The West African Ebola Virus Epidemic

According to the Center for Disease Control, the West African Ebola virus is a rare and deadly disease that most commonly affects humans and other primates. This disease comes from a virus within the genus Ebolavirus and is commonly referred to as simply Ebola or EVD (Ebola Virus Disease) [1]. Ebola is a type of hemorrhagic fever virus that affects the blood’s ability to clot correctly. This can lead to internal bleeding while blood leaks from the small blood vessels in the body. It can also cause tissue damage or inflammation.[2] Two principal organs that this disease attacks are the liver and the spleen. [3]

Ebola was first identified in 1976 during two synchronic outbreaks: one in the Democratic Republic of the Congo (DRC) and the other in what is now South Sudan. [5] Since 1976, the DRC and Uganda have suffered several large outbreaks. [6] In recent years, the disease has gained a reputation as one of the most deadly and feared diseases. EVD has caused several massive outbreaks within the continent of Africa and has created global panic.[5] Throughout these outbreaks, the average fatality rate has hovered around 50%; although, it has varied between 25% and 90%, depending on the outbreak.[2] As of April 2019, Ebola has caused at least 13,000 deaths worldwide, and experts have said that the total death number could actually be much higher as this number reflects mainly reported cases of Ebola only. Over 90% of these deaths occurred within the continent of Africa.[5]

The longest and most fatal Ebola epidemic started in 2014. This outbreak resulted in 28,652 cases and 11,325 casualties, more than all others combined.[5] Guinea, Liberia, and Sierra Leone were the countries at the center of that particular outbreak. The 2014 to 2016 crisis was the most widespread epidemic of Ebola that the world has seen yet; the majority of the cases were seen in African nations, but cases were also seen in several European countries and eleven diagnosed cases were treated in the United States. Many of the cases in the U.S. and Europe were in health care or aid workers.  In August 2014, the World Health Organization (WHO) declared the outbreak to be a Public Health Emergency of International Concern (PHEIC), prompting an international attempt to quell the spread of the disease. [7]

The Ebola virus can appear anywhere within two to twenty-one days after contact with an infected source; however, the average amount of time before symptoms show is anywhere between eight and ten days. When symptoms do emerge, they may mimic the symptoms of common illnesses such as influenza or malaria. Ebola suffers may experience fever, severe headache, muscle pain or weakness, vomiting, diarrhea, abdominal pain, or unexplained hemorrhages such as bleeding and bruising. [8]

Treatment for Ebola remains very basic. Historically, it consists of providing the patient with intravenous (IV) fluids, electrolytes, and sufficient oxygen. Many patients with Ebola are treated in isolation or quarantine. [9] Experimental drugs began to be developed during the 2014-2016 outbreak and garnered national attention. One organization, WHO, became sidetracked due to an expert meeting regarding the new experimental drugs. Because of this, proven methods of infection control were not facilitated in a timely matter, thus causing more long-term damage.[10] These experimental drugs were used primarily in high-income countries rather than being distributed to all infected regions. The prioritization of medicine for certain people based on their location and wealth is perhaps unethical, especially with a lethal disease like Ebola.

In addition to initial selective treatment, the failure of pharmaceutical companies to seek and develop a drug for Ebola may be due to them seeing no profitability for preventing and treating the disease.[11] Is the lack of aid to a poorer country a selfish one, or one that comes from having the responsibility to care for one’s own before being able to help others? If a country is technologically advanced enough to develop means of aid for poorer countries and does not, then it perhaps becomes an injustice to the country in need of aid. However, when Ebola spread to the United States, the pressure to find a cure intensified. The inequality in how an illness is treated due to this outsider perspective prevents much aid in being carried out in the first place. Without adequate treatment, those infected with Ebola have a much more difficult time recovering.

