Last week, President Obama announced that the United States would be launching Operation United Assistance, involving not bombs nor combat troops, but special forces of another kind: doctors, nurses, and pathologists.
This latest military intervention will, however, involve 3,000 U.S. forces at the spear tip in the fight against Ebola. A Department of Defense assessment team has already landed in Liberia, the center of a West African war zone that, like the Islamic State in Syria and Iraq, involves an aggressive adversary spreading rapidly and leaving senseless death in its wake.
Army personnel will be sent in to build field hospitals and help facilitate the training of health care workers who will be working directly with patients. They will be delivering medicine and medical supplies, but they won’t be providing security (at least right now). It is the kind of militarized aid that no doubt has some critics squirming about America’s expanding footprint on the continent. Others spent the last week groaning that Operation United Assistance takes our eyes and resources off the Islamic State—the “real” enemy—in Syria and Iraq.
But most editorial boards and lawmakers on both sides of the aisle are joining health experts in heralding the move, and here’s why: this is by far the worst Ebola outbreak since the virus was discovered in 1976, and if it is not contained soon, we could be looking at a pandemic rampaging across the Third World on the order of history’s deadliest plagues. Will it come to the North America? It’s not likely, but the human toll is grave. As of Wednesday, Centers for Disease Control (CDC) projections are putting total infections as high as 1.4 million in West Africa by January if nothing is done soon.
If those moral implications aren’t enough, say advocates, think of the instability and economic wreckage that mass infections would provoke across the developing world, including many places already bordering on failed states and breeding grounds for extremism.
“The real danger is if it gets into the cities,” said Dr. Frederick Murphy, former Director of Infectious Diseases at the Centers for Disease Control (CDC), who now teaches experimental pathology at the University of Texas Medical Branch. Murphy was there when Ebola was first named 40 years ago, and was the first person to actually photograph the virus with an electron microscope. He also helped discover the deadly Marburg virus, a sister filovirus to Ebola, first discovered in 1967.
The “Ebola Zaire” strain is now burning through Liberia, Sierra Leone, and Guinea—leaving more than 2,800 dead since March. Current infections are at 5,843 according to the World Health Organization, with deaths at 2,811, but even they acknowledge the count is “vastly underestimated” because of the reality of underreporting in the region. Just this week, WHO released new projections, predicting 20,000 infections by Nov. 2 in the affected areas. Even worse, it said the virus was killing 70 percent of its victims, much more than the 50 percent it had been reporting up until now.
“If (it gets to the big cities) you can have a very large number of cases and that actually adds to the danger of it spreading around the world, to other poor parts of the world, where containment would be much more unlikely,” Murphy said in an interview with TAC.
“The reality is we have to get control of it. Are the resources going into the region sufficient? My guess is not, we are going to have to step it up. Overdoing it right now doesn’t have a lot of downsides,” said Scott Gottlieb, a physician and former Federal Drug Administration official during the George W. Bush Administration.
Like others, he believes the situation brings into focus Washington’s own lack of readiness in the event of a global, or even regional, pandemic. Infectious disease experts have been bemoaning shortfalls in research and development for years. What’s happening in West Africa scares them, whether it’s in their own backyard or not. They see this as a test—are U.S. health institutions ready? Hardly. A recent rebuke by the Department of Homeland Security Inspector General found that the agency isn’t even prepared to protect its own personnel (which includes FEMA and HHS, in many cases the front lines in a federal response), in the event of a pandemic.
“What’s more, a lot of the public seems not to be fully aware or not fully engaged in this,” added Gottleib, who is also a fellow with the American Enterprise Institute, “I was on C-SPAN taking calls from callers and it was fairly consistent that they did not want to see American troops going over there.”
For one, he told TAC, ordinary people see don’t see the military response as commensurate with what appears to be a low body count in West Africa. “But this is a contagion and it is growing.”
Perhaps people would be more on board if they knew what Ebola really is and what it does. The word conjures many images, but nothing could be more horrifying than the description set by Richard Preston in his best selling non-fiction, The Hot Zone, in 1995:
Ebola Zaire attacks every organ and tissue in the human body except skeletal muscle and bone. It is the perfect parasite because it transforms virtually every part of the body into a digested slime of virus particles.
