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Yet Another Ebola Lesson

Once again, the virus that conjures special images of fear among scientists and the general public has surfaced. And, once again, it has emerged in the poorest parts of central Africa.

Ebola.

Few members of the viral world evoke as many Stephen King-like notions of horror and human frailty. It's hardly a major killer in the global scheme of things. Even when compared to other flash-in-the-pan outbreaks, Ebola epidemics cannot, by virtue of numbers of people killed, be considered a top concern on the health radar screen.

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And yet this deadly filovirus merits international concern, not only in its own right, but as a harbinger of things to come. We ignore the current epidemic in Gulu, Uganda at our collective peril.

The Ebola virus, which first came to international attention when it broke out in a missionary hospital in Yambuku, Zaire in 1976, is a member of a thankfully tiny club of hemorrhagic fever agents. It specifically targets the endothelial tissue that comprises the linings of blood vessels, arteries and capillaries, eating away microscopic holes in the body's vital conduits. From these holes drain first water molecules and later, as the leaks expand, red blood cells. Hemorrhaging may occur anywhere in the body, and patients can become terrifying to view as blood pours from their noses, mouths, eyes and all other orifices.

The virus can be passed from one person to another a number of ways--primarily through direct contact. Scientists have recently isolated Ebola viruses from the sweat, blood, saliva and lung tissue of those sorry individuals autopsied during the 1995 Ebola outbreak in Zaire. That epidemic was brought under control through a strategy that sought to limit the skin-to-skin contacts between infected individuals and their healthy, living caretakers.

The take-home lesson of the 1995 epidemic was simple: poor, under-resourced hospitals in which basic elements of public health are ignored serve as vectors for epidemics. There never would have been an Ebola epidemic in Kikwit had there not been a looted, decrepit hospital into which the first handful of cases were admitted. Once inside a facility that lacked any modicum of hygienic practices the virus spread rapidly, first claiming large numbers of health care workers, and then their patients.

The World Health Organization team that responded to the epidemic--five months after it began, illustrating a failure in global disease surveillance--simply implemented classic early-20th-century public health measures. No high-tech solutions were needed: hand washing, quarantine, cessation of funeral practices, contact tracing and public education about the virus were sufficient to conquer Ebola.

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