Containing Global Disease Epidemic: A Case of Ebola

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Abstract

Many countries encountered gross challenges and constraints in controlling epidemic whenever they occur. These challenges run from resources to expertise that is necessary for managing an outbreak at a given time. Typically, outbreaks catch people unprepared and sometimes without any plan. It is difficult for countries that have not developed general measures and capacity to curb any particular outbreak that may be experienced. The preparedness can be designed from experiences and history of disease trends, and lessons learned from other countries.

There are different common epidemics that are experienced by countries all over the world such as Ebola, HIV/AIDS and Avian influenza among others. Ebola Virus Disease (EVD)  which have recently hit the world, and specifically adverse in West Africa is estimated to have hit over 12,000 cases in the West African countries with more than 5,000 deaths reported as at October, 2014 According to WHO (2014). The purpose of this research is to establish how it is possible to contain epidemic disease outbreaks (Morgan MT, 2014), and the role of global institution such as CDC and WHO and partners such as the regional blocks or unity of states in dealing with global disease epidemics and protecting the people at risk.

Outbreaks can spread over large areas through geographical boundaries to cause global disaster. There is a need for responsible agencies to ensure that the necessary actions and steps are taken in order to prevent any further spread of outbreaks. It is necessary for disease agency such as CDC to build verification and disease centers in the affected area to speed up the process of controlling the outbreak and provide quick response to affected people. There is a need for a unified approach to handling outbreaks other than single country effort since the impact of the epidemic may be great affecting global environment and activities in general.        

Background of the Study

International organizations and partners have since been teaming up to contain outbreaks globally no matter where the outbreak occurs. This is because some outbreaks can go beyond borders to affect a larger population contributing an unexpected disaster, which will be more complicated than the initial outbreak. According to Steven (2014), the USA is joining “other countries in a collaborative effort to improve the detection, prevention and response to global infectious disease outbreaks”. There are four billion people protected from infectious disease globally (Steven, 2014). The focus thus needs to shift to initiatives of the past that fallen short. Participating countries in the prevention and curbing of outbreaks should be committed to creating emergency disease centers capable of responding to outbreaks whenever they occur.

Several countries in sub-Saharan Africa face many difficulties in dealing with disease outbreaks over time. This is as a matter incapability and lack of work force to tackle the epidemics among other factors. Even though countries like Nigeria and Senegal have contained the disease, other West African countries are still crippled under the condition with more States reporting cases one after another. Ebola Virus Disease also known as Viral Hemorrhagic Fever have reported in 2014, the worst widespread in history within West African countries with increasing mortality and fatality rates within a short period. Guinea, Sierra Leon and Liberia have reported highest cases in history, with Nigeria, Mali and Senegal also reporting the number of cases (CDC, 2014). There was also another case in the Democratic Republic of Congo, which is independent of the primary case. The reported cases of the Ebola outbreak could add up to 12000 with deaths at about 5000. The figures however are said to underestimate the real facts on the ground that in reality could be three times the reported cases.

Many countries in Africa have encountered gross challenges in controlling the epidemic. There are widespread propaganda and information going round about the disease that could mislead the public, to the extent of authorities disagreeing among themselves based on the outbreak and collective commitment in controlling the disease. The outbreak has brought suspicion, with the general feeling that there could be people behind its spread. Areas of adverse poverty are most affected with Ebola virus outbreak. The areas experience shortage of soap and running water necessary for controlling the spread of the disease. Cultural practices and the reliance on traditional medicine are also possible factors contributing to the spread of the EVD. Hospitals in these areas also require basic facilities necessary to fighting the disease.

Ebola Virus Disease (EVD)  is estimated to have hit over 12,000 cases in the West African states with more than 5,000 deaths reported as at October, 2014 According to WHO (2014). The WHO (2014) however warned that the figures could only represent a third of the real situation on the ground. The WHO raised concern that there could be 10,000 emerging cases reported every week from December of 2014 if the outbreak is not controlled.

