Evaluation of The Issues Related to The Ebola Virus

In the fall of 1347, a boat docked in Messina, Sicily, confirming the doubt that had been lingering in the back of everyone’s mind, too horrible to be believable until that moment. There had been rumors about a pestilence that had ravaged its way across Asia and the Middle East, mowing people down like wheat in a field. It wasn’t until the boat arrived at the port with dead men on board that it was proved true. However, the ship carried more than just dead sailors. It also carried rats and the beginning of a pandemic that during the course of only a few years would kill off roughly twenty-five million people and leave a fear in their hearts so great, it has lasted until this day (Perlin). Today, though we are not still as highly affected by this bacterial disease, we are plagued by another virus known as Ebola. Comparing the two diseases, they are quite similar in many aspects. The thing they have in common the most, though, is how ignorance led to the rapid spread of disease. Whether it’s the handling rats or bats, Catholicism or African superstition, uninformed, well meaning doctors, or even the level of poverty, it would seem that ignorance is more deadly than the infection itself.

Yersinia pestis, or the bubonic plague, had stowed away on board the boat that landed in Messina, and also in ships that traveled to Marseilles, a city in Southern France, and Tunis, a popular port in Africa. By 1353, it had spread all the way up to the northern tip of Scandinavia and had crept its way across the western half of Russia (Nelson). Needless to say, the fourteenth century wasn’t as gifted with technology as we are here in the twenty-first. The Renaissance was starting in Europe and yet people were still stuck in the Middle Ages, relying on old methods dealing with their day to day lives. Even though Crusaders brought soap back with them from Asia and the Middle East, people didn’t always have access to warm water so they could bathe. Most cities adopted the Roman’s idea of public bathhouses, but because of all the wood required to keep the water warm, it became too expensive to continue use. While people did like to bathe, they weren’t able to stay clean, growing accustomed to living in dirt and grime. Over time, people began to think that being too clean was unwise, believing Vikings were neurotic for bathing once a week (Konieczny). They did what they had to do, even if that meant tossing their waste into the streets, unlike members of the upper class who had the gift of a proper toilet. In addition, it was said there were three rats per household and each of those rats carried five fleas (Robertshaw). With such a high vermin population and such a remedial standard of cleanliness, the bubonic plague spread at a startling rate. As modern medicine now tells us, the best environment for an epidemic to begin is often the least sanitary. In a world where exterminators are lowly serfs who have no idea what they are doing, where the doctors you trust are more likely to spread infection than cure it, and people in cities are like sardines in a can, it’s not a stretch to imagine an outbreak occurring.

However, it seems impossible that one disease could do so much damage. Although this may be true, people forget that like most diseases, the bubonic plague had more than one strain. The epidemic starting in 1347 was a combination of three strains: one that attacked your lymph nodes and caused the presence of the buboes, one that affected your respiratory system like pneumonia, and one that infected your blood (Nelson). While individually each strain is deadly alone, the combination of them all contributed to the high lethality rate and widespread reach over the continent. The symptoms varied depending on the strain and caused, among other things, buboes or pustules ranging from the size of an egg to an apple, swollen lymph nodes, a red face, bruised looking skin, high fever, coughing, and vomiting; most people succumbed to the disease, dying within three or four days (Nelson).

In the city of Avignon in southern France, it was reported that 400 people died every day and that over the course of six weeks, one graveyard received over 11,000 bodies (Dutch). With the death toll rising substantially each day, monks and priests started to employ the use of mass graves instead as they were both easier to dig and could hold more bodies. Killing a third of the population off in two years’ time tends to leave a trail of bodies so vast it’s nearly impossible to bury them all. In fact, one in three people died as a result of the epidemic (Knox). Known as plague pits, mass graves were filled with corpses by people already infected, literally the walking dead. In London, Charterhouse Square, one of the largest and most well known plague pits, still stands to this day as a monastery dedicated to the souls who never got their last rights in the chaotic years of the outbreak (History). Although it stands for more than that; it stands as a symbol of a plague so widespread and so lethal, sometimes in the heat of the moment, we forgot that the deceased were people too.

