October 14, 2014
The Ebola outbreak in West Africa is the largest Ebola outbreak in history. It can be traced back to a boy who died of Ebola in December; he lived in Guéckédou in southeastern Guinea, which is surrounded by Sierra Leone and Liberia. Easy movements in and out of these countries, combined with poor facilities and delayed identification, have contributed to Ebola’s rapid spread, creating a public health disaster. As of this writing approximately 3,000 people have died from Ebola since December and over 6,000 people have been infected. This particular strain of Ebola (i.e., the Zaire strain) was discovered in Zaire (now the Democratic Republic of Congo) in 1976, and is thought to be spread through animals, perhaps by bats. Prior Ebola outbreaks were easily contained because they occurred in sparsely populated regions.
On bioethics.com, we document disasters through the lens of news headlines and journal articles. The timeline of news events since March when the outbreak made international news highlights the outbreak’s rapid progression as well as bioethics questions that are specific to epidemics: the slow response of international aid groups, the use of Ebola drugs that were untested on humans, hastening clinical trials of Ebola remedies and vaccines, medical workers being flown back to their home country while infected West African medical workers must stay, appropriate allocation of resources from foreign countries, and containment practices that may violate human dignity.
“4 Health Care Workers among 66 Dead in Ebola Outbreak” by Sydney Lupkin, ABC News, March 27, 2014.
“The ongoing outbreak has sickened 103 people in Guinea in all, and this Ebola strain has a 64 percent fatality rate, WHO officials said. The number of people reported sickened by Ebola in Guinea has more than doubled in the past five days. Sierra Leone and Liberia have reported suspected cases and deaths among people who traveled to Guinea, according to WHO, which first reported the outbreak [March] 22.” (abcnews.go.com/blogs/health/2014/03/27/4-health-care-workers-among-66-dead-in-ebola-outbreak/)
“Ebola Virus Claims Lives of More than 200 People in Guinea” by AFP, The Guardian, June 4, 2014.
“More than 200 people have died from the highly contagious Ebola virus in Guinea, amounting to one of the worst ever outbreaks of the disease, the World Health Organisation said on Wednesday. The UN’s health agency said it had so far registered 328 confirmed or suspected cases of Ebola in Guinea, including 208 deaths. Twenty-one deaths were registered between 29 May and 1 June alone.” (www.theguardian.com/world/2014/jun/04/ebola-virus-200-guinea-who-sierra-leone-liberia)
“Ebola Challenges West African Countries as WHO Ramps Up Response” by The World Health Organization, June 26, 2014.
“Since March 2014, more than 600 cases of Ebola and over 390 deaths have been reported in Guinea, Liberia and Sierra Leone. While the number of suspected, probable and confirmed cases and deaths changes rapidly, the outbreak is causing concern among health authorities because the deadly disease is being transmitted in communities and in health-care settings, and it has appeared in cities as well as rural and border areas.” (www.who.int/mediacentre/news/notes/2014/ebola-response/en/)
“Ebola’s Deadly Spread in Africa Driven by Public Health Failures, Cultural Beliefs” by Dick Thompson, National Geographic, July 2, 2014.
“As the largest Ebola outbreak in history continues unabated, health authorities from 11 West African countries and international agencies began a two-day crisis meeting today in Accra, Ghana, on how to combat the crisis. The World Health Organization (WHO) says “drastic action” is needed to stem the outbreak, which since March has grown to 759 confirmed cases in Guinea, Sierra Leone, and Liberia, including 467 deaths. Given that surveillance and response measures have held this terrifying disease in check for the past decade, why has the situation gotten so far out of hand this time?” (news.nationalgeographic.com/news/2014/07/140702-ebola-epidemic-fever-world-health-guinea-sierra-leone-liberia/)
“Ivory Coast Blocks Refugees amid Ebola Fears” by BBC, July 15, 2014.
