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7:20AM BST 18 Oct 2014
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THE EBOLA VIRUS – its very name seems to have come straight from the heart of
darkness – is striking fear across the globe. It has killed (officially)
4,546 people out of 9,191 infected since the first case in West Africa in
December 2013, but it now poses a risk to millions. Yesterday, David
Cameron, the Prime Minister, described it as the “biggest health threat to
the world in a generation”. A politician’s soundbite, or the
stark reality?
The Belgian scientist who co‑discovered the virus is phlegmatic. Professor
Peter Piot, now director of the London School of Hygiene and Tropical
Medicine, says there is good news – and bad. Back in September 1976, he was
a 27‑year-old researcher at a microbiology laboratory in Antwerp when he
identified the new pathogen. He discovered it in vials of blood taken from a
Flemish missionary nun in Zaire (now the Democratic Republic of Congo), who
had died of a mysterious illness that was killing scores of people. Prof
Piot flew out a few days later, part of a team who would track the virus to
its source – fruit bats – in the rainforest.
Microbiologist Professor Peter Piot co-discovered the virus (REUTERS)
He saw the effects of the disease rampaging through a remote jungle community
of Yambuku, and witnessed the agonising prelude to death, of fever,
dehydration, vomiting, diarrhoea and haemorrhage. The worm-shaped virus,
consisting of just seven genes, attacks the immune system and dissolves the
body’s blood vessels. Most people who are infected die within a month.
Prof Piot knew then that he was dealing with something new and unusual, but he had not yet realised it was a virus that had the potential to kill millions.
“I could never, ever have imagined then that we would have a major epidemic from this virus,” Prof Piot, now 65, says. “In 38 years we had maybe 1,500 deaths – say 40 a year. That is not a public health crisis. I never thought it would come to the point that we see today.”
Despite its terrifying nature, Ebola – named after a small river near the village where the nun died – is actually a poor candidate for the “Apocalypse virus” beloved of Hollywood epics. And Prof Piot insists that it is still impossible to predict how bad the African epidemic will become.
He says that he likes to “put myself in the mind of the virus”. And if you are an Ebola virus then “we humans make a very, very bad host. You need to jump to another host in a week because your host is dead”.
Paradoxically, it is the very virulence of Ebola – it rapidly incapacitates its victims and kills between 50 and 70 per cent of them – that has meant all outbreaks predating this one have rapidly burnt themselves out. A virus wants its host to stay alive and mobile for as long as possible, so it can infect other people. With Ebola, once the symptoms start, you will not be going anywhere (one of the reasons that screening air passengers arriving in the UK may be pointless). Ebola is also hard to catch – it requires direct contact with bodily fluids, and you cannot infect others until you are symptomatic.
So what has changed? Earlier outbreaks occurred in remote areas of the Congo, a vast, sparsely populated nation with few roads. Such places are a form of natural quarantine, says Prof Piot, and after killing a few dozen people – most often doctors and nurses, who are most likely to be exposed to infection – these outbreaks subsided.
But the countries of Guinea, Liberia and Sierra Leone, where the current outbreak has taken root, are very different. More densely populated and urban, with better transport links, they have young, mobile populations who depend heavily on West Africa’s vast fleet of shared taxis to get around (a major transmission risk, not least when they were used to transport infected corpses for burial).
Even so, Prof Piot is convinced that the world could have brought the disease rapidly under control months ago if prompt action had been taken. The World Health Organisation reacted too late, he says, and by the time the seriousness of the outbreak was fully realised it was heading out of control. According to one estimate, it will cost around £1 billion a month to build and staff the treatment centres needed to isolate a notional 100,000 patients, quarantine their contacts and prevent the disease from spreading. So far, despite vague pledges, the international community has given nothing like enough.
“The problem with Ebola is that it is not over until the last patient is either dead or has recovered,” Prof Piot says. “Actually, I thought this outbreak was dying out in May, in Guinea. Then a famous woman, a traditional healer, died, and at her funeral hundreds of people touched the body. Then there was this explosion in three countries.”
