TAYLOR BOROWETZ

What is ebola?

According to the World Health Organization, “Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.”

Dr. Johnmark Opondo, deputy medical health officer with the Saskatoon Health Region, has done extensive work in public health and communicable diseases including research on Ebola.

He said there have been flare-ups in Sudan and the Congo in the past but from late 2013 until now, the biggest outbreak of Ebola ever has taken place. Opondo explained that former outbreaks have been in very remote forest regions in the jungles of central Africa, went through populations and destroyed entire villages, which caused the virus to burn out. However, in the current outbreak, the disease has moved outwards incredibly quickly. It spread from rural eastern Guinea into the rest of the country, but also into Liberia and Sierra Leone.

In smaller countries, the virus tends to move between rural areas and nearby cities. Opondo said that this is the first time Ebola has been seen active in a capital city, which is a massive development. Not only are capital cities densely populated, they have a lot of susceptible individuals, Opondo said. All of the capital cities in the most affected countries have international airports.

With all of these factors working together, Opondo mentioned the incredibly saddening statistics, which to his guess are underestimated; there are over 8,000 confirmed or suspected Ebola cases, and 4,500 confirmed deaths.

Opondo said the scientists at the Centres for Disease Control – Public Health Agency of Canada (PHAC) are learning that even a small dose of viral particles can cause Ebola. Interestingly, they have studied this virus over the years and have reported no genetic change. This outbreak is still the Ebola virus causing EVD and still spreads through close contact, blood and bodily fluids of an infected person or by consuming meat of an infected animal, Opondo said.

Though the virus is genetically the same, eradicating Ebola has numerous complications which are especially challenging. There is no antiviral vaccine or specific treatment. The patient needs a good medical care system to provide support until they can produce the necessary antibodies to fight the infection. Incubation lasts between two and 21 days after infection and in that period there are no symptoms.

Opondo said that contact tracing is extremely important. Public health has to review every single person the patient was in contact with and evaluate that contact. This takes a lot of effort and resources, which are at our disposal in Canada but are simply not available in the three most highly affected countries. Public health becomes even more of a challenge as Ebola disproportionately affects healthcare workers because they are constantly exposed to infection.

Statements from the WHO and others predict at the current level of intervention, the epidemic will continue for another six months.

Opondo said that prospect becomes even more disheartening when you realize that Liberia, Guinea and Sierra Leone are still experiencing exponential rates of transmission over half a year into the outbreak.

Nigeria and Senegal have also had outbreaks, but have been able to control them with strong public healthcare systems. Opondo said they are not yet labeled Ebola-free, but will be after one more 21-day period with no new cases.

Opondo mentioned that Ebola, like other many other illnesses, has to be controlled at the source; it is a well-known truism in communicable disease.

He said although Ebola is consistently present in the media, it is not as easy to contract as one may believe. If an individual has no symptoms, they are not infectious.

“We shouldn’t be overwhelmed and crippled by the fear of Ebola.”

For those in health care, with proper infection control, the right personal protective equipment is sufficient to safeguard you and should be used properly anytime someone has an undiagnosed illness. Opondo also mentioned the importance of hand washing, as with many other infectious diseases.

He suggests that everyone educate themselves and keep an eye on the Health Region website for resources that are available and to review the information that Public Health and other departments are providing.

“This is really one of those areas where knowledge is power.”

What it means

From an international relations point of view, Martin Gaal, political studies professor at the University of Saskatchewan, sees the Ebola outbreak as a call to greater global governance.

“What happens in the rest of the world has an impact upon us,” Gaal said. “It is a call to action, from a global perspective.”

He said that similar outbreaks can also be a symptom of other problems such as extreme economic inequality.

Gaal pointed out that one of the most significant concerns with the current outbreak is its size, along with its unprecedented rate of growth.

“It has far eclipsed the total amount of Ebola victims in the past,” he said. “It is starting to cause panic in the West. It is threatening the South.”

He said the media’s propagation of this panic has had many unwanted effects, including seeing ourselves as more important and seeing the ‘other’ — or anyone outside of our area of familiarity — as a threat. The average U of S student should not be worried about contracting Ebola, Gaal said, adding that they should examine the breakdown in the global system and question what it means.

In the affected states, the virus has the possibility of wiping out any gains made in international development since the onset of the development programs in 1945, Gaal said. Nobody can quantify how great the setback will be.

The outbreak will also indirectly impact all trading partners of affected areas. Gaal said it is going to re-define economic and political relations in that area of Africa for untold time in the future. It is so destructive locally, Gaal said and the global North needs to start taking action.

“We need global institutions. We need to have more interdependence. We need to have greater shared empathy. We need to look at problems abroad as not ‘happening to the other’ but as ‘happening to the self’. What is happening there has an impact on our lives.”

Canada’s response

While it may seem as though the buzz from the federal government about Ebola has quieted down this month, Prime Minister Stephen Harper was definitely clear about the message he was sending out in October.

As he accepted the Rotary Foundation Polio Eradication Champion Award for Canada’s efforts, he said that much like polio, Ebola must not be underestimated.

Harper warned Canadians not to get complacent.

“What has happened recently with Ebola reminds us that in an age of globalization and particularly global trade and travel, what was a problem that was at one time far away from us could arrive at our shores very quickly.”

In more recent news, the Ebola vaccine has been making headlines, with phase 1 trials currently underway.

Ebola researchers at Canada’s National Microbiology Laboratory in Winnipeg created the vaccine and the trials are being conducted in Halifax. The Canadian Immunization Research Network is holding the trials, for which the PHAC and the Canadian Institutes of Health Research have allocated $300,000.

