itself.[footnoteRef:19] Poor countries are incapable to detect new diseases and control them quickly while rich countries merely show interest until the outbreaks directly threaten their population. The governments cover up outbreaks as they only care about their interests, stockpile scarce pharmaceutical supplies, or shut down borders and bar travel.[footnoteRef:20] Looking back on the charts of Ebola cases in spring 2014 that a mid-March upstick followed by a drop in early April, both the WHO and CDC misinterpreted it as the beginning of the end of the epidemic.[footnoteRef:21] However, the Ebola virus was just lurking from the eyes of health authorities. Nevertheless, it is also suspected that the WHO’s early response to the Ebola outbreak was hampered by bureaucratic dysfunction.[footnoteRef:22] However, it is also interesting to investigate the tendency of CDC and WHO that their wise policymaking is headed by their optics of public perceptions and political correctness. The Associated Press showed that WHO’s delay of declaring the emergency over Ebola is due to their concern that the declaration of this emergency corresponding to a global SOS which could hurt other African countries involved.[footnoteRef:23] [18: Laurie Garrett, Ebola’s Lessons: How the WHO Mishandled the Crisis, (New York: Council on Foreign Relations, 2015), 81.] [19: During the 1980s, the importance of HIV and AIDS was failed to be recognized by WHO that their insiders even complained about the amount of money in AIDS funds Mann was raising. The critic was ‘Since more people die of diarrhea—or cancer, or hypertension, or malaria, or whatever—than of aids, why is it getting so much money and media attention?”The same story goes on with H5N1 to H1N1 to H7N9, SARS to MERS, or Ebola, see in Garrett, Ebola’s Lessons, 85.] [20: Ibid., 85.] [21: On May 2015, WHO officially declared that Liberia was free of Ebola, and the nation started focusing on recover the economy. However, in late June, Ebola came back to Liberia, and many other cases have come to light, see in Garrett, Ebola’s Lessons, 86-92.] [22: The impulse of foundations, donor countries, or individuals also impact the WHO’s agenda as they can choose the priorities within WHO’s mandates, see in Ari Schulman, The Ebola Gamble: How Public Health Authorities Put Reassurance Before Protection, (Center for the Study of Technology and Society, 2015), 31.] [23: This could affect their economies or intervene the Muslim pilgrimage to Mecca, see in Schulman, The Ebola Gamble, 31.]

In addition to the outbreak of Ebola, world leaders also contribute to the worldwide threat of Ebola due to their ignorance and fear of intervention. Despite the call of Médecins Sans Frontières (Doctors Without Borders) for states with biological disaster response capacity (civilian and military medical) to west Africa, the response was too late and limited. [footnoteRef:24] Furthermore, some government, specifically, the UK government decided to stop direct flights to west Africa.[footnoteRef:25] This political decision of the UK hampered the response to the Ebola outbreak. The decision was not based on science and consistent with WHO advice. In contrast, it led to the increase in the costs of dealing with the epidemic, and potentially further death.[footnoteRef:26] The entire health systems in the affected African countries had collapsed.[footnoteRef:27] The patients were left without care for even the common illness including malaria and diarrhea. Joanne Liu, the international charity’s president, also emphasized that the Ebola outbreak was a transnational crisis that had economic, social, and security implication for the African continent, and all countries had responsibility to act towards it.[footnoteRef:28] Jim Yong Kim, president of the World Bank, and Paul Farmer[footnoteRef:29], stated that if the Ebola virus had instead broke out in New York, Washington or Boston, the disease could have been contained and eliminated with the good health systems.[footnoteRef:30] The health system would be equipped effective equipment, proper protective clothing and supportive care from doctors and nurses. [24: Ingrid Torjesen, World Leaders Are Ignoring Worldwide Threat of Ebola, Says MSF, (BMJ, 2014), 1.] [25: Anne Gulland, UK Government Is Criticised for “political Decisions” in Response to Ebola Epidemic, (BMJ, 2015), 1.] [26: Gulland, UK Government Is Criticised, 1.] [27: Isolation centers were overwhelmed and health worker became infected or died in vast number.] [28: Torjesen, World Leaders Are Ignoring, 1.] [29: He holds the Kolokotrones university professorship of global health and social medicine at Harvard University. He is also the co-founder of the non-profit organization Partners in Health.] [30: Torjesen, World Leaders Are Ignoring, 2.]