Questions of medical ethics and how to treat an individual when they pose a potential threat to the public health creates a challenge of how should an organization respond in order to fight Ebola while maintaining a balance between the safety of the public and the rights of an individual. [10]

The ability to recover from Ebola is dependent on a series of different factors. These include the strength of a patient’s immune system, good and supportive clinical care, and the resources that a patient has available to them. EVD survivors have been shown to have antibodies to protect against the virus in the future present in their bodies up to ten years after they have recovered.[8] However, recovery comes with many challenges also. Even after recovery, survivors may experience side effects such as fatigue, muscle pain, eye or vision problems, and stomach issues. These survivors also face social challenges as re-entering the community after surviving the illness can be overwhelming and EVD survivors must face the stigma surrounding the disease as the return to their community.[1]

It is still unknown where the disease comes from, although scientists believe that it is animal-borne. [3] The main source of this animal to human transmission is determined to have been in contact with the blood, tissue, or bodily fluids of bats. Some species of bats, such as three types of fruit bats, that are eaten in African countries have now been found to be symptomless carriers of the disease. These three fruit bat types are Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata[3]

Fruit bats hang in trees. These animals are thought to be the main source of transmission from animals to humans. [12]

Most specifically, Ebola can be transmitted from human to human through contact with the bodily fluids of an infected person or corpse. This transmission can be caused by contact through broken skin, mucous membranes in the eyes, nose, or mouth, or through sexual contact. This can also happen through contact with objects that have been contaminated such as needles and syringes.[1]

To protect others from the transmission of Ebola, quarantines are often imposed. These quarantines were seen both in the affected African countries and in the United States for healthcare and aid workers returning from overseas. Volunteers and workers, many of whom were from Doctors Without Borders and the WHO, were put in isolation for 21 days after returning from Africa. The officials who instituted these quarantines stated that it was to protect the citizens in their states from contracting the virus and to help monitor the aid workers until the virus could no longer be present. [13]

A health care worker, who is surrounded by quarantine fences and treatment tents, carries a child with a suspected EVD case. [14]

The process of quarantine was very controversial both in the U.S. and abroad. Critics argued that it was unethical and not based on scientific results. They argued that the disease was hard to spread because it can only be transmitted through bodily fluid contact, not the air.[13] Dealing with the outbreak required a lot of difficult choices, which spurred some ethical implications. The treatment of the Ebola and the use of quarantine seem like a matter which has a relatively easy solution to implement. However, the course of action the CDC and WHO took sheds light on how when a region is unprepared for a sudden outbreak, questionable decisions can be made.

One large proponent to the inefficient treatment of Ebola is the diagnosis of patients that potentially carry the virus and how they were quarantined. In the first case of quarantine for Ebola in the United States, four close family members were ordered to stay within their small apartment. One of whom was Thomas Eric Duncan. Within two days, Duncan was mistakenly discharged from the hospital and by the time he was readmitted he had come in contact with as many as 100 people, two of whom were nurses that became infected and later on recovered through treatment.[15] Later on, 177 individuals would be quarantined and the CDC would revise their recommendation on how to deal with incoming individuals that arrived from West Africa. From a pliant countermeasure in dealing with the spread of Ebola to a stricter one, a decision of how to balance had to be made. While considering to what extent should a person be isolated and treated on illness, it is important to not only view what the individual experiences but also how will quarantine affect the people around them.

The case of Duncan’s quarantine is a relatively small one, yet still managed to impact a lot of people. What happens when there are many more people infected and it is more difficult to keep track and quarantine them? One strategy of quarantine is through a defensive, militaristic means which was instituted to a degree with the Ebola outbreak. Such a method of quarantine is a utilitarian one, where decreasing the risk of spreading the disease takes precedence over an individual’s rights to leave a country. Here is where problems arise between both sides. On one side, the individuals that are not ill are protected from any potential risk of infection outside the country. On another, those that wish to seek medical aid internationally become unable to as they are forcibly quarantined for the “greater good”. Although the treatment of Ebola carrying individuals is still prioritized, it appears that when forcibly quarantined, that individual’s rights to free travel become inhibited in favor of protecting others.[16]

In many affected African countries during the 2014 to 2016 outbreak, officials decided to quarantine entire villages after an Ebola infection; this was an attempt to stop the disease from spreading to other areas. Many healthy villagers in these quarantined areas were put at a higher risk of contracting the disease and many villages started suffering from food and supplies insecurity. These issues got so severe at times that many isolated villagers threatened to break out of the quarantine that had been imposed on them [13].

