How Ebola went from killing 11,000 people in one year to being on the verge of a cure

James Pasley,James Pasley

Aug 31, 2019, 20:00 IST

How Ebola went from killing 11,000 people in one year to being on the verge of a cure

A Liberian woman holds up a pamphlet with guidance on how to prevent the Ebola virus from spreading, in the city of Monrovia, Liberia, Thursday, Aug. 14, 2014.

Since 1976, more than 11,000 people have been killed by the Ebola virus, and nearly 30,000 have caught it.
Deadly outbreaks have occurred in Democratic Republic of Congo, Gabon, Ivory Coast, South Sudan, Uganda, Guinea, Liberia, and Sierra Leone. It made its way to the US in 2014.
Now, there's hope for what was once thought to be an incurable disease. Two new treatments have been successful 90% of the time.
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It's thought to have begun with a bat bite.

The Ebola virus, once considered incurable, has plagued Africa for more than 40 years. Since 1976, nearly 30,000 people have caught Ebola, and more than 11,000 have died. It's often gone silent for years only to reemerge unexpectedly, catching hospitals, governments, and global organizations off-guard.

But scientists might be closing in on a successful treatment. Earlier this month, The New York Times reported two new treatments for the disease work 90% of the time. They'll be given to all patients in the Democratic Republic of Congo from now on.

Here's how Ebola began, where it's spread, and how it went from killing tens of thousands to being on the verge of a cure.

The Ebola virus, which under a microscope resembles spaghetti, is thought to come from a fruit bat bite. There are five types of the virus, and four of them can make humans severely ill.

The virus replicates inside the cells of a host and can cause vomiting, rashes, coughing, dementia, and bleeding. Deadly and historically difficult to treat, it dismantles the body from within.

In 1976, Ebola virus disease, or Ebola hemorrhagic fever, was discovered almost simultaneously in the Democratic Republic of Congo (DRC) and South Sudan.

The first outbreak was in Yambuku, a village 60 miles from Ebola River, in the DRC. It was named after the river, so the town would not be stigmatized by the disease.

The other town was Nzara, in South Sudan. This is a cotton factory where people who caught the earliest cases of Ebola worked.

The first two outbreaks were over 600 miles away from each other. To track the outbreak, surveillance teams interviewed 34,000 families in the surrounding areas looking for symptoms.

Since those two outbreaks, there have also been deadly outbreaks in Gabon, Ivory Coast, Uganda, Liberia, and Sierra Leone.

Ebola is transferred through direct contact with infected blood, vomit, or sweat — often absorbed through broken skin or the eyes, nose, or mouth. During the first outbreak, nurses reportedly used five syringes on up to 600 patients a day. This didn't help stem the deadly virus.

That outbreak lasted about 11 weeks — 318 people were infected and 280 of those died, meaning the death rate was 88%.

In 1989, a group of macaque monkeys were imported from the Philippines into Virginia. Dozens of the monkeys died unexpectedly. They were tested, and Ebola was found to be the cause.

But four workers who were exposed didn't get sick, and scientists discovered that it was the one strain which wasn't harmful to humans. The incident was the topic of the National Geographic mini-series "The Hot Zone" that aired this year, based on the book of the same name.

In 1994, 15 years after the last Ebola outbreak in Africa, several chimpanzees were found dead in Taï National Park, in Ivory Coast. When three researchers found a dead chimp, they dissected it on the spot. Little more than a week later, one of the researchers, a Swiss woman, had Ebola. She made a full recovery six weeks later. It was a one-off case.

In 1995, the DRC had an outbreak that infected 315 people and killed 250 — a 79% death rate.

Also in 1995, the disease hit the mainstream with the American film "Outbreak," inspired by the terror surrounding Ebola. In the fictional film, a viral outbreak makes its way to the US, causing a national emergency.

In 1996 and 1997, Gabon had two breakouts both related to hunting. Forty-five people died after a hunter in a logging camp caught Ebola. And 21 people died from it when hunters ate a dead chimpanzee. In 2001, 53 more people died from it in an area where lots of inexplicably dead animals were found. Bushmeat is a cheap source of protein in Africa, and touching or eating it has often led to people getting infected with Ebola.

Uganda reported 224 Ebola deaths in 2000, and 42 in 2007. Despite not being a new disease, the early symptoms are similar to flu and an upset stomach, meaning there were often false reports and delays in diagnosing it.

In 2004, a victim died from Ebola in Russia in an unusual way. Scientist Antonina Presnyakova was working on a vaccine at a state research center, which used to specialize in turning deadly viruses into biological weapons. She accidentally injected herself with the virus and died.

In 2008, Ebola was found in four pigs in the Philippines. The pigs were infected with the Reston strain, which is the same strain of Ebola that had been found in monkeys. While it wasn't dangerous to humans, authorities were concerned that the virus had jumped species, since pigs are closer to humans in the way they carry viruses.

Several workers who handled the pigs did catch the strain, but remained healthy. It was the first case of the virus moving from pig to human. And there were fears that pigs could transmit the lethal Ebola strains, especially since humans spend a lot more time around pigs than with bats or monkeys.