Despite the fact that the last widespread outbreak of the Black Death was in the 1600’s, we are still plagued by many other diseases that affect us just as widely today, such as Ebola. Named after the Ebola River in the Democratic Republic of the Congo, formerly the country of Zaire, the modern plague started off its track record with a bloody beginning during two separate, although simultaneous outbreaks, the other occurring in the town of Nzara in Sudan. In mid-September of 1976, two dozen cases of an unidentified illness were reported by a small Catholic mission hospital in the city of Yambuku, fourteen of which died (Quammen). Dr. Karl Johnson, head of the Special Pathogens Branch at the CDC back then, determined the disease was in fact a virus similar to Marburg, but different in its own right. However, he had no idea what animal was the reservoir host, nor the animal the disease resided in prior to crossing over to humans was and therefore, he had very little information as to how it was transmitted. After the initial outbreaks in Yambuku and Nzara, Ebola disappeared for fifteen years before reappearing again in another place in Zaire, called Kikwit. It differed from the first outbreak in one crucial way: it was a thriving metropolis of 200,000 people with several well equipped hospitals whereas Yambuku was a small village with a tiny clinic like hospital for minor emergencies (Quammen). The outbreak in Kikwit started January 6, 1995, the first reported case being a farmer who lived five miles south of the city, dying later that week. The CDC confirmed it was Ebola on May 9th that year. Three months after that, in August at the end of the outbreak, 245 people had died and the disease disappeared again. According to David Quammen, acclaimed science writer and traveling journalist, “it was Jack the Ripper- dangerous, invisible, gone.”

Now, thankfully we do know more about Ebola, although we still don’t know what specifically the reservoir host is. What we do know, however, is that it can be transferred between mammals, i.e.: by blood or bodily fluids, contaminated objects such as needles or syringes, and infected animals and bushmeat, or wild animals illegally killed for food. According to Jennifer Connolly, an infection control specialist working at St. Mary’s Regional Medical Center in the Infection Control Department, “it’s not as contagious as you would think. But looking at Africa, we’re also looking at secondary healthcare systems. … A lot of families take care of their own loved ones.” People who are living with and caring for an infected loved one, have come into direct contact with a dead body, or have had direct contact with an infected person’s blood or bodily fluids are at a high risk of getting the disease as well (CDC Evaluating). “It’s very similar to HIV. It’s got to go into an open wound or an open orifice,” Connolly says about transmission.

As discussed earlier with the Plague, most diseases have more than one strain, and Ebola is no exception to this. There are five different strains, each named after the area of origin: Zaire ebolavirus, Sudan ebolavirus, Tai Forest (previously Cote d’Ivoire) ebolavirus, Bundibugyo ebolavirus, and Reston ebolavirus, the incubation period for all of which being anywhere between two to twenty-one days. Up until the point a person starts showing symptoms, they are not infectious (CDC Top). Once they start showing common onset symptoms such as fatigue, fever, abdominal pain, headache or a sore throat, they are contagious. This can be accompanied by nausea and vomiting, diarrhea, rash, kidney and liver failure, and potential internal and/or external bleeding, although that is unlikely (Ebola). In the New York Times best selling book The Hot Zone by Richard Preston discussing the Ebola outbreak in a research lab in Reston, West Virginia, some of these symptoms are highly exaggerated. For example, although conjunctival injection is a possible symptom, it is more likely you’ll get pink eye than cry bloody tears. His book fueled the fear in the hearts of Americans that Ebola was a bloody haemorrhagic fever and that the lab outbreak in Reston was just the beginning. In reality, however, Reston ebolavirus is the only strain that does not transfer over to humans (Kogan). Once again, people get too caught up in the moment, thinking that the world is ending because once again we’re open to infection by disease.