Another way that health care workers attempted to stop the transmission of Ebola during the major outbreaks was through strict infected-body disposal guidelines. Throughout the beginning of this particular EVD epidemic, burial practices in western Africa played a major role in disease transmission.[17] Burial ceremonies involved washing and touching the deceased, which caused funeral guests to contract the Ebola virus if the dead had been infected. West Africa is home to a multitude of cultures and religions, including Christianity and Islam, where many people attribute disease to supernatural, if not religious, causes.

Islam practice dictates that family members of the same gender as the deceased must cleanse a dead body before it is buried. According to the World Health Organization (WHO), 20% of Ebola infections during the 2014-2016 outbreak occurred during burials of deceased Ebola patients.[18] When family and community members perform religious practices that involve directly touching or washing a body, they are still exposed to high levels of the Ebola virus and could it to others.

On the other hand, various sects of Christianity can obscure the etiology of Ebola; one verse from the Book of Deuteronomy claims that God inflicts disease, fever, and inflammation as a punishment for transgressions.[18] Some communities in West Africa have even ascribed Ebola to God’s retribution for adultery and homosexuality.[18]

Because of the large influence of religion and supernatural beliefs, many West Africans continue to accept the advice of spiritual healers and religious figures in lieu of medical aid. WHO estimates that 70-80% of people in West Africa engage in traditional medicine.[18] Without proper medical training, these healers often spread false information; consequently, many people affected by an Ebola outbreak fall victim to quackery, such as taking salt baths and salt drinks in order to prevent getting Ebola. Ironically, the lack of widespread medical education has also affected traditional healers in previous outbreaks; a Guinean government official once had to deter traditional healers from trying to cure Ebola.[18]

Through a public health approach, one step that has minimized the spread of Ebola is through education: teaching traditional healers how to treat patients without contracting Ebola and debunking myths about the disease is far more effective than eliminating their role in society. For example, the WHO is now teaching how to hold dignified burials for Muslim and Christian patients victimized by Ebola.[18] We believe that launching awareness campaigns about Ebola would respect cultural and religious practices in West Africa. At the same time, it fosters trust between health officials and affected communities.

Volunteers who are not wearing full protective gear bury a victim of Ebola[19]

During the 2014 crisis, governmental and health care agency workers dressed in airtight suits to protect themselves collected the dead and worked to dispose of them. These workers collected the bodies from both confirmed and suspected EVD cases from the region where they passed away and transported them to the disposal sites. Some agencies buried the dead at protected mass grave sites and some cremated the bodies. In each of the affected areas, there was a widely published phone number that people would call to report deaths and bodies, a disposal team would respond to the call and take the body. Each team traveled in several utility vehicles, one for the body, one for the majority of the team including the leader, scout, sprayer, and several other workers, and finally a truck carrying police to manage the often angry villagers.[17]

A disposal team carries away an infected body as a loved one grieves and protests. [20]

When the team arrived on site, they would begin by donning personal protective equipment (PPE) and surveying the scene. The sprayer would then enter the home/location of the deceased and spray the area and the body with hypochlorite solution (strong bleach) before the rest of the team entered. After the body was inside the body bag, the sprayer would again spray the body and the inside and outside of the bag and the team would transport it to the truck. Teams would often collect several bodies in the area before transporting them to the disposal site. If the deceased was being buried, workers were supposed to make sure that they were buried more than two meters deep however, as the number of dead increased the burials became rushed and sometimes sloppy. The majority of the dead were buried in unmarked graves. These sites were often protected by high wire fences, orange tape, armed guards, and heavy concrete walls, while some remained unprotected especially in quarantined areas.[17]

Health care workers bury the body of an Ebola victim in an unmarked grave at a protected mass grave site. [21]

Although the 2014-2016 Ebola outbreak ended, there is another in the Congo spreading at a fast rate. The current Ebola outbreak is estimated to have 406 cases and 676 deaths. [22]Again, this goes back to how foreign countries decide to help those unable to set up protocols and methods in preventing outbreaks that are known to be preventable to a certain extent. But should a country rely on another when it is not in a time of need? This question needs to be answered based on context and how likely a certain disease or problem is to present itself. Overall, the balance among quarantine, prevention, and treatment is not only a matter of whether it is ethical to do certain things, but also a problem of resources.