African countries are having trouble in containing the outbreaks, with public suspicion, lack of necessary resources, cultural beliefs and practices, infrastructure and minimal expertise. Because of the outbreak, a number of health workers have been lost, health facilities in the affected areas closed and the capacity of the countries for treating the people infected falling far much below the needed capacity. With only 2000 beds available for admission of the patients all over the affected countries, inability to build capacity to contain outbreaks would cause additional deaths even higher than the outbreak itself. There is a need for massive global response in case of an outbreak, from different aspects necessary for controlling an outbreak and bringing stability in the affected areas

Statement of the Problem

Ebola Virus Disease (EVD)  is estimated to have hit over 12,000 cases in the West African states with more than 5,000 deaths reported as at October, 2014 According to WHO (2014). The WHO (2014) however warned that the figures could only represent a third of the real situation on the ground. If not controlled, the WHO warned that there could be 10,000 new cases reported every week by December of the year 2014.

African countries are having trouble in containing the outbreaks, with public suspicion, lack of necessary resources, cultural beliefs and practices, infrastructure and minimal expertise. Because of the outbreak, a number of health workers have been lost health facilities in the affected areas closed and the capacity of the countries for treating the people infected falling far much below the needed capacity. With only 2000 beds, available for admission of the patients all over the affected countries, inability to build capacity to contain outbreaks would cause additional deaths even higher than the outbreak itself. There is a need for massive global response in case of an outbreak, from different aspects necessary for controlling an outbreak and bringing stability in the affected areas.

Purpose Statement

The purpose of this research is to establish how it is possible to contain epidemic disease outbreaks and the role of global institution such as CDC and WHO and partners such as the regional blocks or unity of states in dealing with global disease epidemics and protecting the people at risk. It will further examine steps taken in creating awareness to people in the affected areas properly to contribute to the control of an outbreak. It will also investigate the capacity of states to handle outbreaks single-handedly as a country or if there is a need for comprehensive support and the areas the help may be needed.

Objectives of the Study

1. To establish the efforts made by nations to contain outbreaks and in creating proper awareness
2. To identify steps taken by the United States and other states in assisting severely Ebola stricken countries.
3. To understand what other countries are doing to reduce, contain and fight the spread of Ebola.
4. To create an understanding of what CDC is doing to prevent and combat Ebola and the best practices.

Research Questions

1. What can nations learn about outbreaks and act to contain them?
2. What are other countries doing to assist reduce, contain and fight the spread of Ebola?
3. Does an internet survey, phone interview create awareness of Ebola,
4. What are the symptoms of Ebola and the best practice?
5. What is CDC doing to prevent and fight Ebola?

Hypothesis

H₀ Each country can deal with an epidemic independently without international efforts and contain or eradicate the epidemic disease.

H₁ Countries like the African states requires global support in dealing with epidemic disease outbreak in order to contain or eradicate the epidemic.

Literature Review

In most recent past, there was an outbreak of Ebola reported in the West African Countries, which have caused uproar all over the world with some countries sending medical response teams, while others giving travel notices and even cancelling flight routed to the affected countries. Horn of Africa deployed about 200, and other African countries 1000 health workers (Tesfa, 2014) to West Africa to respond to the epidemic. This came after an appeal from the African Union to its member states to dispatch workers to the affected regions since the outbreak was becoming a national threat.

The USA, on the other hand, contributed 1100 military personnel to the West African states. The main areas of support by other countries to the affected states was case management, supporting disease surveillance in the affected countries and proper organization of community care to increase the capacity of the ailing countries to respond to the outbreak. Apart from the personnel support, the volunteering countries also made cash donations to support the activities undertaken.

Other institutions such as CDC, WHO and Mercy Corps play an important role during outbreaks. They deliver health care services and training programmes, together with a commitment to humanitarian assistance while others focus majorly on the disease eradication according to Congressional, (2014). These institutions can improve the quality of life to communities through proper health interventions in order to improve the capacity of underserved communities in dealing with unprecedented health events. They offer training, health care and medical assistance to communities at highest risk with less rigidity to respond to emergencies. They rehabilitate devastated systems of health restoring them to self-reliance.

Delayed response to diseases causes an outbreak, reaching levels uncontrolled. This brings a shift of focus, as most concentration would be placed in treating the conditions with the temptation of little focus on prevention. This will call for a multi-agency response such as the USAID, Britain`s Department for International Development, the European Commission`s Humanitarian Aid and Civil Protection department (ECHO), Irish Aid, WHO, the CDC and other International NGOs, to institute the highest response in order to contain the situation and prevent further spread.

