Ebola’s Toll Was Horrific. It Could Have Been Much Worse

President Barack Obama isn’t declaring that Africa’s Ebola crisis is over. But he’s making clear that he believes that the spread of the virus, which public health workers once feared could infect hundreds of thousands, has been largely stopped in its tracks.

“Our focus now is getting to zero. Every case is an ember that could light a fire,” Obama said at a celebratory news conference Wednesday praising the U.S. troops and doctors who had traveled to Africa to help fight the disease, while announcing plans to scale back America’s presence in West Africa by withdrawing all but 100 of the 3,000 troops who had been sent there to stem the outbreak. “We’re shifting from fighting the epidemic to extinguishing it.”

The size of the outbreak in West Africa in the summer of 2014 caused an international panic. The Centers for Disease Control and Prevention projected 550,000 Ebola cases in Liberia, Guinea, and Sierra Leone, and said that the count would be much higher if the disease spread to Nigeria. The World Health Organization declared an emergency. The World Bank estimated the outbreak could cost West African GDPs $32.6 billion by the end of 2015, a potentially devastating blow to the region’s fragile economies. And there were concerns the epidemic could become a pandemic if it escaped West Africa and made its way to Europe, Asia, or the United States.

“Bodies lying in the street…gangs threatening to burn down hospitals. I believe this disease has the potential to be a national security risk for many nations.,” Ken Isaacs, the vice president of program and government relations for the aid organization Samaritan’s Purse told lawmakers in August 2014. Obama’s ambassador to Nigeria, Jeffrey Hawkins, warned of an “apocalyptic urban outbreak.”

In response, the Obama administration committed $6.2 billion to combat the disease in West Africa and to prepare American medical facilities to treat Ebola. The president also sent 3,000 U.S. military personnel to West Africa to build medical facilities and coordinate international aid efforts. By April 2015, only 100 troops would remain, Obama said Wednesday.

More than half a year later, those dire predictions have proven to be wildly inaccurate. The number of cases is a fraction of early projections. The World Bank now estimates West African nations would lose just $500 million in gross domestic product this year. The total number of cases in the United States stands at just three; all survived. Most of the American troops, meanwhile, found themselves operating treatment centers in areas with few actual Ebola cases. Many of the facilities largely sat empty.

None of that is to deny the enormous human toll of the outbreak, which is the worst Ebola epidemic in modern history. The CDC estimates that 22,894 cases have resulted in 9,177 deaths, mainly in Liberia, Sierra Leone, and Guinea. Horrific as those numbers are, many had feared that they would be even worse.

But the number of Ebola cases is steadily declining across West Africa, especially in Liberia, where the country recorded only four Ebola cases last week, according to the WHO. Martin Friede, who is heading the WHO effort to coordinate the development of an Ebola drug, told NPR that the lack of new patients “is excellent for the countries involved,” but “from a drug research and development perspective, this is not so good.”

Aileen Marty, a professor of infectious diseases at Florida International University who treated patients infected with the virus in Nigeria, said initial coverage of the outbreak was “media hype [that] went a little overboard.”

Still, she said, “sometimes you need it to wake people up.”

Indeed, Ebola’s toll would almost certainly have been far worse if governments around the world hadn’t launched an unprecedented effort to help contain the outbreak. China sent more than 200 aid workers and medical personnel, along with $123 million, to West Africa to combat the disease. The European Union added another $1.3 billion. The Pentagon built 10 clinics across Liberia and trained 1,500 Liberians to treat the disease.

On a more localized level, doctors battling the Ebola outbreak had to find success on a number of fronts. First, they had to engage in some old fashioned epidemiology: find people infected with the virus, treat them, and then track down people these patients had been in contact with to make sure the bug hadn’t passed. According to Julie E. Fischer, an associate research professor with the George Washington University Milken Institute School of Public Health, these efforts have been successful: Patient zero has been identified as Emile Ouamouno, a 2-year old boy from Guinea.

“It’s getting to the point where every single case has a known origin. There’s no case you can’t track down to a specific exposure,” Fischer said. “When you have this, you know you really got a handle on the epidemic.”

Second, doctors needed to stop the spread of the disease in Nigeria, especially in Lagos, a city of 21 million where half of the population live in slums with poor sanitation. Because the disease is spread by bodily fluids, that was a powder keg that raised the prospect of the disease rapidly infecting huge numbers of impoverished people jammed into areas that lacked access to modern medical facilities. Lagos also contains one of Nigeria’s biggest airports, which meant that infected people could potentially have carried the virus to other continents.

“When I landed in Nigeria, we went nuts,” Marty said. “We made up songs, we did dances on how to avoid Ebola. Where there was Internet, messaging went out through social media. Messages went out through texts. We did campaigns meeting with chiefs of villages.”

By the end of October 2014, the disease had been largely eradicated there. Twenty cases were documented; eight of those patients died.

“If we hadn’t gotten the outbreak under control in Nigeria, with Lagos being a huge hub for transportation, it would have been bad,” she added.

In late October, the United States issued travel bans routing travelers from West Africa through five airports for screening. In some states, mandatory quarantines for health workers returning from the region were issued (and ignored in the case of Kaci Hickox, a nurse who treated Ebola, who defied a quarantine by New Jersey Governor Chris Christie). All of the Americans who contracted the virus on U.S. soil are alive and well. Of the eight American aid workers, doctors or nurses who caught Ebola in Africa, only one, Martin Salia, has died.

“Because we didn’t have more cases of Ebola in the United States, it’s safe to say the measures we took were correct. The response was appropriate in terms of border control and contact tracing,” Vicky Hausman, director of the consultant group Dalberg’s Global Development Advisors global health practice, told Foreign Policy.

Yet despite all of the positive steps made against Ebola, the World Health Organization issued a grim reminder Wednesday that West Africa is not out of the woods. It reported that the number of new cases is up in Guinea for the second week in a row.

“Despite improvements in case finding and management, burial practices, and community engagement, the decline in case incidence has stalled,” WHO said in its announcement.

Obama is right to tout some notable successes in the fight. But it’s far too soon for him to have a “mission accomplished” moment.

Photo Credit: Issouf Sanogo