Conclusion

The Ebola outbreak has reminded us that we are still fragile creatures in the nature and in our own human community. The epidemic of Ebola has killed a vast number of people and may continue further if we are still unable to resolve our human problems and political issues involved. Although some measures adopted by states combating the virus might be justified, every individual right and life are not worth to be sacrificed for the common good of the authorities.

References

1. Garrett, Laurie. ‘Ebola’s Lessons: How the WHO Mishandled the Crisis.’ Foreign Affairs 94, no. 5 (2015): 80-107. http://www.jstor.org/stable/24483741.
2. Gulland, Anne. ‘UK Government Is Criticised for “political Decisions” in Response to Ebola Epidemic.’ BMJ: British Medical Journal 350 (2015). https://www.jstor.org/stable/26518318.
3. McCormick, Joseph B. ‘Ebola Virus Ecology.’ The Journal of Infectious Diseases 190, no. 11 (2004): 1893-894. http://www.jstor.org/stable/30077722.
4. Monath, Thomas P. ‘Ecology of Marburg and Ebola Viruses: Speculations and Directions for Future Research.’ The Journal of Infectious Diseases 179 (1999): S127-138. http://www.jstor.org/stable/30117614.
5. Schulman, Ari N. ‘The Ebola Gamble: How Public Health Authorities Put Reassurance Before Protection.’ The New Atlantis, no. 45 (2015): 3-42. http://www.jstor.org/stable/43551433.
6. Torjesen, Ingrid. ‘World Leaders Are Ignoring Worldwide Threat of Ebola, Says MSF.’ BMJ: British Medical Journal 349 (2014). https://www.jstor.org/stable/26517025.
7. Victory, Kerton R., Fátima Coronado, Sâa O. Ifono, Therese Soropogui, and Benjamin A. Dahl. ‘Ebola Transmission Linked to a Single Traditional Funeral Ceremony — Kissidougou, Guinea, December, 2014–January 2015.’ Morbidity and Mortality Weekly Report 64, no. 14 (2015): 386-88. https://www.jstor.org/stable/24856447.

Ebola is defined as a rare disease in the United States, it has only occurred because cases were obtained in other countries that eventually led it to spread by human transmission (CDC, 2019). There are fewer than 1000 US cases per year, but in West Africa Ebola is considered a zoonotic disease because it originated from animals to humans (Mayo Clinic Staff, 2019). It’s a catastrophic disease that is infectious and frequently fatal.

Ebola marked by a fever and critical internal bleeding. It also contagious if contact with infected bodily fluids by a filovirus or broken skin even if the individual isn’t alive (CDC, 2019). In 1976, the Ebola virus was first discovered near the Ebola river or now known as the Democratic Republic of Congo, from which this disease takes its name today (CDC, 2019). The virus lead to outbreaks in several African countries but it began in Guinea and moved along with the land borders to Sierra Leone and Liberia (CDC, 2019). Ebola is known to affect all races, all ages and animals but it mostly affects the people who lived in West Africa and Southeastern. But it’s told that In 2015, young children who are infected with the virus are at a high risk of dying than adults and older children (Blaszczak, 2015). In the new case researchers have examined Ebola case in younger adults under the age of 16 during the outbreak in Guinea where it’s all began from including the two other countries in Sierra Leone and Liberia (Blaszczak, 2019). It’s discovered that the outbreaks death rates are higher in younger children than older adults and older children (Blaszczak, 2015). “The disease has killed about 90 percent of infected children under-age 1, and about 80 percent of kids ages One to Four who have been infected. Older children who have been infected with Ebola may have a much better chance of surviving’ (By Agata Blaszczak-Boxe March 25, 2015).

Scientists compared nature virus to the Ebola virus because they were unsure where the disease came from, but with testing scientists believed that the virus may originally come from fruit bats which then evolved to other animals as pigs, gorillas, monkeys and many more (CDC, 2019).