“Ivory Coast has blocked 400 refugees who fled to Liberia from returning home because of fears they could spread the Ebola virus, a UN official has said. The decision violated domestic and international law, the official added. Ivory Coast said it could not allow the refugees in because of the Ebola “pandemic” in Liberia, Guinea and Sierra Leone. The virus has now killed 603 people in the three states, with 68 deaths reported in the last week, WHO said.” (www.bbc.com/news/world-africa-28313888)
“Chief Ebola Doctor Overseeing Cases in Sierra Leone Contracts the Virus” by Caleb Hellerman and Millicent Smith, CNN, July 24, 2014 (original article has been updated).
“A doctor who has played a key role in fighting the Ebola outbreak in Sierra Leone is infected with the disease, according to that country’s Ministry of Health.” (www.cnn.com/2014/07/23/health/ebola-outbreak-west-africa/index.html)
“Sierra Leone’s Top Ebola Doctor Is Dead from Ebola” by Abby Ohlheiser, Washington Post, July 29, 2014.
“A Sierra Leone doctor who treated more than 100 Ebola patients has died from the virus, the country’s chief medical officer Brima Kargbo confirmed to the media on Tuesday. Sheik Umar Khan has been hailed as a “national hero” for his work treating Ebola.” (www.washingtonpost.com/news/to-your-health/wp/2014/07/29/sierra-leones-top-ebola-doctor-is-dead-from-ebola/)
“Emergency Efforts in Africa to Contain Ebola as Toll Rises” by Adam Nossiter and Denise Grady, New York Times, July 31, 2014.
“As the death toll mounted from the worst outbreak of the Ebola virus, West African leaders quickened the pace of emergency efforts on Thursday, deploying soldiers and authorizing house-to-house searches for infected people in an effort to combat the disease… The viral illness has exacted a terrible toll, killing 729 people, including top physicians in Liberia and Sierra Leone, nations that already faced an acute shortage of doctors.” (www.nytimes.com/2014/08/01/world/africa/sierra-leone-declares-health-emergency-over-ebola.html?partner=rss&emc=rss&_r=1)
“Ebola Crisis: Infected Doctor Kent Brantly Lands in US” by BBC, August 2, 2014.
“A US doctor infected with the deadly Ebola virus in Liberia has arrived in the US for treatment at a specialised unit in Atlanta, Georgia. Dr Kent Brantly arrived in a specially equipped private plane at a military base before being driven to Emory University Hospital. Fellow infected US aid worker Nancy Writebol is expected to follow shortly. Ebola has claimed 728 lives in Guinea, Liberia and Sierra Leone this year. The current mortality rate is about 55%.” (www.bbc.com/news/world-us-canada-28596416)
“Ebola Crisis: World Bank Announces $200m Emergency Fund” by BBC, August 4, 2014.
“The World Bank has announced that it is allocating $200m (£120m) in emergency assistance for West African countries battling to contain the Ebola outbreak. The money will be distributed to the governments of Liberia, Sierra Leone and Guinea as well as to the World Health Organization (WHO). The number of people killed in the outbreak has reached 887, the WHO says.” (www.bbc.com/news/world-africa-28652083)
“Two Americans Who Contracted Ebola in Africa Received an Experimental Serum” by Brady Dennis and Lenny Bernstein, Washington Post, August 4, 2014.
“This so-called experimental serum is a cocktail of antibodies that have the capability of blocking the virus,” Fauci said, adding: “The physicians in charge of the patients’ care made a risk-benefit decision. The risk was less than the potential benefit.” (www.washingtonpost.com/national/health-science/2014/08/04/dbc44a48-1c07-11e4-ae54-0cfe1f974f8a_story.html?wprss=rss_health-science)
“WHO to Convene Panel on Use of Experimental Ebola Drugs” by Brady Dennis and Lenny Bernstein, Washington Post, August 6, 2014.
“The World Health Organization said Wednesday that it would convene a group of medical ethicists early next week to wrestle with questions about the use of experimental treatments in the deepening Ebola outbreak in West Africa… The WHO acknowledged Wednesday that treatment of the two Americans has raised questions about whether medicine that has never been proven safe and effective in humans should be used during an outbreak of the magnitude of the one in West Africa.” (www.washingtonpost.com/news/to-your-health/wp/2014/08/06/who-to-convene-panel-on-use-of-experimental-ebola-drug/)
“Second Drug Is Allowed for Treatment of Ebola” by Andrew Pollack, New York Times, August 7, 2014.