Maeve Taylor

Tommy Tran

Raymond Chen

[1] Centers for Disease Control and Prevention, “What is Ebola Virus Disease?,” September 2018. Accessed 3 April 2019.

[2] Johns Hopkins Medicine, “Ebola.” Accessed 2 April 2019.

[3] Leroy, Eric M., Brice Kumulungui, Xavier Pourrut, Pierre Rouquet, and et al. “Fruit Bats as Reservoirs of Ebola Virus.” Nature 438, no. 7068 (Dec 01, 2005): 575-6. Accessed 4 April 2019.

[4] News24, “Ebola in DRC now infecting newborn babies, UN says,” 2018. Accessed 7 April 2019.

[5] Centers for Disease Control and Prevention, “Years of Ebola Virus Disease Outbreaks,” April 2019. Accessed 7 April 2019.

[6] Centers for Disease Control and Prevention, “Ebola Virus Disease Distribution Map: Cases of Ebola Virus Disease in Africa Since 1976,” December 2017. Accessed April 7 2019.

[7] Briand, Sylvie, Eric  Bertherat, Paul  Cox, Pierre  Formenty, Marie-Paule  Kieny, Joel Myhr, Cathy  Roth, Nahoko  Shindo, and Christopher  Dye. “The International Ebola Emergency.” The New England Journal of Medicine 371, no. 13 (September 25, 2014): 1180–82. 10.1056/NEJMp1409858. Accessed 5 April 2019.

[8] Centers for Disease Control and Prevention, “Signs and Symptoms,” May 2018. Accessed 3 April 2019.

[9] Davis, Charles Patrick. “What Is the Medical Treatment for Ebola Hemorrhagic Fever?” Edited by Jerry R. Balentine. Ebola Hemorrhagic Fever (Ebola Virus Disease). MedicineNet. Accessed 7 April 2019.

[10] Gericke, C. A. “Ebola and Ethics: Autopsy of a Failure.” BMJ 350, no. Apr 23 10 (2015).

[11] Dawson, Angus J. “Ebola: What It Tells Us about Medical Ethics.” Journal of Medical Ethics 41, no. 1 (2014): 107-10.

[12] Johorey, Janhvi, “Fruit Bats as Pets: Guidelines and Tips,” June 2018. Accessed 7 April 2019.

[13] Drazen, Jeffrey M., Kanapathipillai Rupa, Edward W. Campion, Eric J. Rubin, Scott M. Hammer, Stephen Morrissey, and Lindsey R. Baden. “Ebola and Quarantine.” The New England Journal of Medicine 371, no. 21 (Nov 20, 2014): 2029-2030. doi: Accessed 7 April 2019.

[14] Bajekal, Naina & Aryn Baker, “Ebola Health Care Workers Face Hard Choices,” Time, 13 October 2014. Accessed 6 April 2019.

[15] Rothstein, Mark A. “From SARS to Ebola: Legal and Ethical Considerations for Modern Quarantine.” SSRN Electronic Journal, 2014, 227-73.

[16] Koch, Tom. “Ebola, Quarantine, and the Scale of Ethics.” Disaster Medicine and Public Health Preparedness 10, no. 04 (2015): 654-61.

[17] Cordner, Stephen, Heinrich Bouwer, and Morris Tidball-Binz. “The Ebola Epidemic in Liberia and Managing the dead—A Future Role for Humanitarian Forensic Action?” Forensic Science International (Online) 279, (10, 2017): 302-309. doi: Accessed 6 April 2019.

