What you need to know about the Ebola Virus Disease

On July 17, 2019, the World Health Organization (WHO) declared the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) a Public Health Emergency of International Concern (PHEIC). In their statement, the WHO called upon the international community to take notice of the situation, work together with the DRC to end the latest outbreak (declared on August 1, 2018) and build a better health care system.

As Canadians living half a world away from the DRC, it may be difficult to understand why fighting Ebola is a matter that concerns us all. But as you read about the virus and how easily it can spread from one person to another, you’ll find that we’re not as immune to the disease as you might think.
 

1. What is Ebola?
2. What are the symptoms of Ebola?
3. Is Ebola treatable?
4. How does Ebola spread?
5. How did the Ebola outbreak start in 2014?
6. Why was the 2014 Ebola outbreak in West Africa so hard to contain?
7. What is the latest news with the current outbreak?
8. What factors are impacting the 2019 Ebola outbreak?
9. How does Ebola affect children?
10. What is World Vision doing about Ebola?
11. What can I do to help people affected by Ebola?

1. What is Ebola?
Ebola is a rare but often deadly virus that can be transmitted from infected animals to humans or from person to person. The Ebola virus damages the immune system and organs, causing fever, body aches, diarrhea and sometimes severe, uncontrollable internal and external bleeding. This contagious disease kills up to 90 per cent of those who are infected.

Grace with her children in their home in Beni, Democratic Republic of Congo. She received hygiene kits from World Vision International in an effort to prevent Ebola in the area. Photo: Patrick Meinhardt

2. What are the symptoms of Ebola?
Ebola virus symptoms appear any time from two to 21 days after exposure, typically in days eight to ten. Once infected, a person can experience sudden bouts of

• fever,
• weakness,
• muscle pain,
• headache, and
• sore throat.

Without proper laboratory testing, these and other non-specific early symptoms of Ebola can be mistaken for serious diseases like malaria and typhoid fever, or even pregnancy. Laboratory testing accomplishes two things:

1. It helps limit the spread of Ebola by identifying infected patients and treating them as soon as possible; and
2. It helps patients who tested negative for Ebola to receive proper diagnosis and medical treatment for their symptoms.

The above symptoms are often followed by vomiting, diarrhea and abdominal pain, which may progress to

• altered mental status,
• shock,
• multi-organ failure,
• abdominal bleeding,
• red eyes,
• hiccups,
• chest pains, and
• difficulty breathing and swallowing.

3. Is Ebola treatable?
A  new hope
On August 2019, the World Health Organization announced that Ebola can no longer be called an incurable disease – thanks to two experimental drugs that significantly reduced the death rate for Ebola patients.

These experimental drugs – Regeneron’s REGN-EG3 and a monoclonal antibody called mAb114 – yielded the most successful results in a trial of four potential Ebola treatments. They were developed from antibodies harvested from Ebola survivors and will be offered to all patients in the Democratic Republic of Congo (DRC), where the disease has been spreading since August 2018, making it the world’s second largest Ebola outbreak in history.

While experts state that Ebola can never be completely eradicated, they believe these drugs can help prevent regional outbreaks from turning into full-blown epidemics.

Managing symptoms
Until recently, treatment for people infected with the Ebola virus focused on managing their symptoms, starting with medications to reduce pain, fever, vomiting and diarrhea. Ebola patients can experience dehydration due to severe loss of bodily fluids, so keeping them hydrated orally or intravenously is essential to avoiding shock or other serious complications. Patients may also receive

• anti-anxiety medication,
• vitamins,
• therapeutic foods,
• electrolytes,
• oxygen,
• blood pressure medication,
• blood transfusions, and
• mental health support to help them face the psychological effects of the illness or cope with the loss of family members from Ebola.

While these measures are not a cure for Ebola, the combination of keeping patients hydrated with oral or intravenous fluids and treatment of their specific symptoms improves their chances of survival.


Pole Pole from the Democratic Republic of Congo was told he had Ebola after one of his children and his sister in law died. He was taken to the Ebola Treatment Center and survived. Photo: Patrick Meinhardt

4. How does Ebola spread?
Healthy humans can become infected with the Ebola virus in the following ways:

1. Through close contact with the bodily fluids of infected wild animals, such as fruit bats (thought to be natural Ebola virus hosts), chimpanzees, gorillas, monkeys, forest antelope or porcupines.
2. Through direct contact (i.e. broken skin or mucous membranes) with the blood or bodily fluids of someone who is sick or has died from Ebola.
3. By touching objects that have been contaminated with the fluids such as blood, feces or vomit of someone who is sick or has died from Ebola.