“The Food and Drug Administration helped clear the way on Thursday for a second experimental drug to be tried by people in Africa stricken with the Ebola virus. The drug, being developed by Tekmira Pharmaceuticals of British Columbia, was in the initial phase of human testing, which is on healthy volunteers, when the F.D.A. last month halted the trial because side effects were observed.” (www.nytimes.com/2014/08/08/health/second-experimental-drug-allowed-for-treating-ebola.html?partner=rss&emc=rss)
“Ebola Declared a Public-Health Emergency” by Erika Check Hayden, Nature, August 8, 2014.
“The WHO has formally declared the outbreak to be a “public health emergency of international concern,” director-general Margaret Chan said after a two-day meeting with experts in Geneva… By 6 August, 932 people had died in the current outbreak, most in Sierra Leone, Guinea and Liberia.” (www.nature.com/news/ebola-declared-a-public-health-emergency-1.15689)
“Tracing Ebola’s Outbreak to an African 2-Year-Old” by Denise Grady and Sheri Fink, New York Times, August 9, 2014.
“Patient Zero in the Ebola outbreak, researchers suspect, was a 2-year-old boy who died on Dec. 6, just a few days after falling ill in a village in Guéckédou, in southeastern Guinea. Bordering Sierra Leone and Liberia, Guéckédou is at the intersection of three nations, where the disease found an easy entry point to the region. A week later, it killed the boy’s mother, then his 3-year-old sister, then his grandmother. All had fever, vomiting and diarrhea, but no one knew what had sickened them.” (www.nytimes.com/2014/08/10/world/africa/tracing-ebolas-breakout-to-an-african-2-year-old.html?_r=1&gwh=B4559D7F10DE5FE23BF70DD96D11A2F4&gwt=pay&assetType=nyt_now)
“WHO Says It Is Ethical to Use Experimental Drugs to Fight Ebola Virus” by Monte Morin, Los Angeles Times, August 12, 2014.
“A World Health Organization panel advised Tuesday that it was ethical to use experimental, nonapproved drugs to combat the ongoing Ebola virus epidemic in West Africa… To date, 1,013 have died in the outbreak.” (www.latimes.com/science/sciencenow/la-sci-sn-ebola-ethics-20140811-story.html)
“Ethical Considerations for Use of Unregistered Interventions for Ebola Virus Disease (EVD)” by World Health Organization, August 12, 2014.
“Ethical criteria must guide the provision of such interventions. These include transparency about all aspects of care, informed consent, freedom of choice, confidentiality, respect for the person, preservation of dignity and involvement of the community.” (www.who.int/mediacentre/news/statements/2014/ebola-ethical-review-summary/en/)
“Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas” by Donald G. McNeil, Jr., New York Times, August 13, 2014.
“The Ebola outbreak in West Africa is so out of control that governments there have revived a disease-fighting tactic not used in nearly a century: the “cordon sanitaire,” in which a line is drawn around the infected area and no one is allowed out.” (www.nytimes.com/2014/08/13/science/using-a-tactic-unseen-in-a-century-countries-cordon-off-ebola-racked-areas.html?smid=tw-share&_r=0&gwh=15D3A93A13944946936259A32A001DA1&gwt=pay&assetType=nyt_now)
“WHO: Toll of Ebola Outbreak Has Been ‘Vastly’ Underestimated” by Abby Phillip, Washington Post, August 15, 2014.
“There have been 1,069 deaths attributed to Ebola so far, but the true toll of the virus could be far greater, the World Health Organization said on Thursday.” (www.washingtonpost.com/news/to-your-health/wp/2014/08/15/who-toll-of-ebola-outbreak-has-been-vastly-underestimated/)
“Agencies Issue Warnings over Ebola Cures” by Donald G. McNeil, Jr., New York Times, August 16, 2014.
“Panic over Ebola has the makers of dietary supplements aggressively targeting Africans, claiming to have a cure for the lethal virus. Late this week, both the World Health Organization and the United States Food and Drug Administration issued strong warnings about false Ebola cures.” (www.nytimes.com/2014/08/16/science/agencies-issue-warnings-over-bogus-ebola-cures.html?smid=tw-share&_r=0&gwh=8DFBF5BDC1E88EEF2804DC0F36010830&gwt=pay&assetType=nyt_now)
“Ebola Crisis: Liberia Finds ‘Missing Patients’” by BBC, August 19, 2014.
