WHAT EBOLA MEANS FOR AUSTRALIA
BY Paul Purcell
THE STORY SO FAR The Ebola outbreak across west Africa has claimed nearly 5000 lives according to the latest World Health Organisation (WHO) figures, a number many experts believe is grossly underestimated. While there have been no cases of the disease in Australia so far, the federal government has banned state-sponsored travel to, and suspended all humanitarian visas from the disease-stricken area. More than 13,000 people have being diagnosed with Ebola since the outbreak began in March. WHERE DID EBOLA COME FROM? The Ebola virus first appeared in two simultaneous outbreaks, one in Sudan and the other in the Democratic Republic of Congo (DRC), better known as Zaire, in 1976. The outbreak in the DRC occurred in a village near the Ebola River, from which the disease takes its name. Experts believe fruit bats are the natural Ebola host and the virus was initially introduced to humans through contact with the blood or faeces of infected animals found in the rainforest. It’s thought the current outbreak in west Africa began after a young girl came into contact with an infected fruit bat in Guinea. There are five known subtypes of Ebola, the deadliest being the Zaire strain. Preliminary testing by the WHO suggest it is this strain that is largely responsible for the record-breaking number of deaths in west Africa. The countries worst hit by Ebola are Guinea, Sierra Leone and Liberia. HOW DOES IT SPREAD? The outbreak initially occurred through contact with animals infected with Ebola. Once introduced to humans, the virus spreads through contact with the bodily fluids, including blood, faeces, organs or secretions of a person infected with the disease. Touching surfaces and materials contaminated with these fluids with broken skin can also spread the virus. Ebola cannot be contracted through air or water. Health officials say a “perfect storm” of conditions including civil war, sub-standard health infrastructure as well as significant connection between rural and urban communities have been largely responsible for the unprecedented spread in west Africa. WHAT DOES IT DO? After an incubation period of between two and 21 days, Ebola targets several immune cells, which are usually the first line of defence against infection. As it is a systemic infection, every organ and tissue, with the exception of bone and skeletal muscles, are constantly under attack from the disease. While the exact mechanisms of Ebola are known, it is believed the virus releases proteins that weaken the body’s immune system making it unable to defend itself. WHAT ARE EBOLA SYMPTOMS? In its early stages, people infected with Ebola will have a sudden onset of fever, intense weakness, muscle pain, headaches and a sore throat. As it progresses, those with the disease experience vomiting, diarrhoea, rashes and in some cases, both internal and external bleeding such as oozing from the gums or blood in stools. HOW DEADLY IS EBOLA? Based on 14 previous outbreaks of the Zaire strain of Ebola between 1976 and 2012, there were 1097 deaths from 1388 cases in Africa. This means there is only a one-in-five chance of surviving the disease if contracted and treated in Africa. Experts say the extremely high mortality rate is due to the severe lack of health infrastructure. During the current outbreak, the mortality rate is estimated to be about 70 per cent. In Western countries with established health systems, authorities say it’s difficult to assess how dangerous Ebola is when treated early with modern medicine but believe the risk is minimal. There have been four cases of Ebola in the US during the current outbreak, with one person dying, two making full recoveries and one person in New York still listed as being in a serious condition. WHAT IS THE WORST CASE SCENARIO WHO says if the situation is not brought under control soon, it is possible there could be more than 10,000 new cases of Ebola each week by December. A report by the US Centres for Disease Control in September says the worst case scenario would be about 1.4 million cases of Ebola by January, a 107-fold increase on WHO’s current estimation of Ebola cases. HOW DOES THE DISEASE THREATEN AUSTRALIA? With one of the world’s best health systems, experts assess the risk of Ebola in Australia as minimal. But Australia does not have any Ebola-specific treatments such as the experimental ZMapp medicine, and a vaccine is still under development. Queensland’s health minister has voiced concerns about the disease reaching Papua New Guinea saying the “porous” border between the two countries has long been a concern in relation to spreading diseases. WHAT SAFEGUARDS DOES AUSTRALIA HAVE IN PLACE The federal government announced on October 27 that all travel to, as well as humanitarian visas from Ebola-affected regions, are banned for the foreseeable future. Since August 9, protocols have been put in place at all entry points into Australia that people entering from west Africa are subject to further questioning by immigration officers. If deemed necessary, they are put into isolation and questioned further by specialist health officials where they make an assessment whether the person is required to be put under surveillance and under 21-day quarantine. Of 190 returned people from west Africa to NSW, four healthcare workers and two families on humanitarian visas have been put under surveillance. Each state has a designated hospital where all suspected Ebola cases are to be treated. Paramedics ask all patients with fever and other Ebola-like symptoms whether they have visited west Africa, and if so, they’re required to contact their state’s public health department. Australia has specialist health officers on stand-by in Darwin to tackle any cases of Ebola, which arise in neighbouring countries such as Papua New Guinea. IS THERE ANY TREATMENT OR CURE FOR EBOLA There are no proved Ebola-specific treatments now but there have been encouraging results from the experimental medicine ZMapp. The ZMapp treatment was effective in two separate trials with monkeys, and was given to two Americans who contracted Ebola while in west Africa. They both recovered. But a Spanish priest, who was also given the treatment, died in hospital in Spain. Scientists are scrambling to develop a vaccine, with a Canadian program set to begin trials in Europe, Gabon and Kenya in December. It is still uncertain whether a vaccine will be ready for distribution in 2015 as hoped. Sources: Marie Bashir Institute of Infectious Diseases and Biosecurity, NSW Health, World Health Organisation (WHO), Centres for Disease Control and Prevention (CDC).