The spread of Ebola is, of course, fuelled by the fact that the nations affected have no health systems to speak of (in 2010 there were only 51 doctors in the whole of Liberia) and that traditional funeral practices involve the touching and kissing of the deceased.
“Can it be stopped? It will be a bumpy ride. I am worried for West Africa. We will see a decline in cases eventually, but without a vaccine I am not sure we can stop it.”
Several companies are fast-tracking vaccines: two in particular, one being developed in Canada and one by GlaxoSmithKline in Britain, hold promise. But yesterday GSK said their vaccine would be “too late” for this outbreak and probably not available until late 2015.
Healthcare workers are likely to be the first recipients, as it is Ebola’s ability to strike the very people caring for victims that has contributed to the spread. “Ebola has literally destroyed the health services in these countries,” Prof Piot says. As a result, it is quite possible that more people have died as a result of the lack of treatment for other diseases, such as malaria, than of Ebola itself.
Prof Piot admits to being “very worried” about Africa, but remains optimistic that Ebola will not be a major problem in the West. “Even in Nigeria, when they had a small epidemic, it was quickly contained. The authorities acted promptly, including a non-negotiable quarantine. Also, in Congo, a recent outbreak was contained… and Congo is not the best-organised country in the world.”
However, he agrees that if the African outbreak continues to spread, it is inevitable that cases will occur elsewhere. “If it does get to the UK, I am convinced that we can contain it.” He is also dismissive of claims made by several scientists that the virus could become airborne, pointing to the Aids virus as an example: “Even though it has had millions of passages through humans, HIV is still transmitted in the same way it always was.”
He is more worried that Ebola will mutate into a less virulent strain (something that is more likely as it spreads through a larger population) – one that may only kill 30 per cent of those infected. “That may well lead to more secondary cases [because more infected people will be mobile for longer].”
There is no evidence that the virus is becoming more virulent and reports that the death rate have risen from 50 to 70 per cent are a result of insufficient data during the early days of the outbreak, Prof Piot insists. A strong public health message is being broadcast by local radio stations and there are signs that dangerous practices, such as open coffins at funerals, are on the wane.
There is some truth in the Prime Minister’s assertion yesterday. Ebola has killed thousands of Africans and will kill tens of thousands more, possibly millions, before it is brought under control. It has the potential to destroy the economies of some of the poorest nations on Earth (Sierra Leone’s nascent tourist industry is probably now dead) and spread to other continents where millions live in poverty.
But there is hope, too, says Prof Piot. “Change in behaviour has to come from within these communities, not from a bunch of white doctors telling people what to do.”
And we need to spend the money. A billion pounds a month sounds a lot, but it is eight times less than the world spends on video games. We can’t afford not to defeat Ebola.
Prof Piot knew then that he was dealing with something new and unusual, but he had not yet realised it was a virus that had the potential to kill millions.
“I could never, ever have imagined then that we would have a major epidemic from this virus,” Prof Piot, now 65, says. “In 38 years we had maybe 1,500 deaths – say 40 a year. That is not a public health crisis. I never thought it would come to the point that we see today.”
Despite its terrifying nature, Ebola – named after a small river near the village where the nun died – is actually a poor candidate for the “Apocalypse virus” beloved of Hollywood epics. And Prof Piot insists that it is still impossible to predict how bad the African epidemic will become.
He says that he likes to “put myself in the mind of the virus”. And if you are an Ebola virus then “we humans make a very, very bad host. You need to jump to another host in a week because your host is dead”.
Paradoxically, it is the very virulence of Ebola – it rapidly incapacitates its victims and kills between 50 and 70 per cent of them – that has meant all outbreaks predating this one have rapidly burnt themselves out. A virus wants its host to stay alive and mobile for as long as possible, so it can infect other people. With Ebola, once the symptoms start, you will not be going anywhere (one of the reasons that screening air passengers arriving in the UK may be pointless). Ebola is also hard to catch – it requires direct contact with bodily fluids, and you cannot infect others until you are symptomatic.
