Benson Cowan is a Toronto lawyer and a writer. He currently lives in Liberia where he works for a large international organization.
When I arrived in Liberia in early July, the total number of reported cases of Ebola Viral Disease (EVD) was less than 200. When I left Monrovia for New York at the end of September, the total number of cases was about 4,000. The curve of the graph has been predictable – the number of cases doubles every two to three weeks; these are reported cases. Most experts expect that the number of actual cases is at least two or three times the official number. Different projections suggest that by the new year, if left unchecked, the total number of cases across West Africa could easily exceed 500,000. Even the best-case scenarios consider that it will take many months to turn the tide. At this point it is an even bet that EVD will be endemic in West Africa indefinitely.
The North American media has been reporting on the outbreak in its usual sporadic and sensationalistic waves. While EVD has penetrated the consciousness of North Americans it remains a vague but frightening event in Africa where so many vague and frightening things have happened over the years. It is easy to think that it is something happening there and not here. But this is wrong. The horror of this disease will not stay in West Africa. So we should get ready for it.
I saw Liberia's weak health care system crumple under the weight of the early stages of the epidemic. But as the recent events in Dallas show us, even the most advanced health care systems can get scrambled when they have to confront Ebola. There are a few lessons that we can draw.
First, all travellers from West Africa should be tracked by public health authorities when they arrive. Don't believe the general assurances from governments that this is happening. In the fewer than three hours it took me travel from Monrovia to Accra, I had my temperature taken four times. Had I been symptomatic for that period, I would have been detected, but for a disease that takes up to three weeks to incubate it is not a particularly effective prophylactic measure. In leaving Accra, flying into New York City and then, six days later, entering Canada, the fact that I was coming from EVD ground zero was not noticed – despite a clear stamp in my passport – and required no explanation or assurances from me. I strongly believe that keeping the skies open to travellers from West Africa is essential. But it is foolish not to track and follow up with all travellers from the region.
Second, the public health response has to be nuanced. This disease terrifies people. The outbreak in West Africa has a fatality rate in excess of 70 per cent so, to some extent, the fear is rational. But if health care professionals are not educated about EVD and trained to ensure that potentially infected people are welcomed into care then patients will go underground or resist care. Treatment – including the quarantine process – for EVD should not feel like a lockdown at a maximum security prison. For it to be effective it must be safe, of course, but it must treat the patients as subjects to be healed – not objects to be decontaminated and destroyed in the event of death.
As we saw in Dallas, the health care system failed to address these concerns in a number of ways. Thomas Duncan, the EVD-positive traveller, lied about his exposure to the disease. This should not come as a surprise. It is worth noting that had he stayed in Liberia he probably wouldn't have found an available hospital bed and would have fallen sick at home in his community, possibly infecting dozens of others. When he did show up to a hospital, because of insufficient knowledge about EVD, he was sent home. By the time he was admitted to hospital he had brought others into potential contact with the virus. Then no one would remove and dispose of his bedclothes and his family were forced into quarantine. And this was only one case in a wealthy, sophisticated city with world-class health care professionals.
The third lesson is that we have to do all we can to stop the spread of EVD. It must be beaten on the ground. Liberia, Guinea and Sierra Leone are among some of the poorest countries in the world. This poverty, some of the local cultural practices, and a legacy of ineffective central governments have combined to make exceptionally fertile conditions for the spread of the disease. Developed governments have been slow to address the problem and each incremental step that is taken to increase aid is, by the time it makes its way to the ground, too little and too late. At this point, a response that it is adequate to address the devastation on the ground will have to be massive, fast and sustained for months and months. Such a response, if it is to be effective, might appear from here to be excessive, an over-reaction. But even then, by the time it gets on the ground, it might not be enough to stop EVD.
One way or another, this is now the time of Ebola. How we turn to address this problem will mean the difference of tens – if not hundreds – of thousands of lives. This is not a West African problem. It requires a co-ordinated, smart and human global response. And for North America this should start with better public health tracking of travellers from the affected countries.