Members of a cleaning crew with "Bio Recovery Corporation" wearing personal protective equipment (PPE) push a barrel to be loaded in a truck of Centers for Disease Control and Prevention (CDC) after cleaning the apartment where Dr. Craig Spencer lives in New York October 24, 2014. New York and New Jersey will automatically quarantine medical workers returning from Ebola-hit West African countries and the U.S. government is considering the same step after a doctor who treated patients in Guinea came back infected, officials said on Friday. REUTERS/Eduardo Munoz (UNITED STATES - Tags: HEALTH SOCIETY) - RTR4BJAH
Ebola developed in Africa. It’s not a new disease, potentially a very old one, harboured by fruit bats and other fauna. It was first found in humans in 1976, and most outbreaks were limited in scope by geography.

So why is it emerging now? Let’s take a look at Africa. It’s a young continent, due to massive growth over the last half century. Currently about 1.1 billion people live on the continent. The continent has gone from about 200 million people in 1950. In many countries, half the population is under age 25, owing to war, disease, famine and drought.¬† And that continent is HUGE, second largest in the world. From the northernmost point to the southernmost point, is about 5,000 miles, and from west to east, again, the largest spread, it’s about 7,500 miles across. The population is relatively mobile for a lot of reasons. Again, war, disease, famine and drought cause people to migrate. Increasing population leads to growth of both cities and villages. Further, there is little true infrastructure throughout most of the continent. More people have cell phones than landlines. Roads are in many areas non-existent, as are the things we take for granted like potable water, indoor plumbing, walls and roofs. There are tons of natural resources, but they’re owned by very corrupt governments. Think a kind of unimaginable poverty.

Illness is a huge problem. Not just malnutrition, starvation, and general infections. Malaria is endemic. Five times as many children are blind in Africa then elsewhere in the world due to a combination of Vitamin A deficiency and measles. Health care? In Liberia, when Ebola broke out this year, there were 51 (native) doctors meaning one doctor for every 76,000 people. More doctors have arrived from MSF and other aid organizations since then.

As people move around, and populations shift geographically, there is more interaction with wildlife. Further, when people are hungry, they’ll eat what there is, and that, in Africa, often means bushmeat, which is often infected with all sorts of diseases, including Ebola.

Further, there are certain cultural priorities in Africa, such as interaction with corpses, no matter what the matter of death, and a belief in non-Western healing. Far too many people trust a witch doctor over a European or American one.

The emergence of Ebola in a highly populated area was always a matter of time.

So what is Ebola? It’s a hemorrhagic fever. There are five different strains identified so far. It is passed from fruit bats and bushmeat to humans, and then from human to human by exposure to bodily fluids. A full description of the history and epidemiology of Ebola can be found¬†here.

Of note, the viral load of a person with full-blown Ebola is very high. “Viral load” relates to the number of viral cells in an amount of human fluid such as blood, urine, etc. With Ebola, the virus keeps multiplying even for a short time after death. In half a teaspoon, we’re looking at thousands of virus cells in AIDS, half a million in Hepatitis C, and up to 10 million in Ebola. Thus, it is more contagious in later stages than other viruses.

And this brings us to why the rate of infection in medical personnel is as high as it is. You’ve likely seen articles about the huge rate of infection, but not all groups were infected similarly. In African hospitals, there have been many deaths. But MSF has had hundreds of people on the ground with little transmission. And Samaritan’s Purse had one infected doctor, Kent Brantly, who is now recovered and donates blood factors to other patients, including today Nina Pham, the Dallas nurse.

Two things: first, Samaritan’s Purse personnel were trained by MSF and strictly follow their guidelines. MSF guidelines have been developed since they worked the first epidemic in 1976. These folks REALLY know what they’re doing, and their protocols are much more stringent than the “standard” CDC guidelines which are outdated, limited in scope, and not actually useful. The personnel at Emory and in Nebraska follow protocols even more stringent to the MSF ones, as they have access to things like autoclaves that are not exactly easy to find in Africa.

Second, people go into medicine to help people. As people get sicker, they try all sorts of life-saving measures, even when those attempts are futile. Treating Thomas Eric Duncan with intubation and dialysis was too little, too late, and the increased risk from those procedures easily overran the CDC protocols.

The question I keep hearing is whether Ebola will end up making the US look like West Africa. It’s unlikely. I am hopeful that the CDC, in concert with NIH will come around to updating their protocols, and that patients will be treated in Ebola centers and not community or even teaching hospitals.

In Part 3, we’ll take a look at what governments need to bring an end to this epidemic before Ebola becomes endemic to Africa, and then really does start reaching other continents in epidemic numbers.