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The latest Ebola outbreak in West Africa is now the largest and deadliest outbreak ever. And unlike outbreaks of the past, it is affecting both rural and urban areas. Jeffrey Brown talks to Laurie Garrett of the Council on Foreign Relations about a recent summit on the outbreak, distrust building against health workers in infected areas and how porous borders make this outbreak so hard to contain.
Late yesterday, I spoke about the situation with Laurie Garrett, author and senior fellow for global health at the Council on Foreign Relations.
Well, Laurie, since we last spoke in April, there was some thought that this was more under control, but instead the situation seems to have worsened. Give us an overview.
LAURIE GARRETT, Council on Foreign Relations: This is the first time we have ever seen an urban as well as rural Ebola outbreak.
It is the first time we have seen Ebola in the capital cities. It is the first time we have seen Ebola crossing borders, now in three countries. And it is the first time we are having an Ebola experience in an area rife with the tensions and the hostilities born out of two really brutal civil wars in Sierra Leone and in Liberia, with spillover into neighboring Guinea.
So these are three small, deeply impoverished West African countries where, in the best of times, they are hard-pressed to meet the public health needs of their people and now to have what is officially designated an out-of-control epidemic on their hands.
I am sorry, but remind us now a little bit of what Ebola is and how it is transmitted.
Ebola is a virus, of course.
And it first is known to have appeared in 1976 in a country that was then called Zaire, now Democratic Republic of Congo. It has sporadically appeared a few times since then. I was in the epidemic in 1995 in Zaire.
And it's a virus that attacks the actual lining, so sort of integrity linings of capillary, blood vessels and so on, punching little microscopic holes in the blood linings, so that slowly but surely, molecule by molecule, the blood starts to leak out of the bloodstream.
And when it does that, you go into hemorrhaging. It may start out as internal bleeding, but it can eventually be that you are bleeding from your eyes, your nose, every orifice and in your brain, so that you become quite deranged.
There is no real treatment, just palliative care, and there is certainly no cure, and there is no vaccine.
Is it — you were talking about the spread. Is it correct that authorities really don't quite have a handle on how many people are at risk at this point?
We have a number of problems with this.
One is that this is a heavy-duty Ebola — I mean, malaria area. So you already have lots of people walking around with high fevers and other kinds of symptoms that could confuse diagnosis of Ebola. And it is also a region that is known for Lassa fever, another viral, terrible disorder carried by rats, symptomatically, in the beginning, very similar, and some Lassa patients will also hemorrhage.
So you have difficulty in making a proper diagnosis. And we're now getting reports from all over Sierra Leone, from all over Liberia, all over Guinea, of people turned away from hospitals for routine care simply because they have a fever or simply because they seem dizzy and a little out of it, as, of course, would be a symptom of malaria.
And as a result, we have widespread fear and rage building in the population against the health care systems, because the system is afraid to take the contaminated patients into the facilities.
And all of that is clearly making it harder for health care workers to do anything.
Well, it is making it hard for everybody.
I mean, even the Red Cross has now abandoned parts of Guinea because their workers are getting physically attacked. Medecins Sans Frontieres, or Doctors of the World, have also been brought under violent attack. And even the health workers from the given countries have been brought under attack.
Partly, it is a general fearfulness from the population, widespread crazy rumors, such as the doctors are infecting people, or the other side, meaning the old wounds of the civil war, your opponents from those days, the people that came and chopped your children's arms off or stabbed your grandmother, these people are spreading an evil omen through, and you have to stay away because they are running the hospitals.
All of this is making the problem absolutely catastrophic.
And what about on the medical — from the medical community. What are the theories on why it has spread to so many different countries and to urban areas, for example, as opposed to in the past?
Well, first of all, in the past, when I was in Kikwit — Kikwit is a big city — — quote, unquote — "city," with no infrastructure of any kind, but more than 400,000 people.
However, incredibly difficult to get to, no airport, no real highways or anything to get in and out. So there was never any real risk that it was going to leave the area. And that's pretty much been the case with every prior outbreak.
What makes this very unique is that in this part of West Africa, a rain forest swathe cuts across all three of these countries. And it is a swathe inhabited by the bats that normally carry this virus. Something has been going on in that rain forest. And for some reason, the bats are coming in proximity with monkeys or whatever the humans have secondarily come in contact with in order to become infected.
And there may have been more than one introduction from the bat rain forest normal area for the virus into the human population. So the first problem, is all three countries have this rain forest, this habitat.
The second problem is the borders are very porous between these three countries, and there are a lot of ethnic groups that really don't have any respect for the boundaries. They have frequently flowed, as we saw with the famous civil war led by Charles Taylor, a bona fide war criminal, because he readily crossed the borders between Sierra Leone and Liberia, and made his war a two-country war.
All right, Laurie Garrett, thanks so much.
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