[18] Manguvo, Angellar, and Benford Mafuvadze. “The Impact of Traditional and Religious Practices on the Spread of Ebola in West Africa: Time for a Strategic Shift.” The Pan African Medical Journal, September 22, 2015. Accessed April 8, 2019. doi:10.3897/bdj.4.e7720.figure2f.

[19] Accessed 6 April 2019.

[20] Epatko, Larisa, “Bringing safer burial rituals to Ebola outbreak countries,” PBS News Hour, 14 October 2014. Accessed 7 April 2019.

[21] Quinn. Maureen, “Governance and Health in Post-Conflict Countries: The Ebola Outbreak in Liberia and Sierra Leone,” International Peace Institution, June 2016. Accessed 7 April 2019.

[22] Hermitanio, Maui. “Ebola Outbreak In Congo Spreading At Its Fastest Rate, WHO Says.” Tech Times. April 03, 2019. Accessed April 04, 2019.


  1. I think that this post introduces an interesting contradiction because the only started to develop after the US was infected, however without the treatment many more people would have died. How do we implement worldwide measures to help combat these incredibly deadly diseases even if they are not a n immediate threat to domestic soil? How do we determine which instances supersede international financial struggle to provide a treatment to a country that may not be able to afford it and focus on humanitarian efforts?

  2. This post provides many different perspectives on the procedures and effects of Ebola on West Africa and the United States. I was upset to hear that because of the high amount of deaths due to the virus, the burials became sloppy. How do you think this makes the families of the dead feel? Is it ethical to dispose of a body in this way, not treating the person with the respect that they deserve?

  3. I think you article sheds light on an important of health that often goes neglected: the idea of preparedness in times of epidemics. Your article was very well researched with clear and concise information.

    A bit of a stretch, but I feel that this argument of how to prevent spread of Ebola by preventing certain burial practices applies to the idea of green burials. As cremation and traditional burial waste so much land and resources, they make future burials less likely for people in the future. But, is it ethical to prevent someone from having a burial they feel is the only way in order for someone else be able to be buried the way they wish? Is it fair that Muslims are barred from washing their lost loved ones though it may save their lives?

    However, your suggestion of promoting culturally competent and safe burials for Muslim and Christian patients affected by Ebola is such a simply and positive change that should be implemented on a large scale campaign. I also agree that it would foster more trust between health officials and communities. However, I think in addition to these measures, having western biomedical professions engage with the traditional healers and collaborate on treatments would spark more trust within the community. Their cultural beliefs around health and healing would have a chance to be held in the same light as western medicine which too often has followed waves of colonialism and leaving medical mistrust in its shadow. However, the question is how far are we willing to prevent a family from caring for their loved ones in their last moments in order to prevent future deaths.

    You should check out the short documentary about the epidemic I linked below. It discusses the issue of lack of resources to help during a crisis such as Ebola in unprepared healthcare systems. It has some moments that may be hard to watch (gore at 15:14 – 16:00) but very much an interesting watch (

  4. Even though this happened a short time ago, I never really learned the full timeline of events that happened. Being able to sit down and read through exactly what happened when helped me to better understand this epidemic. Additionally, reading about the ethical and moral issues surrounding this epidemic helped to create a much larger picture than I believe I would have gotten otherwise. This post also raises interesting questions about the job of countries to help each other, as well as the role of scientific communities in cultural spaces.

  5. The ethical question quarantine seems to have a slight solution to it. Considering the mention of antibodies in survivors, wouldn’t it be possible for them to help those with the disease and give them some more human interaction? Im not considering doctors in this case due to the intense gear they have to wear. This may also help with children who contract the disease and just generally show people that they can recover and give more human interaction and support.

