In the past, outbreaks of the Ebola virus have been sporadic, confined to rural areas, and comparatively small (the largest of all previous epidemics, in 1976, amounted to about 600 total infections with less than 500 deaths). The current crisis in West Africa has shattered all expectations by continuing to grow months following the initial case and in turn this has necessitated a massive and global emergency response. Columbia University’s National Center for Disaster Preparedness (NCDP), in collaboration with the Earth Institute, gathered various experts Monday to question what the current crisis means for West Africa and the world.

“At the end of the day, Ebola is not only a health emergency,” said Chernor Bah, a Sierra Leonean Peace Activist who spoke from the disease epicenter in Africa via Skype to the conference attendees. “I think it’s a poverty crisis... I think it’s an infrastructure crisis, I think it’s an education crisis.” Bah described his interviews with 55 survivors of the disease and in particular, one woman who outlived her mother, her father, and her older sister. After returning home from the hospital, she is now responsible for taking care of two younger sisters with little to no resources. This, according to Bah, is a common circumstance. Many people, poor and uneducated to begin with, have now lost their families within communities that lack the government and healthcare infrastructure to help them.

“Why is it so hard for us to deal with this?” Bah asked. In part, he says, shaking hands, taking care of the sick, and burial rites “are really a vital part of who we are,” and these fundamental aspects of their lives are not so easy to change. Additionally, he believes, West Africans are so much in shock, they are only dealing with Ebola and cannot continue other social services.

Faulting the World Health Organization

“In general, the world is not equipped for any of these events,” said Dr. Jeffrey Sachs, Director of the Earth Institute, as there’s “no reliable global system to handle this.” Sachs explained how humanity is spreading into new habitats with people increasingly coming into contact with animals and zoonotic viruses. Events like the current Ebola emergency, then, are not likely to fade into the past. “More to come,” he succinctly phrased his opinion.

Sachs singles out the World Health Organization (WHO) for much of the blame regarding the current Ebola outbreak. “They blew it,” he said, noting the WHO failed to sound the alarm early enough, which allowed the epidemic to grow. Sachs explained how, when one person spreads the virus to two people, and each spreads it to two more, a geometric progression begins. The current Ebola event had a doubling time of roughly 20 days during the Spring and early Summer, and, because it was not stopped immediately — and because it is not self-limiting like all earlier Ebola events — this contributed to the collapse of already precarious healthcare infrastructures in the affected countries which helped to extend the run of disease.

Less inclined to attribute direct blame, Dr. Irwin Redlener, Director of NCDP, questioned the world’s general preparedness. Noting the difficulties of “moving policy into practice,” Redlener described how NCDP is focusing on five general issues when considering how to curb the epidemic: scale and scope; coordination; priorities; work force; and funding.

Dr. Ranu Dhillon, Senior Health Advisor, Earth Institute, also dwelled on practical realities when speaking via Skype from West Africa; he emphasized the Four T’s: Transport, Testing, Tracing, Treatment. He explained that any amount of time shaved off each step — for instance, if you transport a symptomatic person one day after displaying symptoms instead of two — means there's less of a chance of one person infecting others and so the total number of people affected is reduced.

Mention was made by Dr. Robert Kanter, Adjunct Senior Research Scientist at NCDP, of an October 16 study which polled 1,000 hospitals in the United States and found just six percent were prepared for an Ebola patient. Considering this low level of readiness, he said the real question is not “Are we prepared?” but “Are we serious?” He recommends four steps: implementing mandatory requirements; mechanisms of enforcement and accountability; training and practice; and research.

“All of this is logistics,” said Sachs: “Action, action, action.”

What’s Ahead

“For several years people would have thought a vaccine is impossible but now we’ve had several that show effectiveness in animals,” said Dr. Stephen Morse, professor of epidemiology, Columbia University. GlaxoSmithKline and other companies, he noted, were preparing vaccines and it was likely at least one of these would be “available in the field” by end of this year or early next year. Morse explained several new antiviral treatments are also in the works from various companies including one in Canada and another in Japan, while a French enterprise is working on a rapid diagnostic test that could be performed at home.

Currently, laboratory based PCR tests are used to detect the virus. Answering the question on many minds, Morse said, “There’s some evidence that you can detect the virus by PCR before symptoms appear.” He explained the problem is there’s not enough research to understand whether the results are sensitive enough and reliable. “It shows promise. It would save a lot of people a lot of unnecessary labor and time off if we could do that.” Mass screening, though, may never be feasible given the possiblity of false positives, and in such large screenings, "there's always a false positive," he said.

Dr. David Abramson, Deputy Director, NCDP, who moderated a panel of doctors which included Morse, asked many questions concerning ethics, including one “allocation of scarce resource question.” Essentially, what do we do if we have to portion out available resources? Dr. Robert Klitzman, Professor of Psychiatry, Columbia, argued first responders and healthcare workers get any vaccines or medications first, and after that, “you have a very transparent process for thinking about who gets it next... And I would not necessarily trust local political leaders to make these decisions.”

Morse wondered aloud why we’ve seen much lower mortality rates during this current epidemic, when “Ebola has always been a death sentence.” He ventured Medicins sans Frontieres (MSF) would say, lacking modern medicines and vaccines, the difference is simply better care and aggressive techniques, including using, whenever possible, convalescent serum (transfusing survivors’ blood into sick patients, a time-honored practice) as part of standard care.

According to Klitzman, MSF, a nimble non-profit, has been able to identify necessary and special medical protocols surrounding the Ebola epidemic more accurately and faster than other stakeholders including the U.S. and Western Europe.

“Speed matters,” Abramson said.