Garry, a virologist from Tulane University in New Orleans, knew a thing or two about how outbreaks of Lassa, Ebola and related viruses play out. “Lassa simmers,” he says. “Ebola explodes.”
And as the international community dozed, an outbreak detonated. Through the spring and summer of 2014, Ebola swept through Guinea and into its neighbors, Sierra Leone and Liberia.
The 2014 Ebola epidemic, the first in West Africa, was driven by a confluence of factors: poverty and lack of health care infrastructure; traditional burial practices that helped spread the disease; deep-seated mistrust of Westerners, health care workers and authorities; and the region’s growing mobility.
In May, women from Sierra Leone attended the funeral of a traditional healer who had treated Ebola patients across the border in Guinea. One of the mourners, a young pregnant woman, showed up at Kenema Government Hospital, where she miscarried and was diagnosed with Ebola. In all, 14 of the mourners were infected and spread the virus to their contacts in Sierra Leone, stoking that country’s epidemic, according to a DNA-sequencing study that Garry, renowned Sierra Leonean virologist and doctor Sheik Humarr Khan, Harvard virologist Stephen Gire and 55 colleagues later published in Science.
Garry and some colleagues, including Khan, readied the Kenema Government Hospital for Ebola patients. Soon he returned to the U.S., where he contacted federal officials to express his fears about a brewing epidemic. He received only “polite responses,” he says.
Meanwhile, in Monrovia, Liberia’s capital, physician and Christian missionary Kent Brantly began setting up that country’s first Ebola isolation ward. Before long the disease took hold in Monrovia’s dense slums, filling Brantly’s ward to overflowing.
“The disease was spiraling out of control, and it was clear we were not equipped to fight it effectively on our own,” Brantly testified later to the U.S. Senate. He said he and his colleagues “began to call for more international assistance, but our pleas seemed to fall on deaf ears.”
On Aug. 8, WHO finally declared the epidemic a public health emergency of international concern. “No one was really imagining we would get to this situation,” WHO spokesman Tarik Jasarevic says. Within weeks, Liberia had surpassed Sierra Leone as the outbreak’s epicenter. By then, more than 2,400 had been infected and 1,346 had died.
Ebola’s spread caught many scientists off guard at first. They knew that shortly after infection, the Ebola virus commandeers or kills immune cells, weakening the body’s defenses and letting the virus run wild. They also knew that the virus interferes with blood clotting, which leads to bleeding and, in many cases, multiple organ failure.
But no proven therapy or vaccine existed at first, in part because of long-standing funding shortfalls for diseases that mostly affect the developing world. By summer, however, researchers worldwide were racing to the lab to combat the epidemic.