Even babies are not safe from the Ebola virus, which can be transmitted from mother to baby in utero, during delivery or through maternal fluids such as breast milk after birth.

Because the early symptoms of Ebola can present as other illnesses like malaria or typhoid, the risk of inadvertently spreading the disease is quite high. Before the more severe symptoms of Ebola can manifest, an undiagnosed, infected patient can encounter dozens of people who in turn may come into contact with dozens more. This makes health care workers particularly vulnerable to infection, especially when infection control methods are not enforced. Wearing protective clothing such as face masks, gloves and boots can help health care staff and caregivers from also becoming infected with the Ebola virus.

Because the Ebola virus remains in the blood after death, certain burial practices, like washing or touching bodies of the deceased, have put family members, faith leaders and other mourners at high risk of infection. Therefore the bodies of those who succumbed to Ebola must be cremated or buried immediately by people who are wearing appropriate protective clothing.

Although the risk of international spread is low, the WHO believes that the risk of the Ebola outbreak spreading to other parts of the DRC and neighbouring countries is very high. They have made recommendations regarding international travel to help mitigate the risk of spreading the virus.

The Government of Canada has issued its own set of guidelines for people who choose to travel to the DRC and the surrounding regions, urging travellers to follow all recommendations in order to stay safe.


Children wash their hands as part of the program Channels of Hope in the DRC, which aims to raise awareness about Ebola. Photo: Carole St. Laurent​

5. How did the 2014 Ebola outbreak start?
The world’s largest and longest Ebola outbreak in history occurred in West Africa from 2014-2016 – and it all started with just one sick little boy. Thousands of people died from the disease, largely concentrated in three countries: Guinea, Sierra Leone and Liberia.

Below is a timeline of key events that show how easily ebola can spread – across land borders and, in some cases, across oceans.

December 2013

• An 18-month old boy in Guéckédou, Guinea dies from a mysterious hemorrhagic fever. His mother and three-year old sister die within days. Later, it is believed he was exposed to the Ebola virus from contact with infected bats.

January 2014

• The boy’s grandmother is next in the family to succumb to the mysterious illness. People from all over travel to her village, close to the Sierra Leone and Liberian borders, for her funeral. Unknowingly exposed to the Ebola virus, they carry it back home with them.
• The first waves of alarm are sounded on January 24 after fatal diarrhea claims the lives of five additional people in the area.

February 2014

• The virus spreads to Macenta, Nzérékoré and Kissidougou, Guinea. Health care workers and families caring for patients who are sick with fever, vomiting and severe diarrhea, are also getting sick.

March 2014

• The fatality rate rises to 86% as the disease spreads.
• The Ministry of Health in Guinea and Médecins sans Frontières (MSF)/Doctors without Borders are finally alerted to an unidentified illness.
• The mystery illness is confirmed as Ebola Virus Disease (EVD) by the Pasteur Institute in France and the World Health Organization (WHO) officially declares an outbreak.

April-June 2014

• bola quickly spreads to Guinea’s neighbours, Liberia and Sierra Leone, thanks to weak surveillance systems and poor public health infrastructure.
• By the end of June, there are more than 600 cases and 390 deaths in Guinea, Sierra Leone and Liberia, with a mortality rate of up to 90%.

August 2014

• Over 900 people have died from Ebola in Guinea, Liberia, Nigeria and Sierra Leone.
• The WHO declares the situation in West Africa a Public Health Emergency of International Concern (PHEIC), a designation that signals the need for a coordinated international response to prevent a potential international epidemic.
• Over the course of the epidemic, Ebola spreads to Italy, Mali, Nigeria, Senegal, Spain, the United Kingdom and the United States.

September 2014

• According to the WHO, health care systems in Liberia, Guinea and Sierra Leone are overwhelmed.
• Over 2,800 people have died in the three countries, leaving approximately 3,700 children orphaned and abandoned by relatives too scared to take them in.
• The first case of Ebola diagnosed in the U.S. is Liberian Thomas Duncan, who was in Dallas, Texas visiting relatives. One week after his arrival, he is sent home from the Texas Health Presbyterian hospital with antibiotics to treat a high fever, despite telling staff he came from Liberia. Two days later, he is readmitted to the hospital and placed in isolation.

