Ebola challenges our assumptions

A World Bank study published last week estimated that the economic cost of the Ebola epidemic to West Africa could be as high as $33bn if the disease is not largely contained to Guinea, Sierra Leone and Liberia.

But with the US having confirmed its second case of Ebola - a nurse infected while caring for the now deceased first patient, supposedly while wearing the required protective clothing - it is apparent that containment may not be as simple as the world initially assumed. The International Monetary Fund's decision to change its rules to allow countries that have been afflicted by Ebola to borrow more and run up bigger deficits will help in the short-term, as will the sharp increase in pledges of aid from the developed world now that the US cases have focused minds.

It is essential that health services in the worst-affected countries do not collapse under the burden of the disease - it was reported yesterday that thousands of Liberian health workers were set to begin an indefinite strike at midnight in protest at a shortage of protective clothing and intolerable working conditions in isolation wards - and that outside assistance is being stepped up dramatically. Apart from the obvious humanitarian justification for this, it is becoming increasingly clear that neither previous Ebola outbreaks in Africa, nor epidemics such as the severe acute respiratory syndrome (Sars) scare of 2002-04, provide an appropriate comparison.

The former events were contained largely because they occurred in isolated, rural environments with little contact with the outside world. Sars, on the other hand, although highly infectious, started in Asia and quickly affected countries that were deeply integrated in the global economy. The reason it was stopped was that the threat to the world was so clear that there was a rapid, efficient and well-co-ordinated regional response with significant international assistance.

As a Barclays Bank foreign exchange research report points out, the latest Ebola outbreak has been centred in urban areas, with Freetown, in Sierra Leone, and Monrovia, in Liberia, being among the hardest hit. The epicentre of the disease is also on the edge of one of Africa's most densely populated regions - 334-million people live in the West African coastal corridor, many of them uneducated and without access to basic sanitation after suffering years of civil war.

That is a recipe for disaster in the absence of outside intervention - the combination of porous borders, ignorance, weak governance and poverty might make the World Bank study's prediction appear hopelessly conservative. A further concern is that the latest outbreak appears to have included a higher than usual proportion of healthcare workers and it is unclear whether this is because of poor working conditions or that the particular Ebola strain is more virulent.

The great fear is that the virus will mutate to enable transmission through the air, which researchers have documented in strains affecting pigs and monkeys. Health Minister Aaron Motsoaledi is correct to warn of complacency, even though Ebola has never been diagnosed in SA. As much as it may pain us to admit it, many of the factors that contribute to the rapid spread of such contagious diseases are present in this country, and it is no secret we have a large illegal immigrant population and porous borders.

The assumption must be that SA will sooner or later have to deal with a confirmed Ebola infection, and systems must be put in place to ensure that quarantine is effective and medical personnel adequately protected. Above all, the government must be prepared to cope with the possibility of panic among the population. SA has relatively advanced infrastructure compared with the parts of West Africa that are worst affected by Ebola, including access to sophisticated media - it must be ready to use them.

Editorial Comment: Business Day, 14 October 2014