When the disease is transmitted by body fluids, blood or tissue of the infected person or animal, the virus causes onsets of fever, muscle pain, intense weakness, sore throat and headaches which is dangerous because it’s very hard to control (CDC, 2019). When an individual dies of the Ebola virus, the virus survives in the body within Seven days making it more dangerous because there are no current vaccines available for Ebola (NBC Staff, 2015). There is a team who is trained to deal with bodies to properly bury them (CDC, 2019). They created a way so that families aren’t exposed to the disease while saying goodbye to their loved ones. They must first find the people who have Ebola, find the people have been in contact with them, let the workers do their jobs, isolate the patients, so that they aren’t infectious, prevent transmission from the disease in the healthcare setting, stop the transmission disease of the dead body by wrapping them into a plastic bag, then they’ll finally transport the coffin to a Gravesite, so that the family may say their last words, and goodbyes (VDX,2019).

Scientists are trying to develop vaccines that might help the other generation but at this time none are available for clinic use (Mayo Clinic Staff, 2017).

Ebola tends to spread quickly among friends and families as they are exposed to the infectious secretions by taking care of an ill individual. The onset of the symptoms ranges from two to twenty-one days to start appearing, but during day eight to day ten patients may experience rashes, coughs, red eyes, vomiting, loss of appetite and bleeding outside and inside the body which makes diagnostic extremely difficult (CDC,2019). If a patient shows signs of Ebola virus disease the person must be isolated immediately so that it does not cause a big outbreak within other patients.

There are two blood tests that a doctor will perform to confirm the virus which would be a polymerase chain reaction and an Enzyme-linked Immunosorbent assay (Mayo Clinic Staff, 2019). A polymerase chain reaction is a technique to diagnose Ebola. A polymerase chain reaction makes multiple copies of a specific DNA. In this case it’s used to detect low levels of Ebola virus but if the virus is no longer present in great numbers in the blood the polymerase chain reaction test will no longer be effective (CDC,2019). Enzyme-linked Immunosorbent assay is a technique to detect quantifying substances such as antibodies, proteins, hormones, and peptides (Timothy J. Leg, 2017). When sending these blood test to the laboratory and the test comes back confirmed it’s noted that the public health authorities will be involved and then conduct a public health investigation.

The symptoms of Ebola virus are treated as soon as they appear. The basic interventions can significantly improve the changes in survival if they maintain oxygen status, provide fluids and electrolytes through infusion of the vein, using medications to support blood pressure while they maintain the fever and reduce vomiting including diarrhea (CDC, 2019). Four Investigational treatments were available to treat patients during 2018 in Democratic Republics of the Congo. Two treatments called mAb114 and Regeneron made survival changes much higher than before. MAb114 is a Monoclonal antibody that binds the core receptor binding the Zaire Ebola virus surface of the proteins, so that, it stops infecting the human cell (NIH, 2019). These two antiviral drugs are used to this day for patients confirmed with Ebola.

To prevent from getting Ebola transmitted you must do the following to avoid contacts with fruit bats and non-human primates or blood, contact with semen from a man who previously had the Ebola virus and any items that have been in contact with an infected person’s body fluids or blood (CDC, 2019). That included fesses, urine, sweat, saliva, vomit or breast milk even if they touched anything they have used to have contact with its bodily fluid like clothing, bedding, medical equipment. Ebola is a new imported disease that has not spread fully around the world, especially in the United States because of CDC support. They were deployed to west Africa to assist with labatory testing, contact tracing, response efforts including surveillance and more (CDC). CDC were the ones who handle Ebola from spreading all over the world (CDC). To prevent cross border transmission CDC screened west African travelers at the airports and the United States also enhanced entry screen for those who were coming from Sierra Leone, Guinea and Liberia (CDC). Scientists are now trying to find ways to come up with vaccines that will help to prevent it from coming back Ebola was one of the top spreading diseases in African countries.

Ebola virus disease mainly about a zoonotic disease caused by Genus Ebola virus infection. It is an epidemic disease and commonly causes fatality not only among the humans infected but also among the animals like chimpanzees, monkeys and gorillas. The Ebola virus commonly infect people who lived in Guinea, Liberia, Sierra and Leone. This disease was first discovered in 1976 where there are two cases of fatal haemorrhagic fever happened in different parts of Central Africa which are near the village at Ebola river and around South Sudan. There are several types of Ebola virus, such as Zaire Ebola virus, Sudan Ebolavirus, Tai Forest Ebola virus, Bundibugyo Ebola virus, Reston virus and Bombali Ebola virus. Within these types of several viruses, only few of them can cause disease which are Zaire, Sudan, Tai Forest and Bundibugyo viruses (Centers for Disease Control and Prevention, 2018). Meanwhile, Reston virus can cause disease in nonhuman primates and pigs while Bombali cannot be determined whether it can cause disease in either animals or people.