When people think about history repeating itself, they often think about the rise and fall of governments and wars breaking out. They don’t always consider that epidemics can happen more than once. The outbreak of the Black Death in 1347 is reminiscent of the Ebola outbreak in West Africa last year in more ways than just a high lethality rate. Both outbreaks started as the result of contact with infected animals or a zoonosis. “Each of them reflects the action of a pathogen that can cross into people from other species,” David Quammen writes in the prologue of his book Ebola: The Natural and Human History of a Deadly Virus. While the Bubonic Plague was the result of living with and around black rats, which have since gone extinct in Britain (Robertshaw), Ebola is the result of coming into contact with bushmeat or dead primates (Ebola). Additionally, both diseases spread from person to person when the dead are being buried, although during the Middle Ages only other infected people handled the corpses so nobody else would be at risk. When asked how people in West Africa deal with their dearly departed, Jennifer Connolly replied, “there is a team over there that you’re supposed to respond to and tell them and they will come and pick up the body for you and bury it.” However, this isn’t always done as people in a community know they will be shunned if they admit they or someone they love has it. As a result, they bury their dead themselves, unknowingly infecting themselves as they clean up after any left over bodily fluids and come into contact with infected blood.

Therere is also a religious aspect in all this. In West Africa, people believe in tribal religions and don’t necessarily always listen to logic and medicine. When someone in a village gets sick, they don’t accredit it to a virus or a disease; they believe the person is possessed by an evil spirit or a curse sent upon people who did not share their previous good fortune with their family or their village (Quammen). Comparitively, people in the Middle Ages believed that the Black Death was the resulting effect when the Crusaders gave up their holy mission, passing the blame onto Muslims and Jews, as people often do when they need a scapegoat. Some did not believe blaming others was the cause of pestilence, but rather themselves. Flagellants went around from town to town, staying for a month in each new place, whipping each other and crying out their pleas of forgiveness to God. However, in both cases, people believe that when they do what their religious leaders say, the disease will leave them alone. Even so, the disease only continues to spread despite their beliefs as the result of ignoring the benefits of medicine.

Thankfully, we live in the twenty-first century with access to vast amounts of knowledge, technology, and best of all-- medicine. Almost a hundred years ago on the first of July, 1916, 350 children in New York City had been paralyzed by poliomyelitis, 75 of whom had died (Kluger).Thanks to Jonas Salk and Albert Sabin, who in 1955 announced the success of the vaccine to prevent the disease, Polio was officially erradicated from the United States in 1979. Modern medicine is a gift that helps us live longer, healthier lives we can enjoy without fear of dying early on. Now, if there’s a case of the Bubonic Plague, we have a well tested vaccine available so people won’t have to suffer the same fate people did six hundred years ago. For things we don’t have preventative vaccines for yet, like Ebola, people are still able to take the proper precautions to keep themselves safe. Much like any normal person would do to prevent getting the flu, one only has to use common sense to avoid getting sick from most things; if you’re sick, stay home or if you touch something unsanitary, make sure to wash your hands and try to avoid touching your eyes, nose, and mouth (Wallis).

During the peak years of the Bubonic Plague in Kilkenny, Ireland, Brother John Clyn a monk in the Friars Minor, recorded what he saw was happening, “lest things which should be remembered perish with time and vanish from the memory of those who come after us” (Dutch). He feared what few of us to believe to be true...that history would repeat itself; that no one would remember what had happened and be able to learn from the past. Although nobody has been able to forget the horrible scar left on the world by the Black Death, people have forgotten why it happened: not because the rat population got out of control, but because people didn’t learn. And we face the effects of that every day, whether it’s parents who can (but refuse to) vaccinate their children or forget to wash their hands after coming into contact with anything unsanitary. Ignorance leads to outbreak after outbreak, proving that it really can be more deadly than infection itself.