“Seventeen suspected Ebola patients who went missing in Liberia after a health centre in the capital was attacked have been found, a minister has said… New UN figures show that 1,229 people have now died since the beginning of this year in the outbreak that has also hit Sierra Leone, Guinea and Nigeria.” (www.bbc.com/news/world-africa-28852384)
“Ebola Patient Revels in ‘Miraculous Day’ as He and Another Exit Hospital” by Alan Blinder and Donald G. McNeil, Jr. New York Times, August 21, 2014.
“Emory said on Thursday that Dr. Brantly, who lived in Fort Worth before going to Liberia, and Nancy Writebol, a missionary from Charlotte, N.C., who also contracted Ebola while in Africa this summer, had been released from its specialized isolation unit this week.” (www.nytimes.com/2014/08/22/us/two-us-ebola-patients-are-released-by-atlanta-hospital.html?partner=rss&emc=rss&_r=0)
“Anecdotal Evidence about Experimental Ebola Therapies” by World Health Organization, August 21, 2014.
“Clinicians working in Liberia have informed WHO that 2 doctors and 1 nurse have now received the experimental Ebola therapy, ZMapp. The nurse and one of the doctors show a marked improvement. The condition of the second doctor is serious but has improved somewhat. According to the manufacturer, the very limited supplies of this experimental medicine are now exhausted.” (www.who.int/mediacentre/news/ebola/21-august-2014/en/)
“World Struggles to Stop Ebola” by Erika Check Hayden Nature, August 26, 2014.
“The WHO reports that the Ebola outbreak has so far claimed 1,427 lives in four West African nations — more than all previous recorded outbreaks combined, and probably an underestimate. It says that the epidemic will last for another 6–9 months, and the scientists and doctors who are fighting it agree.” (www.nature.com/news/world-struggles-to-stop-ebola-1.15768)
“Ebola Virus Mutating Rapidly as It Spreads” by Erika Check Hayden, Nature, August 28, 2014.
“By comparing their data to the Guinean sequence data, Goba’s team confirmed that Ebola was probably imported to Sierra Leone by 12 people who attended the funeral in Guinea, and that the West African outbreak originated in a single event in which the virus passed from an animal into a person. Further comparisons suggest that the virus that caused the outbreak separated from those that caused past Ebola outbreaks about 10 years ago. It had accumulated more than 395 mutations between that time and June, when the researchers collected the last samples included in today’s analysis.” (www.nature.com/news/ebola-virus-mutating-rapidly-as-it-spreads-1.15777)
“Ebola Outbreak: Senegal Confirms First Case” by BBC, August 29, 2014.
“Senegal’s health minister has confirmed a first case of Ebola, making it the fifth West African country to be affected by the outbreak… The current outbreak, which began in Guinea, has killed more than 1,500 people across the region.” (www.bbc.com/news/world-africa-28983554)
“Experimental Ebola Drug Heals All Monkeys in Study (Update)” by Marilynn Marchione, Medical Xpress, August 29, 2014.
“An experimental Ebola drug healed all 18 monkeys infected with the deadly virus in a study, boosting hopes that the treatment might help fight the outbreak raging through West Africa—once more of it can be made. The monkeys were given the drug, ZMapp, three to five days after they were infected with the virus and when most were showing symptoms.” (medicalxpress.com/news/2014-08-prototype-ebola-drug-early-hurdle.html#ajTabs)
“Ebola Drug Trials Set to Begin amid Crisis” by Declan Butler, Nature, September 2, 2014.
“The first phase of clinical trials, to test for a product’s safety, is usually carried out in healthy volunteers in facilities with sophisticated clinical-trials infrastructure. But an unusual combination of factors — the difficulty of implementing public-health measures to control the disease’s spread in the affected countries, the huge social and economic disruption that it is causing and the fact that the current outbreak kills about 53% of the people it infects — makes this crisis an exception.” (www.nature.com/news/ebola-drug-trials-set-to-begin-amid-crisis-1.15813)
“Ebola Now Threatens National Security in West Africa” by Dina Fine Maron, Nature, September 3, 2014.