As mentioned above, there are two cases of fatal Ebola virus disease discovered in 1976 at Ebola River at Central Africa and at South Sudan. Since then, the virus has been infecting people from time to time, lead to outbreaks in several African countries. The scientists do not know on what causing Ebola virus disease. However, based on the nature of similar viruses, they believe the virus is by animal transmission, with bats commonly function as vector. The bats which carry the virus can transmit it to other humans and animals as hosts such as chimpanzees, monkeys as well as gorillas. The human can be infected from the animals usually because of the person’s in contact with another infected person’s body fluid or with the humans which die due to the Ebola virus disease. Moreover, if the person has a broken skin, the virus can easily penetrate into the body through skin. Plus, the virus also can be transmitted by sexual transmission (World Health Organization, 2018).

Structure of Ebola virus

The shape generally in long cylindrical and tubular shape and it can be appeared as a “U-shaped” and circular. It has approximately 80 nm in diameter and 970 nm long. The virus contains viral envelope, matrix, and nucleocapsid components. They have a virally encoded glycoprotein (GP) projecting as 7-10 nm long spikes from its lipid bilayer surface. Glycoproteins are proteins that contain carbohydrate chains (glycans) covalently attached to their polypeptide side chains. The glycoprotein GP is the sole resident of the Ebola virus surface and is the only surface proteins that accounted for both attaching to and entering the new host cells. The outer viral envelope of the virion is derived by budding from domains of host cell membrane into which the GP spikes have been inserted during their biosynthesis (Sagar Aryal, 2018). Ebola virus has a single stranded RNA genome which encoding eight structural proteins which are nucleoprotein, virion protein, polymerase protein, transmembrane glycoprotein and soluble glycoprotein (Daniel R. Beniac & Timothy F. Booth, 2017).

Symptoms of Ebola virus disease

Several symptoms can be observed from the Ebola virus patients. For instance, at the early stage of infection, the patients will undergo fever, severe headache, muscle pain, weakness, fatigue, vomiting, diarrhea as well as abdominal pain and in severe condition, haemorrhage. These symptoms can be occured anywhere in 2 to 21 days after being infected. However, there are also common illness which can have these same symptoms like malaria and influenza (Centers for Disease Control and Prevention, 2018).

Inside the cell, the protein virus which is glycoprotein will disrupt the cell structure. The cells will have problems to adhere to each other and to the extracellular matrix. Within the blood vessel, the penetration of the virus causing the blood vessel to disrupt which resulting in leaky and haemorrhagic blood vessels. Plus, Ebola virus also affect the liver cells. The liver’s ability to clear toxin out of body was reduced. Besides, the virus also affect the immune system which resulting in increase of area of infection. This will cause more organ failure which lead to fever, diarrhea, vomiting and resulting in increase of loss of electrolytes, blood plasma and fluid (Ilana Kelsey, 2014).

Transmission of disease

During the first outbreaks of Ebola virus disease, it is found that the infection was transmitted and spread easily due to the uses of needles and syringe. For instance, in the first outbreak at Republic of Congo, the nurses reported that they use five syringes for 300 to 600 patients per day.

In 1989, scientists discovered the Reston Ebola virus and confirmed that the infection spread by droplets’ transmission among the monkeys, however, it is not proven that the air-borne transmission can be a significant factor among the humans. After the outbreak of Cote d’Ivoire Ebola virus outbreak, the health practitioners had been aware of the usage of contaminated needles and syringe by introducing the disposable needles. They also decrease the transmission of disease by using face masks, gloves and gown of healthcare personnel. By 1995, Zaire Ebola virus outbreak, the public health community educate the community on how the disease transmit and the healthcare practitioners also has been provided of the necessary equipment. During 2014-2016, Ebola outbreak has been occured in West Africa, mainly transmitted among the family members which may be because there is direct contact with the dead person suffered from Ebola virus disease (Centers for Disease Control and Prevention, 2018).

Ebola virus has a genetic material called DNA which used for assembling new viral particles. However, in order to form new viral cells, the virus cannot replicate within itself and it need another host cell to reproduce. Thus, it must enter the cell membrane of the host cell which protects the cell from its environment. The penetration of virus to the cells will trigger the cells to engulf the virus. The virus takes opportunity of the non-specific engulfing process which called “macropinocytosis”, which allows the viral to be entered into the host cell via wave-like motion of the cell membrane (Ilana Kelsey, 2014).