Then, deliberately testing the reader’s own gastrointestinal fortitude, Preston launches on a description of the viral breakdown of the body, calling it “wiping the slate.” This involves systematic blood clotting, causing dead spots and hemorrhaging in the brain, liver, lungs and intestines, and tearing of the connective tissue that holds things, like organs, together. The virus rips out the top layer of the tongue and the lining of the eyeballs. It pushes unclotted blood out of the mouth and nose.
“It triggers a creeping, spotty, necrosis that spreads through all of the internal organs”— while the victim is still alive, he wrote.
The virus destroys the brain, with Ebola victims going through violent epileptic convulsions through the last stage. At death, the organs, which had “been dead or partially dead for days,” begins a “shock-related meltdown…. the corpse’s connective tissue … begins to liquefy, and the fluids that leak from the cadaver are saturated with Ebola-virus particles.”
Different strains of Ebola can kill both humans and animals, particularly primates, and is typically transferred from host to host—in a quite aggressive, predatory manner, writes Preston—through bodily fluids, including blood, secretions and the handling of organs. There have been reports of African villagers contracting the virus by kissing corpses at funerals.
There is a hot debate over whether Ebola can be transmitted through the air. Most experts say no. But there is some cause to believe that another strain, Ebola Reston, named after an outbreak among crab-eating macaque monkeys shipped to Reston, Va., for laboratory experiments in 1989, had traveled from the primary group of infected monkeys through the air ducts, infecting different monkeys in another room. That strain did not affect humans, so it’s sometimes lost in the debate over respiratory transmission. But the door in that conversation has not been closed, particularly when most scientists readily admit that Ebola Zaire is mutating all of the time.
“It’s still a controversial question because there is not an awful lot of data,” proving it either way, said Murphy, who was called in for the Reston outbreak. Already, according to a study released at the end of August in the journal Science, the strain in the current outbreak has already undergone “hundreds of mutations,” that make it different from past outbreaks and more difficult to study.
As of the beginning of this week, Ebola Zaire—the most deadly of the currently identified strains—has killed over 2,800 people in West Africa since March. For context, consider that of all the previous outbreaks recorded in the last 40 years, the highest number of people killed in one event was in the first one, in the Democratic Republic of Congo in 1976, when 280 people died.
“One of the scary things about this outbreak is that all the general models of the past have been broken,” John Connor, an investigator at Boston University’s National Emerging Infectious Diseases Laboratories, told the Washington Post on Monday.
For Americans, this might evoke a generalized, uncomfortable feeling, but that’s more or less offset by media assurances that Ebola is not a direct threat, if Gottlieb’s C-SPAN callers are any indication. Aside from the largely forgotten Reston episode, the closest Ebola has gotten to the U.S. since then was this summer, when two American missionary aid workers contracted the disease during the current outbreak in Liberia. They were flown to a top medical facility in Atlanta and given the experimental drug ZMapp.
They survived. But there is no known vaccine or treatment for Ebola, and even if ZMapp turns out to be the cure—which is far from decisive (a Spanish priest who contracted Ebola in Sierra Leone died in August, even after taking ZMapp), its makers said this week that they have no more to give, and that it would take months to make a new batch.
That is why the resources—Obama has pledged $750 million, which includes the military component—are so important right now. The densely populated urban landscape, the lack of education and clean, equipped hospitals, the growing civil unrest (arbitrary lockdowns and travel restrictions are resulting in a shrinking food supply and other economic strains), poor sanitation, and fragile security conditions, all combine to make host-happy conditions for Ebola.
Gottlieb said if people really needed a national security reason to support Operation United Assistance, it was there, festering and bleeding out, a little more every day.
“It’s not just a Liberia problem,” he said. “We have to treat all these other countries as one big hot zone … if we get it wrong the results could be catastrophic.”
Kelley Beaucar Vlahos is a Washington, D.C.-based freelance reporter and TAC contributing editor. Follow her on Twitter.