There are two big questions about this outbreak which will no doubt be turned over in public health circles for months to come. Why is this Ebola Outbreak happening now, and why is it so huge ?
Why did Ebola suddenly show up in Guinea?
The most dangerous strains Ebola thus far has been confined mostly to Central Africa and Sudan. West Africa has been home to the Tai Forest virus, which in terms of Ebola strains is pretty lame. If you've already read my Ebola FAQ, all of this is old news to you.
Anyway, it seems that Ebola may have been circulating for some time in Guinea. The disease is carried by bats, who can migrate between different regions of Africa, carrying Ebola with them.
Ebola might have been in Guinea for a while before this outbreak started.
So how does Ebola get from bats to people?
Most of the early Ebola outbreaks were traced to the monkeys and chimps. In truth, the primates got the disease because they share the treetops with bats and eat them. Ebola travels up the food chain, making monkeys sick, and then the chimps that eat the monkeys get sick. Then chimps get hunted for their meat, and the people who eat them get Ebola.
The point is, Ebola can travel up the food chain. Some cultures actively go out and hunt bats and wild "bushmeat", often consisting of whatever animal that can be caught in the forest.
How does this explain why the outbreak started?
Ultimately, it's about the local economies of the border villages in Guinea. Guinea itself, despite its vast natural resources, has 20% of its population living in extreme poverty, and it's gotten worse for isolated regions of the country.
Ailing infrastructure means less trade between cities and these villages, and rising food prices forces people to stop shopping for food, and start hunting for it.
Poverty forces people to hunt for food in the forest, and to eat bushmeat. Which is one reason why the Guinean governments ban on the consumption of bushmeat could hit these communities as hard as the Ebola outbreak itself.
How can this explain why the outbreak has spun out of control?
Guinea's government has neglected the local populations within these regions, which is why what few medical facilities there were early in the outbreak were completely overwhelmed. This was one of the reasons why there was such a big delay between the first case of the disease, and Guinea declaring an emergency. The first case of the disease is thought to have happened in December last year, and we were only alerted to the outbreak in March.
In those four months , it spread to multiple villages and towns and cities, establishing multiple clusters of infection. The outbreak was out of control before we even knew it was happening, and we've been playing catch up ever since.
It doesn't help that people are refusing treatment for the disease, and chasing away health workers....
A friend who works in public health laid out the situation pretty simply to me. There were riots in Guinea over its last election, as people took to the streets to protest the results, and were put down by the government. Sierra Leone still bears the scars of its decade long civil war, and Liberia too has suffered from civil wars in recent years.
It's very hard to trust the authorities when they have tried to kill you,your friends, or even people who happen to be the wrong ethnicity. It's not hard to imagine the people in authority attempting to murder you again when they have done it in the recent past.
It doesn't help that the poorer communities have not only been neglected by the governments, but had their land plundered for resources. Those kinds of actions don't help to build trust.
So this explains why the outbreak is so bad, but why is it happening now ?
Clear cut logging and deforestation have pushed bats and humans into much closer proximity than ever before, and combined with increased isolation of rural communities has forced people into hunting for more bushmeat. Again, forcing more interactions between bats and humans. Once all of these factors came into play, it was only a matter of time before the disease jumped into humans. Mix in poor and underdeveloped infrastructure and widespread mistrust of authority, and you have all of the ingredients for the largest Ebola outbreak in history.