That got your attention.
Yesterday the first known North American case of Ebola was announced in the media. The luckless bastard who contracted the disease, Thomas Eric Duncan, had recently travelled to Liberia and came into contact with a symptomatic carrier of the virus, reportedly because he kindly helped a pregnant woman to the hospital when she went into labour; a common act of kindness that may cost him his life.
Public hysteria and internet disinformation aside, here’s the way that Ebola works: It’s a virus, transmitted via bodily fluids, which takes a couple of weeks to set up shop and then proceeds to destroy the victim’s internal organs, causing fever, vomiting, diarrhea, and eventually the hemorrhaging of a lot of blood. All of the victim’s now-evacuated fluids are jam-packed with the virus itself, which is how the virus reproduces and spreads. It is a brutally, horribly painful way to die… and it is usually, although not invariably, a fatal affliction for the unfortunate victim.
Here’s the thing, though: You can’t just “catch” Ebola — it’s not airborne. Your mucous membranes have to have contacted the bodily fluids of somebody currently suffering the symptoms of the disease. The initial phase, where the virus is in the body but still setting up shop, is non-contagious unless you actually go out of your way to consume the infected tissue (which is how they figure this outbreak got started — people eating meat from animals infected with the virus). Even after the victim is symptomatic as long as basic medical precautions are taken such as wearing medical barriers like gloves and breathing masks, sterilizing the environment and medical equipment, and so on — stuff our hospitals are very careful to do already — then the threat of the virus spreading is minimal.
So why are thousands of people in western Africa dying of this disease?
John Green, who along with his brother Hank is the founder of the online community/subculture Nerdfighteria, (full disclosure: I identify as a member of the Nerdfighter subculture) posted an excellent vlog about six weeks ago that pretty much sums up the problem: Ebola is spreading because of a lack of public health infrastructure in the afflicted countries.
It is extremely difficult to prevent infection by a virus with Ebola’s contagion vector when you don’t have latex gloves, sterile facilities or even, as is often the case in these countries, clean water. As a good example Liberia has (or at least had at the most recent census) exactly 51 registered doctors for a population of approximately 3.8 million people. Most of those doctors work outside the major cities in facilities that often lack the most basic amenities, like a water tap or a sewage system. One point that John Green makes in the vlog post I linked above is that a lot of the virus’ spread can be contained simply by providing clean, running water and bleach to these healthcare professionals trying to contain the disease. In many cases, the healthcare workers themselves — educated people who know the risks involved — are becoming infected simply because of the lack of proper resources to prevent the spread of infection.
The fact that these people, lacking the most basic resources, are still getting up each morning and doing their level best to fight a disease that has a 50-70% mortality rate is why the word “hero” is in our collective vocabulary… and why I despise the cheapening of that word through the modern habit of applying it to people who have done nothing more courageous than beating the point spread.
The Ebola crisis is further complicated by a general lack of education in the effected countries on the threat and transmission of the disease (sadly unsurprising in countries whose educational infrastructure is in worse shape than their medical infrastructure) and widespread public distrust of the authorities. The bodies of the victims must be isolated and carefully incinerated, as must their bedding and anything that has been contaminated with their blood, vomit or feces… and in the final stages of hemorrhagic fever these substances are copiously produced. But in many cases the local custom is that the dead must be carefully washed — by hand! — and buried near the community. (Their goods, including the soiled bedding, are often simply reused by these desperately poor people.) These customs have, sadly, contributed greatly to the spread of the virus and it’s feared that when officials tried to intervene, it merely resulted in people hiding their sick and dead from the authorities in order to follow their traditional burial customs, not knowing (or believing) that this would endanger themselves. Widespread fear and ignorance has even led to frightened people attacking and looting ebola clinics and carrying infected patients away.
The lack of education, the distrust of the authorities and above all the absence of proper infrastructure have come together to create pretty much the perfect environment for a deadly, pervasive virus like Ebola to spread rapidly. This tragedy is going to continue for a long, long time.
Which might explain the western world’s morbid fascination with it. The western response has been all over the map, ranging from pious outrage to smug satisfaction (and then there’s the sick fucks who are eager for it to spread), but generally speaking I’d describe the public reaction as titillated horror. Jokes about zombie outbreaks aside, a lot of people seem to regard the spread of a single patient to North America as the harbinger of the End Times. But it won’t be… in fact, it won’t even be a moderately serious health outbreak. More people will die from the flu in North America this week than will die from Ebola ever, because we have a comprehensive infrastructure in place. While individuals with Ebola are a serious concern for health officials in North America, they have the authority and the public support — not to mention the basic resources — to stop the spread of the virus. Period, end of list. The response of the authorities in Dallas to the case of Mr. Duncan is a clear demonstration that the spread can be stopped with relatively basic precautions and public cooperation: anyone potentially in contact with Mr. Duncan is being identified, tested and if necessary isolated. It doesn’t take draconian laws or superdrugs or TV-drama theatrics; it takes an informed public and basic hygiene.
The solution to the Ebola outbreak, both here and in Africa, is quite simply to invest in a robust healthcare and educational infrastructure. In North America and Europe we already have that infrastructure in place, so Ebola is going to be far less of a threat our public health than traffic accidents.
But in western Africa the the infrastructure clearly does not exist. A recent estimate of the effected countries projected the need for a hundred million dollars in order to deal with the outbreak, which the World Health Organization and the CDC have pledged in support. But that’s only to address the immediate crisis. Real investment in improving the standard of living for people in the poorest parts of the world is desperately needed in order to prevent future disease outbreaks — both of Ebola and others — from threatening global health.
And it’s not just these high-profile diseases that are the problem. Like Influenza, Malaria is far more endemic and will kill more people in any single day than Ebola ever will… but it’s simply prevented and can be effectively treated, and a little bit of funding towards prevention will go a long way. That’s why charitable efforts, such as the awesomely-named Nerdfighter fundraising effort The Foundation to Decrease World Suck or the Gates Foundation are so important.
For centuries, the developed world has treated sub-Saharan Africa as a giant resource-extraction piggy bank; minerals, oil, cash crops and labour (including, sadly, the extraction of human beings as slave labour.) The current wealth of the western world is largely built on the colonial exploitation of the resources of Africa and Asia; the wealth gap between our countries and theirs is largely a reflection of these historical realities. We used them to get a leg up. We’re still using them to keep our costs down… without a corresponding investment in their well-being.
That’s changing a bit, of course: humanitarian investment is beginning to have an effect on the developing world; but it’s not changing fast enough. Real, systematic change needs to occur and it needs to occur now; It’s long past time for the West to start giving back. We live in a world where people can fly anywhere in less than 24 hours: the considerations of common decency and humanity aside, there’s no benefit in having the poorest parts of the world stay poor, and as this outbreak has demonstrated, there’s a least a moderate amount of risk. Governments, global organizations and charities have invested hundreds of millions in dealing with the Ebola outbreak in west Africa. But if this kind of money had been spent on infrastructure even five years ago, when there was no crisis, how many lives could have been saved?