So what has changed? Earlier outbreaks occurred in remote areas of the Congo, a vast, sparsely populated nation with few roads. Such places are a form of natural quarantine, says Prof Piot, and after killing a few dozen people – most often doctors and nurses, who are most likely to be exposed to infection – these outbreaks subsided.
But the countries of Guinea, Liberia and Sierra Leone, where the current outbreak has taken root, are very different. More densely populated and urban, with better transport links, they have young, mobile populations who depend heavily on West Africa’s vast fleet of shared taxis to get around (a major transmission risk, not least when they were used to transport infected corpses for burial).
Even so, Prof Piot is convinced that the world could have brought the disease rapidly under control months ago if prompt action had been taken. The World Health Organisation reacted too late, he says, and by the time the seriousness of the outbreak was fully realised it was heading out of control. According to one estimate, it will cost around £1 billion a month to build and staff the treatment centres needed to isolate a notional 100,000 patients, quarantine their contacts and prevent the disease from spreading. So far, despite vague pledges, the international community has given nothing like enough.
“The problem with Ebola is that it is not over until the last patient is either dead or has recovered,” Prof Piot says. “Actually, I thought this outbreak was dying out in May, in Guinea. Then a famous woman, a traditional healer, died, and at her funeral hundreds of people touched the body. Then there was this explosion in three countries.”
The spread of Ebola is, of course, fuelled by the fact that the nations affected have no health systems to speak of (in 2010 there were only 51 doctors in the whole of Liberia) and that traditional funeral practices involve the touching and kissing of the deceased.
“Can it be stopped? It will be a bumpy ride. I am worried for West Africa. We will see a decline in cases eventually, but without a vaccine I am not sure we can stop it.”
Several companies are fast-tracking vaccines: two in particular, one being developed in Canada and one by GlaxoSmithKline in Britain, hold promise. But yesterday GSK said their vaccine would be “too late” for this outbreak and probably not available until late 2015.
Healthcare workers are likely to be the first recipients, as it is Ebola’s ability to strike the very people caring for victims that has contributed to the spread. “Ebola has literally destroyed the health services in these countries,” Prof Piot says. As a result, it is quite possible that more people have died as a result of the lack of treatment for other diseases, such as malaria, than of Ebola itself.
Prof Piot admits to being “very worried” about Africa, but remains optimistic that Ebola will not be a major problem in the West. “Even in Nigeria, when they had a small epidemic, it was quickly contained. The authorities acted promptly, including a non-negotiable quarantine. Also, in Congo, a recent outbreak was contained… and Congo is not the best-organised country in the world.”
However, he agrees that if the African outbreak continues to spread, it is inevitable that cases will occur elsewhere. “If it does get to the UK, I am convinced that we can contain it.” He is also dismissive of claims made by several scientists that the virus could become airborne, pointing to the Aids virus as an example: “Even though it has had millions of passages through humans, HIV is still transmitted in the same way it always was.”
He is more worried that Ebola will mutate into a less virulent strain (something that is more likely as it spreads through a larger population) – one that may only kill 30 per cent of those infected. “That may well lead to more secondary cases [because more infected people will be mobile for longer].”
There is no evidence that the virus is becoming more virulent and reports that the death rate have risen from 50 to 70 per cent are a result of insufficient data during the early days of the outbreak, Prof Piot insists. A strong public health message is being broadcast by local radio stations and there are signs that dangerous practices, such as open coffins at funerals, are on the wane.
There is some truth in the Prime Minister’s assertion yesterday. Ebola has killed thousands of Africans and will kill tens of thousands more, possibly millions, before it is brought under control. It has the potential to destroy the economies of some of the poorest nations on Earth (Sierra Leone’s nascent tourist industry is probably now dead) and spread to other continents where millions live in poverty.
But there is hope, too, says Prof Piot. “Change in behaviour has to come from within these communities, not from a bunch of white doctors telling people what to do.”
And we need to spend the money. A billion pounds a month sounds a lot, but it is eight times less than the world spends on video games. We can’t afford not to defeat Ebola.
