Urban Ebola? Why the Latest Outbreak in Uganda Raises Worries

The presence of an infected person in the country's capital, Kampala, has got the city freaked out — and it could be a rehearsal for the next great pandemic

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Tomas Hajek / Corbis

In Kasese, Uganda, a man distributes newspapers with a title about the Ebola virus outbreak, on August 1, 2012. The Ugandan president has called on people to limit physical contact with each other, after the death toll of a deadly outbreak of the Ebola virus climbed to 18.

Perhaps 1,850 people have been diagnosed with Ebola hemorrhagic fever since the virus was first identified 36 years ago in the Democratic Republic of Congo. (To put that number in perspective, more than 24,000 people fall ill from tuberculosis each day.) Still, Ebola has a grip on the public imagination that far exceeds the danger it actually poses — in part because of those 1,850 sick people, some 1,200 went on to die. And the deaths are rarely easy — Ebola can cause severe fever, muscle pain, weakness, vomiting, diarrhea and unstoppable bleeding. There is no treatment and no vaccine.

That’s why the latest Ebola outbreak in western Uganda, which has involved at least 20 cases and 14 deaths so far, has received so much attention. According to the World Health Organization (WHO), the outbreak originated in a family in Nyanswiga village in Uganda’s Kibaale district, 140 miles (225 km) west of Kampala, the capital. Such rural outbreaks are not unusual for Ebola — like many emerging infectious diseases, including HIV, it first jumped from primates like gorillas and chimpanzees to human beings, and outbreaks often begin with sick animals. It’s not surprising then that the first infections would often take place in the African countryside, where the hunting and consumption of wild animals is not uncommon, as I discovered when I visited Cameroon for a TIME story last year.

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What’s got people worried in this case is that one infected patient managed to travel to a hospital in Uganda’s capital, Kampala, a city of 1.5 million people with air connections to the rest of Africa and the world. Although there has been no evidence yet that Ebola is actively spreading in the city, Kampala residents are, to put it simply, freaked out — so much so that people immediately fled the hospital once word spread that an Ebola patient was being treated there. Ugandan President Yoweri Museveni also raised alarm bells when he called on citizens to avoid physical contact to prevent transmission of the disease:

Ebola spreads by contact. When you contact each other physically then Ebola spreads through sweat, through saliva in case you kiss, blood (exchange of blood), vomiting in case you touch the vomit of somebody who is sick or diarrhea, urine, sexual fluids, etc., all those transmit Ebola. Fortunately it seems Ebola does not spread through air (through breathing); it spreads through contact.

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But unless the virus somehow spreads from the Kampala hospital into the general population, the virus likely poses little threat to urban Ugandans — and even less to the rest of the world. That’s because as frightening as Ebola is, transmission requires direct contact with infected bodily fluids, including blood or saliva. It can’t be transmitted through the air like the flu or SARS. Unlike HIV, which is also passed through bodily fluids, Ebola makes the infected so obviously sick so soon that there’s little chance transmission could happen in secret. The most at-risk group for secondary Ebola infections is actually health care workers, which is why the 20 doctors and nurses who made the journey with the infected patient from Kibaale are in quarantine, just in case they too contracted the disease.

The presence of Ebola in a major African capital should still raise worries, however. New diseases begin in rural areas, where humans and wild animals — especially primates that are genetically closer to human beings — interact. But without roads and air travel, those viruses will mostly stay there. HIV was active among people in Central Africa for decades before it was able to spread to the rest of the world, thanks largely to air travel. The same thing happened with SARS in 2003: though the virus emerged in the marketplaces of southern China, where everything from wild civet cats to snakes are on the menu, it didn’t spread around the world until sick patients made it to Hong Kong, one of the busiest airports in the world.