Epidemics can cripple the already fragile healthcare systems due to the higher response capacity required. This would cause more deaths and shut up of the health facilities due to worker's withdrawal, with people also avoiding to seek services from the facilities due to the fear of being infected. Such circumstances require multi-agency reaching out to assess situations and identify points of action. Establishment of laboratories by partners such as the USA and the CDC will help in turning around results quickly so that they could be acted upon and prevent further spread of disease by dismissing those who test negative from the isolation centers.

    According to Kalu (2014), the virus is transmitted commonly to new places through an infected person travelling to the place. With the disease ravaging in nearby areas, it is difficult to predict the possible precedence since an infection can occur anytime with a possibility of attacking several people. Countries have cancelled flights operating through the affected countries in a bid to controlling further spread. The virus can cause disaster in a country with increased morbidity and mortality. Developed countries may have the capacity in dealing with outbreaks such as cholera, Ebola and HIV, which only needs to be mobilized to be effective. The mobilization can be a success through collaboration of partners and organizations, together with the commitment of the locals and authorities of the affected countries.

    Governments of the affected countries should deliver necessary tools to its citizens that would enable them advance the fight against an outbreak. There should be penetrative awareness that will enable the people at risk have the factual information about the disease outbreak and how to identify and report the case. If the case needs seclusion as that of Ebola, then the people should know the appropriate measures and the steps they would take to avoid possible further spread of the disease (Kalu, 2014).

    Fighting outbreaks requires continuous advancements in science, research and technology that developed nations have shown efforts in, and the raising of the general education standards from theory based to innovative applicable approaches that would contribute to improving workforce capacity in dealing with outbreak at any instance. The deplorable state of scientific Advancements and educational scaling has proved to be a setback for developing countries in dealing with outbreaks. Science and technology are very critical factors in efforts to create awareness, preparedness and capacity in dealing with disease outbreaks. These elements should be incorporated in the culture of the people so that they appreciate the importance and the role they can play in raising their standards of living and alleviate any further outbreak.

    In earlier years, frameworks to accomplish similar goals were placed targeting disease outbreaks. In 2007, 194 member states of the World Health Assembly took to improve capacities to prevent and contain health hazards related to epidemics that would spread across borders to reaching other nations. The research will determine how the success of these countries in supporting their initiatives was achieved and how progress is made in improving initial failures. International health agencies such as the WHO is encouraging governments to focus more on global health threats.Such risks are caused by the emergence of new microbes, increased international flights and migrations, as well as rise in the number of drug-resistant infections. There is the release of biological pathogens either accidentally or through terrorist attacks together with the susceptibility of humans to disease causing organisms that are likely to spread whenever they attack a person.

Theoretical Framework

    The world is now experiencing different epidemics of different diseases in different places at either the same time or different times. The increase in pandemics and epidemics is due to the increased exposure of people to disease-causing strains and pathogens, risky behaviors and increasing environmental contamination. Diseases are also emerging that are resistant to drugs that are currently available and others that have modified strands. These disease-causing organisms may regenerate with the different progress in causing diseases and disabilities.

    International agencies and partners must participate in scientific innovations through their initiatives and funding in order to come up with improvements in the existing systems of responding to outbreaks. Strengthening of past inefficiencies is also necessary in order to contain any outbreak that may come up. International disease centers are empowered to respond to outbreaks and epidemics irrespective of where it occurs and to whom it affects in order to prevent any further spread and stop any new infection while managing existing infections.

    Global partners in health and health organizations must take initiatives of creating awareness about any disease outbreak. Through awareness, people in the affected areas are enlightened on how to handle an outbreak. Any further spread while at the same time responding to the existing cases and improving capacity to manage entirely and contain the situation.

Definition of Terms: Containing Global Epidemic

    Containing would mean restraining or controlling a widespread occurrence of an infectious disease with the ability of spreading worldwide, over wider (international) geographical boundaries causing deaths and mortality.

Ebola Disease Virus

Ebola is a rare disease caused by viral infection with virus strains in humans and nonhuman primates. It is caused by infection of the family Filoviridae, genus Ebolavirus. There are five identified Ebola virus species, four of which cause disease in humans and one in primates.

Scope and Limitation

    The study is cross-sectional and tends to cover countries that recently experienced Ebola outbreak of the states in 2014 to understand the efforts made in containing the outbreak (CDC, 2014). The lack of factual information on the situation from the reviews presented by the response teams in the fields to the disease response centers will influence the outcome of the study. The study is susceptible to bias.