Diagnosis

Diagnosis of Ebola virus disease can be difficult because at early stage, the symptoms are similar to the other common diseases like malaria and influenza such as fever, fatigue and vomiting. Thus, the Ebola virus disease can be confirmed by combining to the other symptoms like the possible exposure to the Ebola virus disease within the 21 days. The exposure may be due to a person’s direct contact with the other person’s blood or body fluid infected by the Ebola virus disease. The patients also may touch the objects which contaminated to the blood or body fluid of the person having the disease or with the person who died from Ebola virus disease. In addition, the patients also may eat the infected fruits bite by the infected bats and last but not least, the person may sexually infect with the semen by an infected man. However, if the person has showed the early sign and the possible exposure, they should be isolated from other persons to prevent from being infected. The patients’ samples of blood should be collected and recorded. If the laboratory test shows positive results, thus, the disease was confirmed (Centers for Disease Control and Prevention, 2018).

Treatment

Currently, there is no vaccines available for Ebola virus disease. Thus, the doctor only treated the patients by providing sufficient fluids and electrolyte by intravenous. The patients also will be given the oxygen therapy to maintain the patients’ oxygen status and blood pressure. They also will be treated for the other infections. However, in October 2014, the World Health Organization licensed two Ebola virus vaccines which are cAd3-ZEBOV and rVSV-ZEBOV. cAd3-ZEBOV contained Ebola virus gene in it by using chimpanzee-derived adenovirus as a vector which has been developed by GlaxoSmithKline in collaboration with the United States National Institute of Allergy and Infectious Diseases (NIH). Meanwhile, rVSV-ZEBOV vaccines uses weakened virus which is one of them contained Ebola virus. Other than that, the patients also can be treated with antiviral therapies such as ZMapp which consist of three chimeric monoclonal antibodies. The patients also will be treated with two antiviral drugs, favipiravir and remdesivir. However, these therapies are still under experimental settings and clinical trials (European Centre for Disease Prevention and Control).

Prevention

If Ebola virus diseases occur in Malaysia, we must take some precautions in order to prevent the disease from being spread rapidly. First and foremost, the Ebola patients must be isolated from the community to prevent them from infecting others because the community do not have protective attire. We also must avoid ourselves from come in contact with the blood and body fluids or even the patients’ equipment (Centers for Disease Control and Prevention, 2018). Besides, the healthcare practitioners also must wear protective clothing such as masks, gloves and goggles in order to avoid themselves from being infected whenever the Ebola patients came to the hospital. Furthermore, the hospital also must use a the sterilize equipment such as needle and syringe to prevent the disease from being spread and the equipment should not be shared among the patients. During the outbreak, we are also must be prohibited from getting too close or in contact with the chimpanzees, monkeys and bats because they may be had been infected (European Centre for Disease Prevention and Control).

The Ebola virus is a fatal disease that spreads rapidly from human to human. Ebola is a type of filovirus, this is a virus that causes extreme haemorrhagic fevers to humans and some animals. This virus has two known diseases in it: The Marburg virus and The Ebola virus. The difference between these two filoviruses is that polyadenylation is a main factor in the ebola virus whereas it is not prominent in the Marburg virus. Another difference is that there are three overlaps in Ebola and only one in Marburg but this doesn’t mean they both aren’t extreme viruses because they no doubt are extremely severe and both are considered an epidemic.

The Ebola virus is split into five different strains, these include: 1) zaire (which was the 2014 outbreak); 2) bundibugyo; 3) sudan; 4) reston; 5) tai forest. Zaire, Bundibugyo, and Sudan are associated with the largest outbreaks in Africa. The Zaire and Sudan are the most common and most fatal for humans whereas the Bundibugyo and Tai forest have only been seen a few times (Chapnick, 2020).

In 1976, The Ebola virus was first discovered near the Ebola River (where the name came from), this river is now the democratic republic of Congo (CDC, 2019). Scientists and Researchers behind this Virus don’t know where the virus comes from but they have an idea that the virus originates from animals because of the nature of viruses that contain similar symptoms (CDC, 2019).

