Although Ebola has been around since 1976, it wasn’t until 2014 that this virulent disease was declared a worldwide epidemic. For the first time in history, the death toll from a single outbreak reached into the thousands. Ebola remains a virus that is primarily localized in West Africa with a few outside cases attributed to travel. The risk of acquiring Ebola virus disease (EVD) is sensationalized in the United States; however, the real risk is in affected countries that have fragile health care systems and lack basic medical resources and personnel. The root of this global epidemic is an issue of public health infrastructure.
As a developed country, we are fortunate to have a robust health care system; the same cannot be said about the countries affected in West Africa. In Sierra Leone, there are only two physicians per 100,000 people compared to 245 physicians per 100,000 in the United States. Additionally, lack of access to medical facilities is widespread; infrastructure of existing facilities is strained due to a burdensome number of patients, and they often face shortages of equipment and resources. Community health workers are also needed to encourage sick patients to come to the hospital to access care as well as aid in quarantine efforts. Poorly equipped hospitals contribute to the high rate of disease spread and mortality. Such areas of vulnerability in health care are the prime reasons developing countries like Guinea, Sierra Leone and Liberia have been devastated by this disease.
To complicate matters, hospital workers in EVD-affected regions are especially vulnerable to Ebola. The Centers for Disease Control and Prevention (CDC) recommends a list of measures to prevent transmission in the medical setting. Health care personnel should adhere to a strict personal protective equipment protocol and universal blood and bodily fluid precautions and practice infection control and sterilization. Health care personnel also should ensure that individuals who have come into direct contact with the virus undergo a period of isolation. The scarcity of adequate infection control and proper training continued to put health care workers and thus more patients at risk of contracting Ebola, contributing to the challenge of breaking the transmission chain in this domino effect.
While we are better equipped medically to contain the sporadic Ebola cases we receive, our public health surveillance systems continue to monitor for potential cases at the local, state and national levels. The CDC has led the prudent efforts to mitigate the spread of this disease in our country by giving up-to-date information on EVD, conducting specialized training of emergency responders, interdicting travelers from affected countries at airports with enhanced screening, subjecting suspected infected persons to quarantine, interviewing family members and deploying public health experts to the affected countries. The CDC has worked tirelessly although not without controversy in leading and supporting the control of this disease.
In January, the first doses of the Ebola vaccine were to arrive in West Africa, created by GlaxoSmithKline and other companies with the National Institutes of Health. Another vaccine by Merck and the Ames, IA-based NewLink Genetics were to be tested as well. In addition to this critical step, our current best protection against EVD remains to practice strict prevention measures, increase access to quality health care services and provide assistance to strengthen health care infrastructures in Ebola-affected areas in order to end this worldwide epidemic.
Sources: World Health Organization; Centers for Disease Control and Prevention; Department of Homeland Security
Disclaimer: This is written from the perspective of an M.P.H. student and not as an employee of the state of Iowa.