Ebola has had decades to try to make it out of Africa and establish itself as a truly global threat. Thankfully for the rest of us, it hasn’t succeeded, and it seems unlikely to do so, barring some mutation in the virus that makes it more portable. But new viruses are always emerging in hot spots like Central Africa, places that are now perhaps just 24 hours’ travel from the U.S. (Remember Contagion?) Eventually one of them may well make it to the rest of the world — and the first stages may well resemble the Ebola outbreak hitting Uganda.

MORE: Bird Flu: More Common, Less Deadly than We Thought?

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wow ok wha5t is this world coming to


Globalisation at work

Matthew Johnson
Matthew Johnson


there has been no evidence yet that Ebola is actively spreading in the city" But with an incubation period as long as 20 days, by the time we know for sure, it will be well underway.

Julius Caesar
Julius Caesar

The fear of the unknown. This one is objectively understandable.

At some point it's going to happen, one Western gets infected, knows about it but escapes the region by air travel without saying anything to anybody, cause he was doing something illegal and because he is a real jerk. Comes to the West and spreads contagion in a major city in Europe or Asia or USA. He then dies just a few days later, with everyone knowing what is going on. Because he is a jerk, he tries to spread as much as possible contact since he knows he will die soon, but because he obviously is sick, it's hard for him to do it openly, cannot pretend to have a flu ... everyone who sees him, knows he is very sick. Nevertheless .. several people will get infected in the middle of a major city. Time 5 days, the medical system will be aware of the issue, but by then, the contagion will have probably reached some 10s of people.  It doesn't matter how many ,.. even if there were hundred of contagions, as soon as the "Ebola is in town news" is on TV, people movement would be stopped brutally.

It's going to happen, it can happen tomorrow or in 30 years from now or later, but it will happen and because travel is getting easier and easier .. every day such scenario gets more likely.

Here is why this is not going to kill millions:

1) if the virus does not mutate and gets airborne, containment will be "easy"

2 ) the symptoms show up very fast, within one day max 48 hrs, so it is easy to detect

3) it kills at 70% rate, which means within days from a contagion start, the system will go in lock down mode, reaction will be swift, not like in the case of SARS where people still move around cause they think they can survive it. The infected cannot go very far before they die, especially after the medical alert is launched.

4) It kills at 70%, which also means that there are no healthy carriers. Those who will survive it,  by the time they do, they will have killed the virus,. As fast as it comes, if they survive, they will do so quickly.

5) most of all, contact with contagion is not that easy. Yes, one kiss will cause infection, but hand contact not necessarily. So .. contagion reach is limited by the requirement of physical contact and contagion speed won't be very fast. Contagion is not guaranteed by just a simple quick contact.

Why is this going to cause a short term recession?

Once the contagion has started, it usually takes 4-5 weeks for the pandemic to reach max and then disappear. Try locking down 100% air travel to  a major city in the USA  for 3-4 weeks and see what that does to the stock market. 

I am exaggerating here .. it probably won't be as bad in term of economic impact, at least if the contagion remains in one city only.

If the jerk flies through a few airports and manage to spread contact to several people in airports ... then contagion will be possibly international. In that case, economic impact will be very visible, even though short term. It will cause real economic turmoil and a recession possibly.

Still , it won't kill millions because the high death rate combined with fast action makes it easy "relatively speaking" to contain.

Now the story would be deadly for general civilization if the virus had following features:

A) kill rate 70%

B) Quite fast action (kill within 10 days instead of 3-4 days

C) Airborne virus! Spreads through breathing. Easy effective contagion rate, just breath.

D) Slow display of symptoms easily confused with normal colds, just before death occurs, which means it i will be hard to detect and easily prevent effective separation of infected people from people who have just a flu. This will cause the medical system to become unable to do any real difference

E) Because it kills quite fast at high rate, it will be very hard to find a vaccine in time to affect the pandemic. 

In this scenario civilization will get hit hard and recovery will take about a century, if not more.

Consider this now: there clearly is over population in the world. What do you think is going to regulate that?


You just retyped the whole Contagion movie script


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