  6. While reading this article, I noticed many similarities to the way the initial HIV/AIDS outbreak was handled in the United States. In both outbreaks, damage control from the US government was delayed and resulted in a greater spread of infection. I agree that there is a prioritization for helping people based on their location and wealth. In this case, the US government did not prioritize providing aid until the disease traveled to American soil. In the case of HIV/AIDS, the government did not want to acknowledge the gay community, and this discrimination based on sexual orientation resulted in a more widespread AIDS epidemic because help was delayed. Therefore, in both cases, discrimination in care resulted in a greater, more dangerous outbreak. Also, both diseases have a similar transmission that occurs when humans come in contact with another’s bodily fluids. However, HIV/AIDS is rarely transmitted through saliva and this is more common for the transmission of Ebola. Thus, burial practices of those who were killed by the Ebola disease must be performed much more carefully than the burial practices of someone with HIV/AIDS, which is not as easily transmitted.

  7. The most alarming aspect of this post is the fact that these people affected by this horrible disease are treated as less than human beings, but as soon as this disease entered the United States, it was all hands on deck to prevent it spreading through a developed country. These people are robbed of showing honor to their deceased family members or neighbors as their dead are shoved into body bags and placed into mass graves. Also, the quarantine process seems almost like a factory, accepting and disposing of people while thee drug research is not funded due to money hungry pharmaceutical companies. I wonder are the doctors who are stationed in these affected countries doing it to save these people as people? Or is there a motive behind it regarding good standing in America?

  8. I found the discussion regarding the ethics of quarantine to be the most interesting. I would suggest, however, looking at the cultural aspect of this in quarantine, how those families felt violated. This could be done in looking at how many traditional West African communities care for the sick.

    I related the Islamic practice of cleaning, washing, and touching the body as a process of grieving. This can be related to my post (the psychology of grieving), in questioning what is the psychology behind the person performing these tasks for the deceased.

    I really enjoyed that the post presented a solution to the problem, being that education and awareness is the solution to decreasing the spread of Ebola in the event of another outbreak.

  9. I really enjoyed this post, and have some insight into how doctors who treat Ebola patients try to respect and maintain some of their cultural beliefs. I recently attended a lecture by a doctor who treats Ebola patients in West Africa. When discussing how they dispose of the bodies, he talked about the importance of listening to locals and respecting their cultural traditions as much as possible. In order to do so, he said they stopped using black body bags upon request because some societies felt that the color black had negative connotations. He also said the doctors and staff would have family members instruct them on how to dispose of the bodies according to what they wanted and believed. This meant, the staff would suit up in protective wear and cleanse the bodies for the families while they watched. I think this an example of how doctors can try to gain victims of Ebola trust as well as ethically care for the dead.

  10. This was interesting insight into the disease Ebola. It does a good job of highlighting how awful of a disease Ebola is and what can happen to the person that contracts it. This article helps to raise major ethical issues like why do the richer countries get to decide who gets medicine, essentially who gets saved or not. Although it is important for the disease not to spread, these health care professionals are still dealing with humans and need to find a better way of containing the virus rather than quarantining patients,because this can get lonely and can also be seen as inhumane. This post also helps raise the question what is okay to do for the greater good? which is important to ask especially in cases like this. Although it is very important to have the workers dispose of the body properly, it is sad that the people cannot do a traditional burial and their dead are just taken away, becoming just another body. Is there a way the WHO can clean and bury the bodies in a way that satisfies both them and the villagers whose loved one has died? Overall great information though!

  11. This post was thoroughly interesting and very informative. I found it interesting to address the ethical side of burying a family member who had ebola. Different cultures have different rituals regarding funerals; therefore, it was heartbreaking to see these people suffering because they could not bury their loved ones properly according to traditions. Yet, if they did bury them, the likelihood of them contracting ebola was much higher indicating how there must be a compromise so that cultures are still able to bury their dead according to tradition without becoming infected to ebola. Additionally, I found it interesting how different socioeconomic groups where incorporated in finding the cure for ebola. I was wondering how this would affect the cure, and the post discussed how those with a lower socioeconomic status had less resources and were not distributed as much of the remedies as others with a higher status. This is relevant not only in ebola but also in the post about HIV/AIDs. Those who are able to obtain more resources easier are unfortunately given an unfair advantage in acquiring the cure. Overall, I found this article very informing and interesting.

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