October 2014

• The Centers for Disease Control sends additional resources to Dallas to help improve infection control. They begin monitoring Texas Health Presbyterian medical staff who were exposed to Ebola through patient Thomas Duncan. This was done after two nurses who treated Duncan tested positive for Ebola.
• Senegal and Nigeria are declared Ebola-free by WHO, which praises both countries for their “strong political leadership, early detection and response, public awareness campaigns and strong partner organizations.”
• Dr. Craig Spencer is admitted to an isolation unit after treating Ebola patients in Guinea with Doctors Without Borders. He is New York City’s first Ebola patient. His friends and fiancée are also quarantined.
• The governors of New York, New Jersey and Illinois issue orders for health care workers and high-risk individuals returning from West Africa to undergo a mandatory 21-day quarantine after treating Ebola patients. Other state governors announce that travellers returning from West Africa will be closely monitored.

December 2014

• The number of deaths since the outbreak began surpasses 5,000 across eight affected countries.

Residents of Moyamba in the Southern Province in Sierra Leone during the 2014 Ebola outbreak. Photo: Jonathan Bundu

January-March 2015

• After no new cases in 42 days, Mali is declared Ebola free.
• With the number of new Ebola cases dropping to its lowest point since June 2014, Liberia reopens its land border crossings and lifts the nationwide curfew imposed in August.
• Health care workers from the U.K. and the U.S. test positive for Ebola after volunteering in Sierra Leone.

May-September 2015

• Liberia is declared Ebola-free. More than 4,000 people died from the disease since the start of the outbreak. Eight weeks later, a young man is found dead from the disease.
• In Guinea, an experimental vaccine appears to be “highly effective,” according to the WHO. Researchers are optimistic that this drug can help prevent the spread of EVD in the future.
• After six new cases of Ebola between June and July, Liberia is once again Ebola-free.

December 2015

• After 14,000 cases in 18 months, Sierra Leone is Ebola-free.

January-March 2016

• After declaring West Africa Ebola-free, the WHO and CDC confirm a new case in Sierra Leone. That patient later dies.
• The WHO ends the PHEIC after no new cases of Ebola are found after 42 consecutive days and a 90-day enhanced surveillance period.

October-December 2016

• A study finds that Zmapp, the experimental drug credited for saving several high-profile patients, is beneficial in the fight against Ebola but doesn’t meet the pre-set standards for efficacy.
• The Lancet, a British journal, publishes the result of a study that finds an experimental Canadian vaccine to be 100% effective.
• Over 28,600 cases and 11,300 deaths later, the Ebola outbreak ends. Get another perspective on the 2014 Ebola outbreak. Watch Outbreak, a vivid, inside story of how the 2014-2016 Ebola outbreak began and why it wasn’t stopped before it was too late.

6. Why was the 2014 Ebola outbreak in West Africa so hard to contain?
Unlike previous Ebola outbreaks, the one that occurred in 2014 lasted for a devastating two and a half years. Many factors contributed to the rapid spread of the disease across 10 countries in Africa, Europe and North America, including:

• Fragile health systems: Guinea, Sierra Leone and Liberia, the three countries at the centre of the epidemic, lacked the health care workers, training, financial support and medical supplies needed to mount an adequate response to the Ebola outbreak.
• Extreme poverty: The areas that were hardest hit by the Ebola virus also had some of the poorest living conditions. Most districts lacked clean water and sanitation facilities, making it difficult for citizens to prioritize washing their hands when they didn’t have enough water to drink.
• Increased mobility: It can take up to 21 days for Ebola virus symptoms to surface, giving an infected person time to travel to another district, region, or even another continent.
• Stigma and fear: The WHO warned that official figures on the outbreak could be up to 50% higher due to families hiding their sick relatives and burying their dead in secret.
• Local traditions: Most families cared for their sick relatives at home, not knowing that they were exposed to the Ebola virus. In parts of West Africa, funerals involve touching bodies before burial, putting family members and communities at serious risk of infection.