“Failure to tamp down Ebola’s spread is stressing the infrastructure of countries stricken with the disease that must still continue to provide basic health and security services and promote routine commercial activity. Fear of its spread is also hindering care for other maladies and may increasingly put the stability of neighboring nations at risk, said CDC director Tom Frieden in a press conference today.” (www.nature.com/news/ebola-now-threatens-national-security-in-west-africa-1.15834)
“American Ebola Patient Coming Home” by Jen Christensen, CNN, September 4, 2014.
“Dr. Rick Sacra was stationed in Liberia when he was exposed to the virus. He will be flown to Nebraska, according to the international Christian mission organization Serving In Mission.” (www.cnn.com/2014/09/04/health/ebola-american-patient/index.html)
“Ebola Vaccines Racing Forward at Record Pace” by Jon Cohen, Science, September 9, 2014.
“On 2 September, a 39-year-old woman in Bethesda, Maryland, received a novel Ebola vaccine never given to humans before. In as little as 2 months, this same vaccine may go into the arms of thousands of health care workers and other first-line responders to the Ebola epidemic now wreaking havoc in West Africa. No experimental vaccine has ever been on a faster track toward widespread use.” (news.sciencemag.org/health/2014/09/ebola-vaccines-racing-forward-record-pace?rss=1)
“U.S. to Commit Up to 3,000 Troops to Fight Ebola in Africa” by Helene Cooper, Michael D. Shear, and Denise Grady, New York Times, September 15, 2014.
“Mr. Obama will offer help to President Ellen Johnson Sirleaf of Liberia in the construction of as many as 17 Ebola treatment centers in the region, with about 1,700 treatment beds.” (www.nytimes.com/2014/09/16/world/africa/obama-to-announce-expanded-effort-against-ebola.html?partner=rss&emc=rss&_r=0)
“Doctor Who Recovered from Ebola Calls Outbreak a ‘Fire Straight from the Pit of Hell’” by Gillian Mohney, ABC News, September 16, 2014.
“The doctor who was the first U.S. Ebola patient to be treated in America testified before a congressional committee today recalling the horror and “humiliation” of a disease that has killed thousands… The Ebola outbreak continues to grow throughout West Africa with an estimated 2,461 deaths attributed to the virus and thousands more infected.” (abcnews.go.com/Health/doctor-recovered-ebola-calls-outbreak-fire-straight-pit/story?id=25544403)
“Eight Bodies Found after Attack on Guinea Ebola Education Team” by Conakry, Reuters, September 18, 2014.
“Eight bodies, including those of three journalists, were found after an attack on a team trying to educate locals on the risks of the Ebola virus in a remote area of southeastern Guinea, a government spokesman said on Thursday… Since then the virus has killed some 2,630 people and infected at least 5,357 people, according to World Health Organization (WHO), mostly in Guinea, neighboring Sierra Leone and Liberia. It has also spread to Senegal and Nigeria.” (www.reuters.com/article/2014/09/18/us-health-ebbola-guinea-idUSKBN0HD2JE20140918)
“Sierra Leone to Start 3-Day Nationwide Lockdown to Stop Ebola” by Sydney Lupkin, ABC News, September 18, 2014.
“Sierra Leone is set to begin a three-day lockdown tonight at midnight to curb the spread of Ebola, according to Doctors Without Borders. Government authorities have ordered the country’s 6 million people to stay in their homes from Sept. 19 through Sept. 21, while volunteers go door-to-door to screen for Ebola and take infected people in hiding to Ebola facilities, according to Doctors Without Borders, which called the endeavor ‘coercive.’” (abcnews.go.com/Health/sierra-leone-start-day-nationwide-lockdown-stop-ebola/story?id=25597357)
“U.N. Security Council Passes Historic Resolution to Confront Ebola” by Joh Cohen, Science, September 18, 2014.
