In the wake of the news that Sierra Leone is now Ebola-free, that is, transmission has stopped, now seems like a good time to talk about Ebola.

We all remember the West African outbreak of Ebola in March 2014, which took the lives of over 11,000 people. It was widely reported in the media as it spread across the world, even making its way to the United States and the United Kingdom.

The last known Ebola patient in West Africa, located in Guinea, has made a recovery and now the countdown is on for 42 days to pass before West Africa can finally be declared Ebola-free. But what happens after that? Is the epidemic really over?


What is Ebola anyway?

Ebola (Ebola Virus Disease, or EVD) is a virus which was first discovered in 1976. It is believed to originate from fruit bats, and can be transmitted to humans through contact with an infected animals’ blood and bodily fluids. Human-to-human transmission then occurs through direct contact with infected humans’ blood and other bodily fluids, or contact with contaminated surfaces and materials.

Ebola may cause a person to develop symptoms including a fever, muscle pains, headache and sore throat, followed by vomiting, diarrhoea, kidney and liver function impairment and internal and external bleeding. Until the virus is eliminated from the bloodstream, Ebola remains and on average the fatality rate of Ebola is 50%, making it potentially one of the world’s deadliest communicable diseases.

Ebola has an incubation period of 2 to 21 days, which is the time between infection and the appearance of symptoms. This means that 42 days must pass without disease before it can be declared defeated.

But Ebola has also had huge implications on social contact and customs. The threat of transmission limits the simple acts of hugs and handshakes, and even aspects of traditional burial rituals and ceremonies.

People in one severely affected country, Liberia, were unable to carry out their traditional finger-snap greeting, and in French-speaking parts of West Africa, the traditional three-kiss greeting was also lost.

Families of Ebola sufferers, and survivors themselves also experience stigma and exclusion. Ebola is not simply a disease from a medical standpoint, it is a disease to communities, a threat to wellbeing on many levels.


So what now?

On November 17th, the last known patient, a three-week old girl, tested negative for Ebola. If over the following 42 days, no new cases emerge, Guinea, and thus West Africa as a whole, can be declared Ebola-free.

However, ‘Ebola-free’ does not mean that taking action against it can stop. In fact, scientists have warned that Ebola could become endemic, that is, maintained in populations, if we become complacent. For this to occur, the virus would have to mutate, making it a more lingering and less recognisable disease.

So while this threat seems distant, we must continue efforts to stop Ebola. Furthermore, there are still significant barriers to reporting Ebola, which means that West Africa will have to continue to remain focused on the threat. For example, some communities deny the problem, and families which fear quarantine may avoid notifying authorities of cases.

These types of issues have long been barriers to Ebola detection, and have also contributed to difficulty in containing it. The fact that the outbreak occurred in West Africa, where poor countries with poor health systems were hit, meant that containing the disease was harder due to delays in lab testing and treatment, hygiene practices, insufficient numbers of doctors, and communication.

Cultural factors have had huge impacts. For example, reliance on traditional healing practices rather than medical treatment, and transmission through traditional burial practices such as washing and dressing bodies have accounted for an estimated 80% of Sierra Leone’s cases. Even the cultural trait of compassion became an issue as people helping others while unprotected often occurred. The fact that other endemic diseases, such as malaria and cholera, may have some identical symptoms to Ebola is also something to remain aware of.

Keeping alert is key, and although this may seem like the end, vigilance is more important than ever in West African countries. Communities will also need to regain strength as the effects of the Ebola outbreak remain. West African health systems which were put to the test will continue to face challenges as Ebola survivors suffer ongoing physical and mental health problems.

To really stop Ebola, the world needs to continue watching.