Phase 1 began by recruiting 40 healthy volunteers between the ages of 18 and 65. Ten each would receive one of three different doses of the vaccine, and the remainder will get an injection of saline as a placebo. The aim is to see if a low dose of the vaccine will trigger a protective response.

Results are expected to be published in early 2015.

Of course, the Government of Canada’s website also has other information: multiple pages, links and online resources pertaining to Ebola virus disease.

Under the heading “Canada’s response to Ebola,” the first thing addressed is what is being done to protect Canadians. It states that the PHAC is working with all levels of government to stop the spread of Ebola to Canada and that this prevention of further transmission is essential to controlling the current outbreak.

The PHAC also meets with provincial and territorial health authorities on a weekly basis to support cooperation and readiness. In fact, they have Ebola Rapid Response Teams that are ready to deploy at any given moment upon provincial or territorial request.

The website also has a section on the dedication of millions of dollars to strengthen Canada’s domestic preparedness.

Over half way down the page, and again elsewhere on the site, it mentions that there has never been a confirmed case of Ebola virus disease in Canada and that the risk is low.

Near the bottom of the “Canada’s response to Ebola” page, it addresses what the government of Canada is doing to fight the outbreak in West Africa. Here, they have listed the country’s pledged financial and in-kind contributions, including $81.5 million USD — the equivalent of just over $91.8 million CAD.

A valuable resource to examine the contributions of various countries is the Ebola Response Tracker at one.org, the website for ONE — an international organization that aims to end preventable diseases and extreme poverty, primarily in Africa. It allows an individual to see how much of the pledged funding has actually been disbursed, with Canada currently sitting at 62.81 per cent. This ranks the country as 11th in financial response. As far as in-kind contributions, Canada has provided protective gear, for example, supplies and 800 vials of the experimental Ebola vaccine being developed.

An important point of contention lies in the fact that Canada has not committed any healthcare workers. Some may have gone independently or with a non-governmental organization but the country has no formal medical presence. However, Canada has deployed two teams of scientists to staff mobile diagnostic laboratories.

 What are diagnostic laboratories?

One such laboratory, the Liberian Institute for Biomedical Research (LIBR), is located about 100 kilometers east of Monrovia, the country’s capital. With a team of experts from the U.S. Centers for Disease Control and Prevention, the U.S. Army Medical Research Institute of Infectious Diseases, the U.S. National Institutes of Health (NIH) and the U. S. Agency for International Development, LIBR is one of the few labs in Liberia where Ebola specimens are sent to be tested.

In September, the scientific lead on this team of experts was U of S graduate Jason Kindrachuk.

Kindrachuk works at the NIH Clinical Center laboratory in Maryland. Recently, he has used an innovative new software called the Platform for Intelligent Integrated Kinome Analysis (PIIKA) to study several infectious diseases, including Ebola. A great step in the relatively new field of bioinformatics, the software system can be used to examine how the virus infects cells and what cells do to fight the infection.

U of S PhD student Brett Trost and his supervisor Anthony Kusalik developed PIIKA. It can evaluate huge volumes of data and several protein samples at the same time.

The web-based system is made to analyze enzymes called kinases. Kinases tell cells how to respond to external factors and maintain their normal functions through signaling pathways.

The NIH U of S team found that when this signaling is interrupted the virus does not replicate, a discovery that could be a massive step forward in the fight against Ebola. Their results were published this summer in the Journal of Virology. The article is easily accessible through the U of S Library website.

 TAKING INITIATIVE

U of S alum Victoria Martinez is currently working on a crowd-funding project with the World Federation of Science Journalists to support local reporters in regions the Ebola virus disease has affected.

The WFSJ, in association with Hirondelle USA and the World Association of Community Radio Broadcasters, created this fundraising campaign to assist local radio stations in Ebola-affected areas.

The campaign mentions that, beyond the devastating effect of the virus itself, poor communication heightening fear among the public has been an enormous obstacle. They state that in many regions the rural radio is the most trusted source of information, but they lack necessary resources.

Funding to the initiative, dubbed Help African Journalists Fight the Spread of Ebola, goes directly to tangible donations: $25 can provide a prepaid phone card so that one local radio station can get news and interviews for one month, while $100 can provide a community radio journalist with a portable audio recorder in .WAV and .MP3 format, for example.

Martinez suggested multiple other channels for students to take action without spending a lot of money. Beds 4 Ebola is another Indiegogo campaign to help fight the outbreak in affected West African nations. Improve Design Supply created the “IMP bed” from the need for inexpensive, disposable beds where patients are being treated. Their funds will be used to manufacture and distribute 1,000 IMP beds directly to relevant authorities in the affected countries.

Community Response to Ebola in Sierra Leone is planning to do just that by providing direct support and coordinating a local response. Their funds will be sent to Rev. Moses Frederick Khanu, a Sierra Leonean man who works with orphans, quarantined families and survivors to offer vital support. He plans to use the money where it is most urgently needed: to provide food to those in quarantined homes, hand washing materials and support for widows, orphans and those who have recovered from the disease.

The Fight Ebola in Sierra Leone campaign has a similar goal but works through Families Without Borders. This campaign is centered in Makeni, the country’s third largest city. Funds to this campaign will be used on medical supplies to treat patients and prevent civilian contraction of the disease, medical support to rehabilitate patients and promote public health, treatment centres for the infected and transportation of supplies to Makeni.

For additional information and current updates about Ebola virus disease, visit the World Health Organization or Centres for Disease Control and Prevention websites.

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Graphics: Cody Schumacher/Stephanie Mah