The Virus is said to perhaps be an animal-borne disease and because it’s a haemorrhagic disease the virus can easily spread when humans come in contact with infected blood or bodily fluids (mucus, urine, saliva). The virus can even be spread through all types of sex and can remain in human body fluids (including semen) even when recovered from the disease (CDC, 2019). As it’s a haemorrhagic disease, the consumption of wild animals or bites from wild animals is potentially the main cause of Ebola transmitted from animal to human.

The signs and symptoms entering the body from the virus can often be quite fatal. The symptoms usually appear 8 to 10 days after coming in contact with the virus. The virus is said to progress from “dry” symptoms in the early stages to then “wet” symptoms. These include: fever, aches and pains, loss of appetite, unexplained bruising or bleeding, weakness and tiredness, gastrointestinal symptoms (vomiting, diarrhea). The effects of these symptoms can leave an extremely distressed body. The Ebola virus can be detected in the blood even 10 years after recovery, and recoverers found to have a stronger and protective immunity to the Ebola virus (CDC, 2019). This disease can often leave people with organ failure, severe bleeding, delirium, seizures, coma, or shock which can all affect the body in extremely terrible ways. For survivors the recovery is brutal and slow, they may experience: hair loss, sensory changes, headaches, eye inflammation, and even testicular inflammation. These symptoms may last for months and may find it difficult to regain weight and strength (Clinic, 2020).

Ebola is one of the most fatal diseases meaning not many people survive. The average Ebola case fatality rate is estimated at around 50%, but the death rate has varied from 25% to up to 90% in the past (WHO, 2020). In 2016 the total cases and deaths were identified, as seen in the graph. Guinea had an outstanding amount of deaths at 2,544 deaths out of 3,814 cases, the results that came from those cases were 11,325 deaths. The virus is also said to be more deadly than contagious, as the average number of people that can be infected by one single parent is on average 1.5-2.5 and the case fatality rate is 70%.

The healthcare systems were greatly affected as an additional problem caused by the Ebola virus, this then led to greater mortality and morbidity. A survey was done in 2013 as little was known about healthcare when the pandemic was in action, the survey was conducted to identify whether people were getting treated well and how the support system was managing throughout the tragic time. 67% of urban and 46% of rural respondents recognized that it was near impossible to access healthcare whilst the epidemic was around. In urban areas, only 20-30% of people seeking care were able to receive healthcare and in rural areas, there was only 70-80% able to access it (ASTMH, 2017). The healthcare systems were struggling immensely during the epidemic which created more patients to become sick as well as impact mental health as there were no support systems.

As a rule, developing countries tend to lack comprehensive and stable civilian structures for dealing with disasters, therefore disaster response in these countries often relies almost entirely upon the military as well as on international civilian and military assistance. Military engagement in disaster relief may contain the negative consequences of major disasters and prevent the crisis from spilling across borders. In my report I will reflect on the positive and negative aspects regarding the military’s logistic response.

When it comes to aid, sometimes the military are the only actors capable of providing the necessary response, Fischer (2011) in Malesic (2015) reports that many experts, influenced by the experiences of complex disasters, have advocated that humanitarian relief should become one of the core and standardized tasks of a modern army. However, Etkin et al. (2011) in Malesic (2015) say that “military assets should be selectively and adequately employed to supplement as opposed to replace civilian disaster management authorities and assets”.

According to Ross (2017), “Early coordination mechanisms failed and the president took operational control away from the Ministry of Health and Sanitation and established a National Ebola Response Centre, headed by the Minister of Defense, and District Ebola Response Centers. British civilian and military personnel were deeply embedded in this command-and-control architecture and, together with the United Nations Mission for Ebola Emergency Response lead, were the dominant coordination partners at the national level”.

A common criticism was that civilian and military disaster management structures do not invest enough will and energy in improving coordination, planning, training, etc., or ‘best practice’. I will elaborate on this later on in the report.

However, there were several aspects though which were out of the military’s control. For example, the different culture and language.

These can be said however to have slowed the operation down. A point that could be made was that, according to Draper (2017), “The most commonly reported challenge from a more ‘ethical’ perspective was whether the unit should have treated more patients”. “Our participants reported that the treatment unit was consistently running under capacity: the facility was never full, it never got beyond 50% capacity and yet there were clear groups of people it wouldn’t take. Many regarded this as a significant ethical challenge because the facilities, expertise and resources were standing idle in a sea of need”. From this It could be said that more patients could have been treated.

