How Ebola is stealing attention from illnesses that kill more people


A sick child waiting for help outside the John Fitzgerald Kennedy hospital in Monrovia, the capital of Liberia, on Sept. 3. (Dominique Faget/AFP/Getty Images)

The Ebola virus has killed more than 2,100 people in four West African nations, and it has left the international community scrambling to contain it.

But as deadly diseases go, Ebola isn't nearly as contagious as tuberculosis, which can be spread through the air. And it isn't as deadly as HIV/AIDS.

It's no malaria, which in Liberia killed 1,725 people and sickened more than 1.4 million in 2012. Cholera was responsible for 1,146 deaths in Liberia in 2011.

So far this year, during the worst Ebola outbreak in history, the virus has killed about 900 people in Liberia. That puts it on par with other deadly, yet preventable ailments.

Diarrhea -- a preventable and treatable condition -- kills about 1.5 million children each year -- more than malaria, AIDS and measles combined, according to global health organizations.

The H1N1 swine flu pandemic killed more than 284,000 people in 2009 and 2010, according to the Centers for Disease Control and Prevention.

Yet Ebola's deadliness and the danger it poses to civil society in affected countries have made this epidemic a problem of global proportions: On Friday, the United Nations announced that it is establishing an "Ebola Crisis Center," with U.N. Secretary-General Ban Ki-moon issuing an "international rescue call."

When an outbreak calls for an infusion of international attention and resources, the World Health Organization is responsible for designating it as a global emergency, which it did for this Ebola outbreak on Aug. 8.

An outbreak is evaluated based on the severity of at least two of these four criteria: the significance of the public health impact and deadliness of the disease; how expected or unexpected the outbreak was; the risk of international spread; and the risk of international travel or trade restrictions.

"If these criteria are met and the director general perceives it as a public health emergency of international concern, that should trigger a coordinated global response," said John Kraemer, a professor of epidemiology at Georgetown University.

That doesn't happen for diseases such as malaria or AIDS because, despite their annual tolls, they require a constant level of public health diligence and are rarely unexpected.

"For diseases that are endemic, we wouldn't think of declaring a public health emergency," Kraemer said. "An emergency response for malaria wouldn't be helpful in the same way; you won’t see malaria spiraling out of control."

The WHO and organizations such as Doctors Without Borders began sounding the alarm about Ebola in West Africa months after the outbreak began, in an effort to bring more international resources to the affected countries. Some argue, however, that the call for help from the WHO came far too late -- months after it was clear that the outbreak met most of the criteria to be considered a global emergency. Nearly 1,000 people had already died in three Ebola-ravaged countries by that time.

"I think it was fairly clear that WHO took too long to declare a public health emergency with Ebola," Kraemer said. "You can debate when exactly when they should have declared an emergency, but the very latest date was late May-early June."

For most people -- especially in the West -- Ebola became a major news story in midsummer, partly because of the horrifying images of health workers in hazmat suits and the fear that the disease might spread beyond West Africa.

Travel restrictions followed. U.S. colleges are now being asked to screen students for symptoms, and dozens of travelers to West Africa from around the world were tested for the virus in what ended up being false alarms.

The chances of a widespread outbreak in the United States are exceedingly slim, yet some 40 percent of Americans reported in a recent poll that they were concerned about an Ebola outbreak in a U.S. city.

When a man who had recently returned from an Ebola-impacted West African country came to New York's Mount Sinai Hospital with a high fever and gastrointestinal problems and wound up "in strict isolation" while he was screened, panic ensued.

That type of hysteria has prompted a secondary concern that panic about Ebola could actually divert resources away from other, equally important public health concerns in African countries.

Earlier this month, Columbia University professor Chris Blattman tweeted that "Ebola is the Kardashian of diseases."

In an interview, Blattman said his comment and subsequent blog post came more out of a concern that the consequences of stigma for affected countries could have a more lasting impact than the disease itself.

"There's this thing that doesn't sound like it's actually the apocalypse, but it's being talked about like the apocalypse," said Blattman. "It steals all the attention; that's the point."

He added: "People don't have a lot of attention for Africa, and sometimes that attention matters."

It is almost impossible to know what impact travel bans, stalled investments and delayed academic research might have on the economic future of Liberia, Guinea and Sierra Leone. But economic damage could have destabilizing political consequences as well, Blattman argued.

"This was a country that was actually turning things around," Blattman said of Liberia. "It's the hype element that makes you think, 'how are they going to climb out of this hole now?'"


Health workers surround an Ebola patient who escaped from quarantine at Monrovia's Elwa hospital, in the center of Paynesville. (Reuters)

Most, however, do not agree with Blattman's objections to the level of attention Ebola has garnered.

Based on their pronouncements, public health organizations from the Centers for Disease Control to the WHO and Doctors Without Borders have calculated that the need for more resources to combat the virus outweighs the risk of spreading further hysteria.

The WHO said Friday that there have been 2,097 deaths in Liberia, Guinea and Sierra Leone, plus another eight deaths in Nigeria. A closer look at the death toll suggests that while Ebola isn't among the world's top infectious killers, the country-level and even regional impacts are extraordinary.

Joanne Liu, international president of Doctors Without Borders, warned that the virus has wiped out "entire families."

"We see entire villages wiped out, we follow the tangled webs of extended families as one by one they become sick and die," wrote Ella Watson-Stryker, who works with Doctors Without Borders in Sierra Leone. "We live in a world where conversations revolve around where to put the all the bodies no one has come to bury."

In Liberia, where the epidemic appears to be rapidly escalating, the average death rate per day has grown exponentially since the start of the outbreak.

"The pace of deaths in Liberia suggests that the number of people who die from Ebola will outnumber deaths from other causes," said Kim Yi Dionne, a Smith College professor who co-authored a counterpoint to Blattman's Kardashian argument. "In a small population like that in Liberia, then it is a serious problem."

And there are second-order concerns: Unlike many other diseases, Ebola has essentially decimated the already weak public health systems in West African countries that have never before seen cases of the virus.

Other diseases are likely going untreated while health professionals struggle to contain Ebola — and often succumb to it themselves.

We may not know for a long time, if ever, what the impact of the 2014 Ebola outbreak is on other diseases and other health threats such as malaria, cholera, infant mortality and HIV/AIDS in the affected countries. And that heightens concern among public health officials.

"There are almost no functioning facilities for basic health conditions right now,” Kraemer said. "If you get into a road crash or you develop malaria, it’s very difficult to treat that right now."

He added: "This is the height of the malaria season right now. All of the things that normally make people sick in these countries are happening at the same time."

[This post has been updated.]

Abby Phillip is a general assignment national reporter for the Washington Post. She can be reached at abby.phillip@washpost.com. On Twitter: @abbydphillip
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