Methodology

This section will describe and explain the study research procedures that are used in the study. It will describe the data collection techniques, the process of collecting the data, means and methods of data analysis. The section also describes the research design, target population, the sampling design and how the final analysis of the data will be handled. This discusses on the research area, study design, sampling and sampling techniques or respondents of the study. Instrument of data collection and the statistical treatment of data will help give the actual picture of where the data was generated and where the research is relevant.

STUDY AREA

This study focuses on global epidemics and covers every country that has been affected by epidemic. The study will focus on the West African countries, the USA, Turkey and Spain. It will be based on the cross-examination on any data on the situation of these countries during the Ebola outbreak.

RESEARCH DESIGN

The study design will be cross sectional study design that will help understand the distribution of diseases in the area where the outbreak occurs and how the global partners are participating in unison to contain such outbreaks.

TARGET POPULATION

The target population is all the countries and the people who have been affected by the recent Ebola outbreak that featured in the West African countries (Internationalsos.com, 2014). Generally, the study will focus on the countries where cases of Ebola outbreak have been reported in the year 2014. There will be no sampling for this study since it will be based mostly on secondary data and observations about the situation in the countries. Every country will be covered as per the details provided by the WHO and CDC.

DATA SOURCES AND INSTRUMENTS

This study will not have sampling methodology or technique since it will be based on figures already available and the information provided by the responsible agencies in responding to outbreaks. Data will be collected through the review of the secondary data that are relevant to the study together with internet surveys and checklists. Data from WHO and CDC will be of importance for understanding the situation on the ground and conduct analysis of resources and online surveys in order to come up with data necessary for concluding this study.

The internet surveys will be structured to be able to establish the preparedness of the global health partners and disease centers in terms of equipment possession and expertise to generate data from previous epidemics that had occurred.

DATA ANALYSIS AND PRESENTATION

Before the analysis, all responses from surveys and the entries in the checklist will be checked for reliability and verification. The data collected will be analyzed both qualitatively using brief explanations and quantitatively using descriptive statistics method such as tables, percentage and pie charts. The data will be collected using questionnaires, which will be   edited for ensuring comprehensiveness and accuracy of the filled questionnaires. Data will be analyzed using descriptive statistics to get frequencies, percentages, tables, graphs and pie charts. The data may also be analyzed using scientific package for social sciences.

Proposed period

The research is intended to take place within six weeks with the possibility for extension if the need is to provide flexibility and response to any matter that may arise from the study.

Case Study of Ebola

Ebola virus disease is a rare and deadly disease caused by viral strains known as Ebola, belonging to the family Filoviridae and genus Ebolavirus (Chapelhillpeds.com, 2014). According to Fau.edu (2014), “there are five virus species of Ebola that have been identified, four cause disease to people”. "Ebola virus (Zaire ebolavirus); Sudan virus (Sudan ebolavirus)" among others (CDC, 2014). The fifth is Reston virus (Reston ebolavirus) causing disease in nonhuman primates. Scientists have not discovered the reservoir that host Ebola virus. “It is however said to be animal-borne, and that bats are the most likely reservoir, from the nature of the similar viruses. Four of the five virus strains are present in an animal host native to Africa” (Ncdhhs.gov, 2014). Its signs and symptoms include "Fever, Severe headache, Muscle pain, Weakness, Diarrhea, Vomiting, Abdominal (stomach) pain, Unexplained hemorrhage (bleeding or bruising)" (CDC, 2014). These may appear between 2 to 21 days after exposure to Ebola virus, averaged to 8 to ten days. Good supportive clinical care and the patient’s immune response recovery are necessary for the recovery of a patient that later help them develop immunity against the virus.

Transmission

Ebola virus natural reservoir has never been discovered to date thus the way in which the virus manifests at the preclinical stage is unknown.  It is however believed that a person will be infected through contact with an infected person or animal rendering the disease contagious. Contact among people with the infected can lead a wider infection and spread in several ways to others. Direct contact (through broken skin or mucous membranes) with blood or body fluids of an infected person and, objects (like needles and syringes) that have been contaminated with the virus from the infected will lead to the contraction of the virus.