Logistical reasons for this could be that the perception that Operation Gritrock was essentially a medical operation whereas military healthcare personnel normally deploy to support combat missions. Draper (2017) concluded that this had the effect of confusion with those on the ground ‘unable to take responsibility for, or justify, the decisions being made, leaving them to implement decisions that, as far as they were concerned, did not make sense in the context of their understanding of the mission. This was also a source of perceived ethical tension’. This is in my opinion is a somewhat cynical and complex viewpoint.

Moving on, polls conducted following the US military assistance during the tsunami in South-East Asia and the earthquake in Pakistan showed a significant increase in positive sentiments towards the US among both the Indonesian and Pakistani population. “There is also the added benefit of establishing useful contacts between the US military officers involved in the operation and the representatives of other militaries, local and international officials and other stakeholders”, and importantly the residents in other words, building trust.

Problems in the delivery of aid included a lack of a ‘harmonized’ approach, in other words being able to coordinate and deliver a unified strategy. In terms of performance the UK military could be said to have struggled to mobilize aid at the right place at the right time. If the military were able to work better at the ‘grass roots’ level with the local government etc., then aid could have reached those in need quicker and Operation Gritrock could have been more successful. Obviously however, the blame does not rest solely with the military, the other organizations can be said to have been standoffish and possibly not willing to collaborate, for example, sharing of resources.

It was necessary for the military to mobilize in Sierra Leone and although the military provided a successful logistic response in terms of being able to mobilize and move resources quickly and efficiently, for example by helicopter. There was clashing between military and civilian organizations, such as NGOs and the local government. To expand on this, it was often hard to collaborate create a joint effort due to conflicting goals however again, the military’s overall goals; to provide security, mobilize troops to build an emergency hospital as well as the Ebola training academy are all positives.

According to Draper (2017), “Many participants regarded themselves as having volunteered for deployment. Indeed, some participants reported making strenuous efforts to go. Nonetheless, for these participants, the decision to volunteer was an ethical one. The majority felt compelled to respond to the unfolding humanitarian crisis and human suffering it was generating”, and the military went into the crisis with nothing but good intentions.

It is clear that a disaster which requires the armed forces to work alongside civilian rescue and search teams, the general public, political decision-makers and humanitarian organizations represents opportunities for a unique civil-military interface. This can foster cooperation and a mutual transfer of values. Alternatively, it may result in competition, conflict and a clash of organizational cultures. It could be said that problems with coordination, politics and tensions in relationships hampered the response, but as the response mechanisms matured, coordination improved and rifts healed.

Hofmann and Hudson (2009) in Malesic (2015) maintain that, “despite the criticism, many humanitarian actors accept the idea that the military can play a legitimate and vital role in supporting humanitarian relief efforts. The argument is that humanitarian organizations should engage more strategically with military organizations in order to overcome the possible risks that may arise from civil-military cooperation, and to reinforce the potential benefits that military involvement could bring to the affected population”.

In conclusion, the UK military were able to deploy quickly and in a ‘variety of roles’ (IWM, 2021). Six Ebola treatment centers were built in collaboration with, for example, the royal engineers and the local military and civilian contractors, checkpoints and tracking of people which helped to bring the virus under control as well as specialist medics providing treatment to other NGO medical workers also the military coordinated with civilians at district emergency response centers. All these points demonstrate that the UK military worked with distinction in a very difficult situation.

References

1. Draper, H., Jenkins, S. 2017. Ethical Challenges Experienced by UK Military Medical Personnel Deployed to Sierra Leone (operation GRITROCK) during the 2014-2015 Ebola Outbreak: A Qualitative Study. BMC Med Ethics 18, 77 (2017). https://doi.org/10.1186s12910-017-0234-5
2. IWM, 2021. How the British Armed Forces Helped Fight Ebola in Sierra Leone. Available at: https://www.iwm.org/ukhistoryhow-the-British-armed-forces-helped-fight-Ebola-in-sierra-leone
3. Malesic M. 2015. The Impact of Military Engagement in Disaster Management on Civil-Military Relations. Current Sociology. 2015;63(7):980-998. doi:10.11770011392115577839
4. Ross E. 2017. Command and Control of Sierra Leone’s Ebola Outbreak Response: Evolution of the Response Architecture. Phil. Trans. R. Soc. B 372.