In late 2013, the worst Ebola outbreak ever began in Guinea. It later spread to Liberia and Sierra Leone. Two of the biggest reasons for the rapid spread of Ebola was the movement of infected people and the way people were buried.

The first reported case was a 2-year-old boy, who was likely bitten by an infected bat in a bush near a small border town in Guinea. Known as Patient Zero, the boy died after presenting symptoms of a fever and vomiting. The risk for Ebola is highest where land-use has recently changed — like areas of recently logged forest, which cause people to venture deeper into bush, often when hunting.

The only way to stop Ebola is to identify infected people, isolate them, and then track down everyone they'd been in contact with. But since there was no cure, some people questioned the point of going to hospital at all.

In Liberia, many people were turning to traditional healers for treatment. Sometimes exorcisms were performed to rid people of the disease, and fake cures were being sold at markets. Some healers were telling people to rub their bodies with lime and onions.

People continued to attend burials and touch the dead as part of local customs. Ebola victims are most infectious just after they've died, so traditional burials were helping spread the disease. Early in the 2014 outbreak, 365 cases of Ebola were traced back to the burial of a local healer.

To limit contamination, the Red Cross conducted burials, attempting to bury the bodies as soon as possible, preferably in body bags, and sanitizing families after ceremonies. But in Liberia, there weren't enough people to collect bodies. According to an employee at Africa Development Corps, bodies were left out on the streets. In Clara Town, Liberia, two victims were left in their house for three days before being removed.

The local media didn't help ease people's fears. People were so afraid that a man in Conakry, Guinea, was left in the middle of the road for nearly five hours after collapsing, even though it wasn't clear whether he had the virus.

In August 2014, the World Health Organization finally declared the epidemic was an international health emergency. It was officially the worst Ebola outbreak ever.

By September 2014, Ebola had made its way to the US, through Thomas Eric Duncan, who was infected when he arrived in Dallas. He died from it, and the two nurses who treated him caught the virus. They survived.

In total, four people in the US died from the virus, including Dr. Martin Salia in Nebraska. But after films like "Outbreak," and news that one of the infected nurses had caught a domestic flight the day before she was admitted, people were terrified. Especially since there was no cure.

Two-thirds of Americans were worried about an Ebola epidemic, according to a Washington Post and ABC News poll. Then-President Barack Obama told America the danger of contracting the disease was extraordinary low. But people traveling began to wear sanitary masks ...

... while others called for travel bans to the infected West African countries. As The Daily Beast's Scott Bixby wrote, "No matter the reassurances of medical professionals, the public, who have seen movies like 'Outbreak' and 'Contagion', fear the introduction of Ebola to America; of something disastrous happening; of it getting out."

The travel bans were rejected and the US provided Guinea, Liberia, and Sierra Leone with $6 billion worth of aid. But it wasn't until January 2016 that the United Nations stated for the first time that the outbreak had been stopped, and no new cases had been reported.

The outbreak lasted for two and a half years, infecting nearly 29,000 people, and killing 11,325.

Afterwards, the World Health Organization was criticized for taking nine months to declare an international public health emergency.

But even though the outbreak was technically over, Africa wasn't safe from the disease. In March 2016, 10 cases were recorded in West Africa.

William Karesh, an emerging-disease specialist and adviser to the World Health Organization, issued a stark warning in 2016: "We know the virus is still circulating in West Africa."

Echoing Karesh's words, in April 2018, thousands of miles away from the countries that were infected by the most recent epidemic, the city of Mbandaka in DRC had an Ebola outbreak.

It was concerning because the outbreak was on the river, in an area where people traveled and traded. But the virus was stopped after three months, and 4,000 vaccinations. Between April and June, 33 people died of Ebola.

But elsewhere in DRC, Ebola cases began to appear, beginning in August 2018 in Mabalako. The virus also appeared in Beni, Oicha, and Mandima.

By August 2019, 2,753 Ebola cases were reported across DRC, with 1,843 deaths. DRC is a difficult place to stop the disease, since the northeast is a conflict zone between different militias.

Foreign health workers were feared and not trusted. In 2019, two Congolese health workers were killed in their homes. And African governments were being accused on social media of creating Ebola to profit off Western aid.

In February 2019, things took a turn for the worse when humanitarian organization Doctor’s Without Borders left DRC. Its workers had been attacked 150 times in a year. Five aid workers were killed, and 50 were injured.

In July 2019, the World Health Organization declared the Ebola outbreak a global health emergency again. It had already considered making the declaration three times. It announced the designation in July, because it had been going on for a year, the disease had reached Goma, a city with 2 million people, it had reappeared in areas already thought to be contained, and the epidemic was nearing Rwanda and Uganda.

By making it a global emergency, more resources, like money, healthcare workers, security, and infrastructure would help to hopefully end the latest crisis.

Finally, in August 2019, new experimental treatments were declared to be working on patients 90% of the time. The treatments were mixtures of antibodies injected into people's bloodstreams. Scientists planned to offer it to all patients. Now that there was a high chance of being cured, researchers hope people will start going to hospitals to be treated.

Although the DRC outbreak hadn't been stopped, there is now hope. Jean-Jacques Muyembe, director general of the Institut National de Recherche Biomedicale, which monitored the vaccine trial in DRC said: "From now on, we will no longer say that Ebola is incurable."

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