7. What is the latest news with the current outbreak?
The latest Ebola virus outbreak in the Democratic Republic of the Congo (DRC) began in August 2018. It’s the second-largest outbreak since the 2014 West Africa outbreak. As of June, 2019, there have been:

• Over 2,600 confirmed and probable cases of Ebola
• Over 1,700 confirmed and probable deaths

On August 12, 2019, scientists announced that they are one step closer to a cure for Ebola, thanks to two experimental drugs that will now be offered to all Ebola patients in the DRC.

8. What factors are impacting the 2019 Ebola outbreak?
The factors contributing to the 2019 Ebola outbreak in the DRC can be described as an accumulation of crises upon crises.

• Ethnic violence: Clashes between armed groups in the DRC and attacks on health centres and health care workers have hampered the Ebola response operations. People fleeing the violence into neighbouring countries like Uganda risk spreading the disease to another already overcrowded population.
• Closed borders: While this may seem like a logical move to contain the epidemic, health officials say that doing so causes mass panic, driving some people who exhibit Ebola symptoms to go underground.
• Lack of international funding: As with the previous Ebola outbreak in West Africa, international response to the outbreak in the DRC has been slow. Without critical funding from the international community, local health care workers will continue to struggle with containing the epidemic while caught in the middle of a literal war zone.
• Multiple epidemics: Measles and cholera outbreaks add further stress to the already fragile health care system in the DRC. Since the start of the year, measles has claimed the lives of 1,500 people, making it the worst measles outbreak since 2011. Meanwhile, 240 people have died due to cholera.

9. How does Ebola affect children?
These are some of the ways that children in Guinea, Liberia and Sierra Leone were affected during the Ebola virus outbreak of 2014:

• More than 17,300 children lost one or both parents during the Ebola outbreak.
• Nearly 20 per cent of all Ebola cases were children under 15 years old.
• By 2015, school closures in Guinea, Liberia and Sierra Leone caused students to miss approximately 1,800 hours or 33-39 weeks of education.
• Vaccination campaigns were either postponed to avoid public gatherings or had their funding redirected towards fighting the Ebola epidemic. Children were left with gaps in their vaccination schedules, putting them at risk for other diseases.
• The psychological impact of Ebola on children is immeasurable. Children who survived Ebola can experience ongoing mental health issues like depression, anxiety and post-traumatic stress disorder (PTSD) for years to come and may not get the adequate support they need to overcome them.

10. What is World Vision doing about Ebola?
Here are highlights of World Vision’s response to the latest Ebola outbreak in the DRC:

• 326,565 people were reached by community health workers to raise awareness on prevention and treatment of Ebola and monitor temperatures.
• 250,000 people reached with messages from faith leaders.
• 29,845 children, families and communities reached with 11,065 hygiene kits.
• 400,000 people reached with life-saving humanitarian assistance since August 2018.
• 90,287 children reached with life saving humanitarian assistance since August 2018.

Religious leaders and World Vision International staff in Beni (DRC) talk on the radio for an hour a couple of times a week to raise awareness about Ebola and to answer any questions listeners may have. Photo: Patrick Meinhardt

Since August 2018, we have been working with communities to improve awareness, prevention and understanding of Ebola, reaching almost a quarter of a million people to date.

We’re relying on expertise from our work during the Ebola outbreak in Sierra Leone in 2014-2015 to work with church leaders, community health workers and teachers to ensure that

• patients are being diagnosed correctly and receiving proper care for their Ebola symptoms;
• family members, caregivers and health care workers are properly equipped to avoid infection;
• health care facilities remain as sterile and well stocked with medicine and supplies as possible; and
• people can give their loved ones dignified burials without becoming infected themselves.

Another way we’re helping communities is through our Channels of Hope for Ebola program. Recognizing that faith leaders are among the most influential members in a community, Channels of Hope for Ebola fully equips them to promote accurate and responsible messages about Ebola and helps them to respond with compassion and care for affected people. Through this program,

• faith communities are engaged in actions that contribute to Ebola prevention, advocacy or care;
• community knowledge about mechanisms to prevent and treat Ebola increases; and
• survivors and families are supported and accepted.

Community members learned through their faith leaders that tackling Ebola isn’t about their individual religious or cultural beliefs— it’s about the well-being of all men, women and children in the community. 

11. What can I do to help people affected by Ebola?
Your donation to our Raw Hope program can provide children living in countries stricken with Ebola with the essentials that can help increase their chances of survival: clean water, education, food, health care and shelter. Whether you can give a one-time gift or every month, your support is greatly appreciated.