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By Dr. Brian Blodgett
Faculty Member, Homeland Security, American Military University
On April 28, the World Health Organization reported 27 new confirmed Ebola cases. This was the highest number of confirmed cases in a single day and culminated in the highest number of new cases in a week – 126 – since the deadly outbreak started in August.
To date, there have been more than 1,500 cases and over 1,000 deaths. Officials from the World Health Organization warned that they were “anticipating a scenario of continued intense transmission.” The worse outbreak occurred in 2014-2016 and killed a confirmed 11,000 victims in Guinea, Sierra Leone and Liberia.
What Is Ebola?
Ebola first appeared in 1976 in two simultaneous outbreaks – one in Sudan and another in what was then Zaire. While these two outbreaks occurred about 500 miles apart, public health officials initially believed a single person caused them.
Later, they discovered two genetically distinct viruses caused the outbreaks: Zaire ebolavirus and Sudan ebolavirus. Two other strains that can infect humans exist, the Tai Forest ebolavirus and the Bundibugyo ebolavirus.
Considerable research has been done to find “ground zero,” or the location where Ebola began and from where it spreads. However, this location remains hidden in the remote areas of Africa. Experts believe that Ebola was spread to humans by local fruit bats.
Humans Can Be Infected with the Ebola Virus in Different Ways
Human-to-human transmission occurs after direct contact with an infected person’s blood, secretions or other bodily fluids. Transition is also possible by touching surfaces and materials contaminated with the infected bodily fluids.
Ebola’s incubation time ranges from two to 21 days. A victim cannot infect anyone else until he or she develops the symptoms of Ebola, which are:
- A severe headache
- Muscle pain and weakness
- Abdominal pain
- Unexplained hemorrhaging
Stopping the Spread of Ebola
With the movement of individuals from village to village, Ebola continuously finds new people to infect. Since there is no cure or effective vaccination, the only way to stop Ebola from spreading is through quarantine procedures, which is how previous outbreaks were contained. People who were symptomatic were separated from those who were not yet showing Ebola’s symptoms and were cared for by public health workers wearing personal protective equipment (PPE), which covers a person’s skin and clothing and prevents any exposure of the eyes, nose and mouth. For an area to be declared Ebola-free, there needs to be no new cases for 42 consecutive days.
There are several Ebola vaccines under development and two of them are currently undergoing testing. The rVSV-ZEBOV-GP Ebola vaccine is now being tested in the DRC. This vaccine is having an effect on preventing the tertiary generation of cases, but not primary or secondary cases.
Why Is This Ebola Outbreak So Bad?
Halting the most recent outbreak in the DRC – the tenth to date – is being hampered by ongoing civil unrest in eastern DRC. Armed groups operate in the region where the Ebola outbreak is concentrated. Michael Ryan, the World Health Organization’s emergencies chief, states that the lack of security is a major issue in the area’s healthcare facilities.
In a statement to the media, Ryan noted, “Since January, we've experienced 119 separate attacks, 42 of which have been directly on health facilities with 85 health personnel either injured or killed in those settings, so we are dealing with a difficult and volatile situation.” In addition to these attacks, the ability to quarantine Ebola victims is especially difficult due to low institutional trust and a belief in misinformation about Ebola.
In a study by British medical journal The Lancet, researchers found that in an Ebola-affected province, 25 percent of residents did not believe the outbreak was real. In fact, some residents are so distrustful of the government that they believe the disease was purposefully introduced to the area. One local stated, “The problem is that people here in this area believe Ebola is a political thing, and that’s why residents are still attacking the teams in retaliation.”
Can Ebola Become Worse?
Currently, the Ebola outbreak is confined to the North Kivu and Ituri provinces, on the far eastern side of the DRC. Both are over 1,800 miles by vehicle from the largest city in the country.
However, they are unfortunately the two most populous provinces in the DRC, and even worse, border Uganda, Rwanda, and South Sudan. According to Gwenola Seroux, the emergency manager at Doctors Without Borders, “the virus has not spread to neighboring countries so far, but the possibility exists.”
Ebola Could Potentially Reach the US
As far as Ebola reaching the United States, Goma International Airport is in North Kivu and has several flights to New York City. All of these flights first pass through Addis Ababa, Ethiopia, and then go on to either Paris, London or Frankfurt before landing in the United States. Each flight lasts approximately 22 hours.
Due to the extreme variation in the incubation period of Ebola, an infected person could be non-symptomatic when they board a plane at Goma but become infectious during the flight or upon landing. While this scenario may seem unlikely, it remains a possibility, especially if the goal of an international terrorist organization was to infect American citizens via a suicide attack.
As early as 2014, Representative Mike Kelly (R-Penn.) stated in a PolitiFact article, “Think about the job (contagious suicide bombers) could do, the harm they could inflict on the American people by bring this deadly disease into our cities, into schools, into our towns, and into our homes."
Similarly, Representative Robert Pittenger (R-N.C.) commented in the same article, “Our nation is in uncharted water with Ebola and is struggling to respond. Those who seek to destroy us undoubtedly look for opportunities to exploit our weaknesses.”
However, since Ebola is harder to pass on than the influenza or the measles because a person must be exposed to bodily fluids, that does not make it an effective bioweapon. But William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University, stated, “If you had one or two or three cases, it would satisfy one of the goals of a terrorist, which is to create a huge amount of hubbub and instill terror."
What Can Be Done?
At this point, there seems to be very little that can be done about Ebola, other than educating the local populace about the true nature of the disease and preventing healthcare workers from coming under attack. According to Dr. Lui, the international president of Doctors Without Borders, “the response to Ebola had to be more community-based, treating patients as humans, not as biothreat. People prefer to stay in the community, not go to treatment centers.”
However, even if the DRC community accepts outside help, the government has to stop militants from attacking the healthcare centers. That will allow the quarantine to work more effectively.
About the Author
Dr. Brian Blodgett is an alumnus of American Military University who graduated in 2000 with a master’s of arts in military studies and a concentration in land warfare. He retired from the U.S. Army in 2006 as a Chief Warrant Officer after serving over 20 years, first as an infantryman and then as an intelligence analyst. He is a 2003 graduate of the Joint Military Intelligence College where he earned a master’s of science in strategic intelligence with a concentration in South Asia. He graduated from Northcentral University in 2008, earning a doctorate in philosophy in business administration with a specialization in homeland security.
Dr. Blodgett has been a part-time faculty member, a full-time faculty member and a program director. He is currently a full-time faculty member in the School of Security and Global Studies and teaches homeland security and security management courses.