image description

Ebola vs COVID-19: A clinical insight and comparison

Klade Thomas, SACARE's Manager of Clinical Services previously worked as a clinician during the West African Ebola outbreak, and below she shares a fascinating comparison of Ebola and Covid-19. The Ebola virus epidemic was a deadly life-threatening virus that affected West Africa, Guinea, Liberia and Sierra Leone. In 2016 the Ebola virus had a hospitalization rate of 57-59% and a mortality rate of 40%. It was one of the worst Ebola virus outbreaks on record.

 As the Covid-19 pandemic carves a relentless path across the globe, I cannot help but experience a sense of deja-vu from my vantage point in Adelaide, Australia. I was part of the Ebola response from 2014-2016 during the outbreak in West Africa and I cannot help but reflect on both sets of unfortunate circumstances (Covid-19 and Ebola) now. Being a clinician, the first thing that comes to mind is the Case Fatality Rate (CFR) in both scenarios. The graph pictured below from an ABC news article most accurately provides a succinct snapshot in relation to CFR of some of the outbreaks the world has experienced thus far.


Case Fatality Rates (CFR)

To reiterate, Ebola spreads through direct contact via broken skin or mucous membranes in the eyes, nose, or mouth, and is considered less easily transmissible than COVID-19. However, it is much more deadly with an average CFR of 50%. For Covid-19 specifically, the next graph culled from the Our world in data website, provides a similar comparison, it allows us to compare CFRs across the globe.


As is glaringly evident when we compare both graphs, Ebola is far more deadly in relation to CFR than COVID-19.However, with COVD-19 you can be contagious even before you show symptoms (up to 24-48 hours before, according to the World Health Organisation), although most transmission happens after symptoms appear. If there is a lag between symptoms appearing and getting a diagnosis, you could be infecting others.

Just wow! I would like to highlight that it is my opinion that COVID-19 is far more sinister in comparison to Ebola. Why? Its symptom can sometimes be less apparent and to date have served as a source of confusion to many in relation to inconsistencies of how the virus manifests in populations according to:

  • Geographical location 
  • Age 
  • Co-morbidities health systems (robust or otherwise)
  • Evidence and onset of symptoms
  • Possibility of reinfection

In comparison, Ebola signs and symptoms were far more evident and detectable, and it also became apparent very quickly to responders that robust healthcare was key in reducing Ebola’s CFR.We also know for sure that Ebola survivors could not become re-infected as they built immunity once cured and served as a unique source of support in the battle with the virus in that they could be safely trained to provide care to the stricken.

Travel

The issue of travel seems to be an ongoing concern whenever there is an outbreak. This was highlighted during the Ebola outbreak of 2013 and was more centered around porous borders between the countries affected and to a lesser extent international travel, for obvious reasons. International travel was managed mostly by:

  • A small number of airlines flying into affected areas
  • Airline staff remaining onboard in most instances
  • Infection control and temperature checks at airports
  • Designated arrival points or gates for these flights in most countries

This seemed to work really well if you could afford to travel, had copious amounts of patience, and could withstand the somewhat condescending treatment you received whenever you ticked the boxes and met the criteria for further screening.

But I digress. It becomes increasingly obvious that there needs to be more work done by various governments in terms of aligning outbreaks and the travel industry to ensure a balance is maintained to a certain extent. Is this wishful thinking? Maybe. But one thing is clear, we need to get it sort of right to mitigate these catastrophic circumstances in the future.

Australian Response to COVID-19

I feel like some would disagree with me on this part, but It is my opinion that Australia’s response to date has been mostly encompassing and a testament to the great services the country offers its citizens and residents. As with all outbreaks, you may experience a moment of shock and panic before everyone can regroup and get down to the matter at hand. Which is kind of what happened in Australia from the onset. In comparison to most other countries, we have been able to keep out CFR low and controlled. This was of course aided by:

  • Robust health systems(free)
  • Social services support
  • Geographical location(phew)
  • Testing

It would have been nice to see more supports given to the international students that flood the universities yearly and bring in revenue to the various states. In a way, this would have seemed reasonable like protecting your investments. There definitely needs to be more input from the disability sector, mostly due to the high-risk client group we manage (ventilated clients, COPD, Diabetes, ABI, mental health etc). Did anyone else get the feeling the sector have been pretty much left to fend for themselves? But most importantly, it is important to find tangible solutions to how we can operate businesses and go about our “normal” existence daily. From what I can see, a vaccine is the only way forward to a return to normalcy.

Bear with me if I am but a somewhat jaded nurse, but with the easing of our lockdown restrictions and no vaccine in sight as yet, I would like to take the opportunity to caution our communities, health and aged services providers to be more vigilant than ever. Continue your staff screening and infection control processes, reiterate to your staff that if they feel unwell to stay home. Together, let us do our part to ensure our communities are safe.