Ebola Virus: 7 Surprising Reasons Why The Infection Spread

 7 human factors explain why Ebola spread in the past—and its future risks.

Posted Mar 01, 2019

Ebola virus infection or hemorrhagic fever causes severe fever, sore throat, headaches, body aches and pains, vomiting, diarrhea, and in severe cases, organ failure with unstoppable internal bleeding.  It is highly contagious and is spread from human to human by contact with bodily fluids: saliva, mucus, vomit, feces, urine, blood, semen and even sweat, tears, and breast milk, meaning that just touching the infected person is enough to spread the virus.  The virus is carried by wild animals hunted for meat, especially bats.  The incubation period is from 2 to 21 days.  Before the vaccine (introduced in 2015), the death rate was over 50 percent.  An effective vaccine started to be widely used in May 2018.  

Ebola was first discovered in the Democratic Republic of Congo (DRC) in 1976 and takes its name from a river in the area.  Since then, the country has had 9 outbreaks of Ebola and there have been 26 worldwide outbreaks.  The worst outbreak was in 2014-2016 with a total of 11,324 deaths in Africa for about 28,652 cases, which ultimately motivated the successful development of a vaccine. 

But why did Ebola spread so easily and rapidly particularly in 2014 and why is it still doing so, despite an effective vaccine?

One would think that Ebola spread because of the qualities of the Ebola virus being highly contagious and because of easy and cheap plane rides all over the world.  It is true that those are very important factors, but there are other less obvious but equally important factors.  Those other factors are human factors. 

7 surprising human factors explain why Ebola infections spread so easily and quickly:

1. The tradition of washing dead bodies before burial:

In some parts of Africa, especially in Congo, Guinea, Liberia and Sierra Leone, when people get sick from Ebola fever, relatives often use their private cars (contaminating the cars) to transport their loved one to the hospital and when there is no more hope at the hospital, they can, sometimes forcefully, against medical advice, take their loved one back home in their same private cars so that their loved one can die at home and be bathed by relatives and buried in their village.  It is a deeply rooted tradition, a religious ritual that relatives should gather around the body, wash it and bathe it to honor it. The family does this with their bare hands but unfortunately, in the case of Ebola infection, the dead body is often covered with sweat, vomit or/and diarrhea, fluids that are all full of the highly contagious Ebola virus. Each person who touches the body with their bare hands is at very high risk of getting infected and in turn, infecting everybody around them. Respecting religious traditions in some parts of Africa is more important than medical safety: Very recently, in May 2018, in the Democratic Republic of Congo, at the beginning of Congo’s 9th Ebola outbreak, 3 people were taken out of quarantine by their family to take them to a religious gathering of at least 50 people in the very highly populated town of Mbandaka (city of 1.2 million people on the Congo river) and the 9th Ebola outbreak started.  The World Health Organization is now organizing “safe burials”, with special teams using protective equipment to wash infected bodies before safely burying them, but those teams are still not accepted everywhere. 

2. Some people in West Africa are in complete denial about Ebola:  

Many local people cannot comprehend that a dead body can be a health threat.  Some think that local and foreign health care workers invented Ebola to lure Africans to clinics to harvest their organs. In September 2014, in southeastern Guinea, Red Cross workers collecting a dead body infected by Ebola were attacked by people throwing stones at them because the family of the dead person had been wrongly informed that the Red Cross was going to cut up the body.

3. Some Africans falsely believe that Americans are spreading the virus:

In Africa, some local people are under the false belief that Americans who come to help (doing safe burials and vaccinations) spread the virus on purpose instead of helping.  Some medical teams are attacked by locals with some medical team vehicles being stoned and even stolen (Mike Ryan at WHO).  

4. People are claiming - so that they can make money- that they have the power to heal Ebola:

A female herbalist in the village of Sokoma in Sierra Leone (in 2014 when there were no cases of Ebola in Sierra Leone yet) claimed she had the powers to cure Ebola.  In order to be treated by her, people who had Ebola in Guinea crossed the Guinea-Sierra Leone border.  The herbalist probably made a lot of money but had no real power against Ebola and she later died from the disease.  She had a lot of mourners coming from many other towns participate in washing her body and, as a consequence, many mourners got infected and started a chain reaction of infections, deaths, washing bodies and more infections in several towns nearby. That is how Sierra Leone went from 0 cases of Ebola virus infections in March 2014 to 127 deaths from Ebola in July 2014 (at the same time, Guinea had 307 deaths and Liberia 84 deaths for total cases of more than 1,000 infected people).  