The virus cannot be spread through water, air and food though the contact with an infected animal or the meat of an infected animal will lead to the contraction of the disease. There is no evidence whatsoever, that mosquito and other insects can transmit the virus. Only a few species of mammals (for example, humans, bats, monkeys, and apes) have been proved to have ability of being infected with and spread the virus. During outbreaks of Ebola, the disease can spread quickly within healthcare settings (such as a clinic or hospital), and the exposure can occur in healthcare settings where hospital staffs are not appropriately furnished with protective equipment.

Sterilization of equipment and avoidance of reuse of medical equipment should be taken seriously, and the already used equipment that is disposable is disposed of and those that are reused be properly cleaned and sterilized. Without adequate sterilization of the instruments, virus transmission can continue and amplify an outbreak. Once a person has recovered from Ebola, they can no longer contact the virus. However, the virus is found to survive in semen for a period of four months and transmitted through any form of sexual intercourse. Thus, abstinence from sex with an infected person or one who is yet recovering is recommended.

People at the closest contact with the infected persons such as the healthcare providers and the family members are at the highest risk of being infected by a virus. This is due to the contact with the blood of the patient and the body fluids.

Preventive Measures

People travelling to Ebola stricken areas are advised to keep a high level of hygiene, make sure they regularly wash their hand in a non-contaminated clean water thoroughly using soap and avoid contact with blood and body fluids. Non-infected persons should at not handle any items that have been exposed to infected people. Any traditional rituals that may expose a person to an infected person or body should be avoided at any point. Raw meat prepared from animals that play host or transmit the virus should not be taken. Any contact with such animals should also be avoided.

Persons are also advised to avoid health facilities where the infected persons are responded to and treated unless authorized and equipped appropriately and in relevant attires. A person who is exposed to Ebola stricken area should be monitored for 21 days. Healthcare workers should wear appropriately and practice proper infection control and sterilization measures as outlaid and recommended. Patients with Ebola should be separated in isolation from other patients without the virus. Contact with bodies demised from Ebola should also be avoided. In the case of any suspicion, health personnel should be informed to assess the situation.

Diagnosis

It is difficult to diagnose a person infected for few days because the early symptoms, such as fever, are nonspecific to Ebola infection and are seen often in patients with more commonly occurring diseases, such as malaria and typhoid fever. However, the early signs of Ebola and has been exposed to likely contract the virus, that person should be isolated, and health professionals notified. Samples from the patient can then be collected and tested to confirm if infected.

Symptoms of Ebola are treated as they appear. The following primary "interventions, when used early, can significantly improve the chances of survival: Providing intravenous fluids (IV) and balancing electrolytes (body salts), Maintaining oxygen status and blood pressure, Treating other infections if they occur" (CDC, 2014). Recovery from Ebola depends on patient's right supportive care, and the immune response to the drugs administered. People who heal from Ebola disease develop antibodies that last longer, up to at least ten years. It cannot be categorically verified if people who recover from ecole virus can become infected with, a different species of Ebola or will remain immune in their lifetime. Complications, such as joint and vision problems have been established from people who have recovered from Ebola.

Treatment

            There is no vaccine discovered for Ebola. The medical personnel treat the Ebola symptoms as they appear on a patient through balancing electrolytes and providing for intravenous fluids. Other infections of known cause are also treated and the blood pressure and oxygen levels in a patient maintained. So far, the viral vaccines that are developed have not been tested to be effective and safe for use (CDC, 2014).

Conclusion

            Outbreaks are able to spread over a large area through geographical boundaries to cause global disaster. There is need for responsible agencies to ensure that the necessary actions and steps should be taken in order to prevent any further spread of outbreaks. Actions such as banning flights to affected areas and secluding the people infected could be considered. There is also need for effective screening to detect persons with signs of the disease on the outbreak to take necessary steps in preventing further spread.

            Global partners and countries should join at the times of outbreak, in order to build capacity and provide funding necessary to containing the outbreak before it gets complicated. It is necessary for disease agency such as CDC to build verification and disease centers in the affected area to speed up the process of controlling the outbreak and provide quick response to affected people.

            Creating awareness is also important. People have theories and beliefs about certain diseases and outbreaks. If there is no proper awareness on the disease on outbreak, people may start politicizing the situation and even become resistant and violent making it hard to control the epidemic. Proper awareness also prevents further spread due to cultural beliefs and traditional practices that people may engage in.

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