“Ebola’s devastation in three West African countries today compelled the U.N. Security Council to convene its first emergency meeting ever to discuss a public health crisis. It unanimously passed a resolution that declared the spread of the virus a “threat to international peace and security” and called on the world to send more health care workers and supplies to Liberia, Sierra Leone, and Guinea, and not to isolate those countries.” (news.sciencemag.org/africa/2014/09/u-n-security-council-passes-historic-resolution-confront-ebola?rss=1)
“Ebola Lockdown Workers Find Dozens of Cases” by Dana Ford, CNN, September 22, 2014.
“One hundred thirty new cases of Ebola were identified during a three-day lockdown in Sierra Leone, Stephen Gaojia, the country’s head of emergency operations, said Monday. Officials are awaiting tests on another 39 potential cases, he said. During the lockdown from Friday through Sunday, no one was allowed to leave home… The latest report from the World Health Organization, released Monday, says at least 2,803 people have died during the Ebola outbreak in Guinea, Liberia and Sierra Leone.” (www.cnn.com/2014/09/22/health/ebola-outbreak/index.html)
“Health Officials Will Begin First Ebola Treatment Trials in West Africa” by Abby Ohlheiser, Washington Post, September 23, 2014.
“Wellcome Trust’s $5 million initiative will include drugs from Mapp Biopharmaceutical, Sarepta and Tekmira, according to Reuters. Mapp makes zMapp, the experimental cocktail administered to two Americans who contracted the disease in Liberia. And Tekmira recently gained the approval of the U.S. Food and Drug Administration to use its TKM-Ebola treatment on confirmed or suspected cases of the disease.” (www.washingtonpost.com/news/to-your-health/wp/2014/09/23/health-officials-will-begin-first-ebola-treatment-trials-in-west-africa/)
“New Figures Paint Even Bleaker Picture for Ebola Crisis” by Dina Fine Maron, Scientific American, September 23, 2014.
“New projections from the World Health Organization paint a worsening future for the months ahead if Ebola is not properly contained, suggesting that the caseload will total more than 20,000 by November. The new data also unseats the common perception that Ebola has a disproportionate impact on women, instead finding that the epidemic has affected men and women in roughly equal numbers.” (www.scientificamerican.com/article/new-figures-paint-even-bleaker-picture-for-ebola-crisis/)\
“Guilty of Ebola Until Proven Otherwise” by Elizabeth Cohen, CNN, September 24, 2014.
“There’s no question that countless Liberians are dying because of Ebola even when they don’t have it. There are few functioning hospitals or doctors’ offices. Health care services, weak before Ebola, barely exist; vaccination rates, for example, have plummeted. ‘The primary care system here is basically shattered,’ says Sarah Crowe, a spokeswoman for UNICEF who is working in Liberia. ‘It’s an outrage that children are dying of diseases, like measles, that are preventable and treatable.’” (www.cnn.com/2014/09/23/health/ebola-deaths-uninfected/index.html)
“Ebola Death Toll Nears 3,000 in West Africa, Says WHO” by Andrew Morse, The Wall Street Journal, September 25, 2014.
“Nearly 3,000 people have died from the current outbreak of the Ebola virus in West Africa and the situation has continued to deteriorate in some areas, the World Health Organization said. The United Nations’ health agency said in a report dated Wednesday that 2,917 people had likely died from the disease as of Sept. 21, 2014. A total of 6,263 people had confirmed, suspected or probable cases of the disease.” (online.wsj.com/articles/ebola-death-toll-nears-3-000-in-west-africa-says-who-1411639068?mod=rss_Health)
“CDC: Ebola Confirmed in Dallas Patient” by Janet St. James and Josh Davis, WFAA, September 30, 2014.
“A patient in a Dallas hospital was confirmed Tuesday to have the deadly Ebola virus, the Centers for Disease Control said Tuesday. Within hours, a team of CDC investigators arrived in North Texas to begin working on the first-ever case of this strain of the Ebola virus confirmed in the U.S. The Dallas patient remains in “strict isolation” at Texas Health Presbyterian Hospital Dallas. Officials said there are no plans to transfer him to a specialized hospital with a biocontainment unit at this time.” (www.wfaa.com/story/news/health/2014/09/29/dallas-presbyterian-hospital-ebola-patient-isolation/16460629/)