5. Some Ebola survivors can sexually transmit the virus via their sperm 3 or even more than 12 months after regaining health:  

One would think that people who survived Ebola infection can be sexually active with no risk of contaminating their sexual partner after 3 months of being healthy.  Well, that would be a wrong assumption. Studies were done in Sierra Leone in 2015 show long term persistence of Ebola virus in the semen of men even after their discharge from the Ebola Treatment Unit. Ebola virus was detected in the semen of 100 percent of men 3 months after Ebola Treatment Unit discharge, in 62 percent of men between 4 and 6 months after discharge, in 25 percent of men after 7 to 9 months after, in 15 percent of men at 10 to 12 months, in 4 percent at 16 to 18 months, at 0 percent at 16 to 18 months, making Ebola a sexually transmitted disease for a longer time than we previously thought.

6. In the USA, hospital staff, clerks, nurses, and physicians don’t pay enough attention to where patients are coming from: 

Late at night on September 25th, 2014 a Liberian man called Thomas Eric Duncan, 43 years old presented to the Emergency Room in Dallas, Texas with a fever, abdominal pain, explosive diarrhea, and projectile vomiting, all typical symptoms of Ebola infection.  But nobody paid attention to the fact that he had just flown from Liberia (where Ebola was active) to Dallas a few days earlier on September 19th to visit relatives.  He was kept in a non-isolated area, exposed the medical staff and 7 other patients to the infection and was released from the ER the morning after he arrived without anybody realizing he could have Ebola fever. In doing so, the medical staff put many people’s life at risk.  Feeling worse each day after that, Thomas Duncan went to Texas Health Presbyterian Hospital on September 28th where he was finally placed on isolation.  He tested positive for Ebola on September 30th but, unfortunately, died of respiratory and kidney failure on October 8th, 2014. In the meantime, he had contact with 50 people on American soil.  Fortunately, those people were contacted and placed in isolation soon enough to avoid a full outbreak in the USA.  The lesson learned from this event is that it is important to ask every patient about their travel history in the last month or couple of months and if they had any close contact with people from Ebola-infected countries.  If in the last month, a patient with a fever was in a country where Ebola is active or if the patient was in close contact with somebody coming from an Ebola-active country, this patient needs to be placed in quarantine until Ebola infection is ruled out. 

7.    Ebola infections in 2018 and 2019 are in armed conflict zones:

Now that everything should be better because we have an effective vaccination (which started to be tested in 2015 and has been widely used since May 2018), there is an additional problem.  New cases of Ebola are in armed conflict zones in the Eastern Democratic Republic of Congo which makes vaccinations very difficult and dangerous for the medical staff. If we add this to the fact that some people in Africa still wrongly assume that vaccinations spread the virus instead of preventing it, and thus sometimes attack safe burial teams and vaccination teams, we can understand why as of February 2019, Ebola virus is spreading again in the Democratic Republic of Congo. 

What lessons can we learn from this?

The lessons learned from those 7 human factors in the spread of Ebola virus infection are that we must be open to change, accept new medical research, learn new technologies and educate our people.  We need to keep an open mind, think about all the possible causes of a symptom and think outside the box.  If we see somebody vomiting in the street, we should keep in mind that it can be anything from a benign hangover after too much alcohol to a deadly, very contagious viral infection.  

So, let's be cautious.

References

https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html

https://www.msf.org/drc-ebola-outbreak-2018

https://www.washingtonpost.com/news/morning-mix/wp/2014/09/19/why-the-brutal-murder-of-eight-ebola-workers-may-hint-at-more-violence-to-come/?noredirect=on&utm_term=.4246d1c54b18

https://www.apnews.com/86fd89fa73594ed0aa098c6c5a063300

https://www.nejm.org/doi/full/10.1056/NEJMoa1511410?query=featured_ebola

https://www.who.int/csr/disease/ebola/advisory-groups/bio-ryan/en/