Ebola – Weekly Geopolitical Report by Bill O’Grady
Last week marked six months since the Ebola outbreak was identified in the African country of Guinea. The current Ebola epidemic is the largest, most severe and most complex outbreak of the disease in the history of the virus. More cases have been diagnosed and more people have died than in all the prior outbreaks combined. All 24 of the previous outbreaks have occurred in Central Africa. The virus was able to spread undetected for months as this is the first episode of the virus to take place in West Africa. Complicating the initial diagnosis was the fact that the symptoms of Ebola are identical to many other diseases in the region.
Ebola is a viral hemorrhaging fever that attacks the blood vessels, causing internal bleeding and leading to multiple organ failure. Fast-spreading and fatal in more than half the cases, the virus can be easily spread through direct contact with an infected person’s bodily fluids or contact with contaminated items. The symptoms start after an incubation period of two to 21 days, and it is believed that a person is only contagious after symptoms appear.
Since the disease is so fast-spreading and healthcare facilities so strained, it is hard to keep an accurate running count but as of the time of this writing the World Health Organization (WHO) estimates the case count is currently at 6,574 and the death count is 3,091. Global observers believe that this number is underestimated. The Centers for Disease Control (CDC) estimated last week that the total number of cases could reach between 550,000 and 1.4 million by January 2015. Without a significant improvement in fighting the disease, the number of cases could double every 20 days. We note that this estimate does not account for the recently announced funding support from the U.S. to combat the disease.
The countries that are most affected by the virus are Guinea, Liberia and Sierra Leone, but Nigeria and Senegal have also experienced cases. Liberia has been the hardest hit, with more than half the fatalities occurring in this country. In addition to being extremely poor, these countries also have weak healthcare systems and very few doctors. In Liberia, there is one doctor per population of 100,000. By comparison, the U.S. has 250 doctors per 100,000. During any Ebola outbreak, but especially in the developing world where hospital sanitation standards are lower, healthcare workers are at a higher risk of contracting the virus. This further robs these countries of experienced medical personnel.
This week, we will explore the Ebola outbreak, looking at the origin of the disease, how it has spread and how it has developed into a serious epidemic. Although it is hard to find comparable epidemics due to the complexities of the disease, we will look at a couple of other disease outbreaks in order to gain a better understanding of the scale of the current Ebola epidemic. As always, we will finish with geopolitical and market ramifications.
The Origins of Ebola
It is unknown how the virus initially originated, but scientists believe that “patient zero” contracted the virus from an animal. Scientists believe that a certain kind of fruit bat is a natural host of the virus, but other small mammals are also known to be carriers of the disease. The virus may have spread to humans through consuming wild animal meat, preparing the meat or touching surfaces that were contaminated with bat droppings.
The 1976 outbreak near the Ebola River in what is now the Democratic Republic of Congo (DRC) was the first recognition of the disease. Interestingly enough, the first outbreaks happened simultaneously in Sudan and DRC. Since then, Ebola outbreaks have occurred periodically in Africa. The initial fatality rate from the disease was 90%, which has now been reduced to around 50%. In each of the previous outbreaks, the total number of Ebola-related deaths in Africa has been under 500, and the deadliest events were mostly spread within hospitals via the use of contaminated syringes. Earlier outbreaks have been relatively easily smothered, partially due to the fact that they occurred in remote villages, not cities, where it’s easier to contain.
All cases of human illness and death from the virus have occurred in Africa, with the exception of three cases of laboratory contamination. No cases have been reported in the U.S. As has been widely reported by the media, three American healthcare workers were flown back to the U.S. after contracting Ebola in Africa. Two of these patients have been released after they were declared “cured” of the virus.
The Current Outbreak
In December of last year, a two-year-old boy in a remote village in Guinea became ill with fever and vomiting. Two days later, the boy died. He would retrospectively be called “patient zero” of the current Ebola epidemic in West Africa. The disease went unnoticed for months, resulting in several transmissions, with all 14 people that were initially infected dying within a short period of time. Although hundreds of cases of a virus had been reported, health workers did not suspect Ebola since Guinea had never had a case of the virus. Complicating matters was the fact that the symptoms mimic many other viral diseases in the region, such as malaria and cholera. Four months after the first death, in March 2014, the mysterious virus was finally diagnosed as Ebola. All countries involved are extremely impoverished, resulting in a more rapid spread of the virus. The countries’ healthcare systems are in their infancies following years of civil war.
One reason behind this sudden appearance of Ebola in West Africa was thought to have been due to bats moving closer to human habitats as forests were cut down for timber and to make room for mines. Bat hunting for food is common in this part of Guinea as is hunting for other small forest mammals.
Ebola can spread quickly within family members and healthcare settings. A swift response to this outbreak is critical as currently the virus is thought to be spread only through direct contact with bodily fluids. It is not known whether the virus could mutate to become airborne. The already thin resources of these countries’ healthcare systems have been stretched even further, with not enough beds in treatment centers. Unfortunately, some people are dying on the streets before they can be admitted. The Liberian ambulance and Ebola hotlines have been so overwhelmed that people sometimes have to wait days before help can arrive.
Fear in the communities has also added to the spread of the disease. Some locals were worried that Ebola would be more prevalent in hospitals and therefore did not seek medical help when Ebola symptoms appeared. Some doctors were worried about increased exposure to the virus and quit, stretching thin the already fragile medical system. Angry villagers in Guinea attacked doctors and government officials that came to communities to educate about the Ebola outbreak. Although the actual number of cases is widely believed to be under reported by global observers, some politicians in Liberia have accused their government of over-stating the numbers to