The Ebola epidemic in West Africa is by far the biggest Ebola epidemic the world has seen so far. Many people wonder why the virus could spread so far here. The Ebola outbreaks in the past in countries like Uganda or Congo could be brought under control much earlier. I’m sure there are many different reasons for this. But one reason which is mentioned again and again, doesn’t seem to hold true: It is claimed that it is the first Ebola outbreak ever in West Africa.
It’s true, it is indeed the first Ebola outbreak in Sierra Leone, Liberia and Guinea. But the border region between Liberia and Sierra Leone is famous for being the hotspot of another virus: Lassa.
Until very recently, I didn’t know anything about Lassa. Incidentally I came across the following paragraph in the book “Chasing the Devil”, written by Tim Butcher:
„Lassa is one of the world’s deadliest diseases and not one to take chances with. It is a viral haemorrhagic fever, similar to ebola, that inflicts a slow and painful death on its victims by destroying blood vessels and causing bodily extremities to swell with excess fluid, like balloons filling with water. In extreme cases blood can gush from nostrils, eye-sockets, ears, even fingernail beds, and victims often die from drowning as their lungs fill with liquid.
What makes lassa so dangerous is that all secreted fluids can carry the virus, so family members, nurses or doctors looking after a victim can easily become contaminated. Entire families can be wiped out and the fatality rate among health workers, especially in the undeveloped world, is often terribly high. When scientists handle the virus in research facilities in the developed world they apply the highest safety standards, known as Biosafety Level 4 (BSL-4), wearing sealed suits inside special laboratories where the air is not just filtered but kept at a pressure lower than atmospheric pressure, so that if there is an accidental leak the air inside the chamber cannot readily leak out. If caught early enough – something that requires sophisticated clinical testing – lassa fever is treatable with antiviral drugs, but by the time it is identified in rural areas in Africa, for example, where testing is limited, it is often so advanced that treatment becomes a battle of fluid levels as medics try to stop the patient from bleeding out while at the same time stopping themselves from becoming infected. Kenema lies in the border area between Sierra Leone and Liberia, a region with the unfortunate distinction of being one of the world’s lassa hotspots. It is most commonly spread by infected rats, through urine trails which they have the unsavoury habit of dripping everywhere as they move.”
That sounds very familiar. In both cases, Lassa as well as Ebola, we are talking about a haemorrhagic fever, and both have to be treated with the same high level of security. By all means: Why was nobody in Sierra Leone prepared for Ebola? Knowledge as well as equipment for viral infections like this should have been in the country already!!! Especially considering measures like the Hyogo Framework for Action (2005-2015), which brought disaster preparedness high on the international agenda.
MSF (Medecins Sans Frontieres) published a report last week and was pointing on similar observations, thereby referring to the last big health crisis, the Cholera epidemic in Haiti:
“The Ebola outbreak has often been described as a perfect storm: a cross-border epidemic in countries with weak public health systems that had never seen Ebola before,” said MSF general director Christopher Stokes.
“Yet this is too convenient an explanation. For the Ebola outbreak to spiral this far out of control required many institutions to fail. And they did, with tragic and avoidable consequences.”
The lessons learned by the WHO from the last international pubic health crisis, the cholera outbreak in Haiti that began in 2010 – were simply ignored and not put in place, says the report.
It is useless to look for one guilty person or agency. But what was missed out after Cholera and Lassa should not be missed out again: To learn from mistakes.
This is a translation of my original article in German.