Ebola is one of the deadliest viruses we know of. If left untreated, it kills about half of those it infects. It can spread through pretty much every fluid your body makes, including blood and sweat. Even the dead can transmit the disease, often doing so at their own funerals.
O ébola é un dos virus máis letais que coñecemos. Se non se trata, mata aproximadamente a metade dos infectados. Pode propagarse a través de case todos os fluídos corporais, incluídos o sangue e a suor. Até os mortos poden transmitir a enfermidade, e adoitan facelo nos seus propios funerais.
On December 26th, 2013, a two-year-old boy in southern Guinea got sick. Just two days later, he died. It took local doctors working with the international community four months to discover that Ebola was to blame, largely because it had never before been detected outside of Central Africa.
O 26 de decembro de 2013, un neno de dous anos do sur de Guinea enfermou. Apenas dous días despois, morreu. Os médicos locais, en colaboración coa comunidade internacional, tardaron catro meses en descubrir que a culpa era do ébola, principalmente porque nunca antes se detectara fóra de África Central.
In those four months, Ebola gained a head start that would prove devastating. The outbreak lasted two years and mushroomed into the largest Ebola epidemic in recorded history. More than 28,000 people contracted the disease and over 11,000 died.
Neses catro meses, o ébola adquiriu unha vantaxe que resultaría devastadora. O brote durou dous anos e converteuse na maior epidemia de ébola da historia. Máis de 28 000 persoas contraeron a enfermidade e máis de 11 000 morreron.
In 2013, Guinea had no formal emergency response system, few trained contact tracers, and no rapid tests, border screenings, or licensed vaccine for Ebola.
En 2013, Guinea non tiña un sistema de emerxencias formalizado, tiña poucos rastreadores e carecía de probas rápidas, controis fronteirizos ou vacinas autorizadas contra o ébola.
After that epidemic, Guinea, with the support of the US and other international partners, completely overhauled their epidemic response system. And in January 2021, that system faced its first real test.
Despois desta epidemia, Guinea, co apoio dos EE. UU. e outros socios internacionais, renovou totalmente o seu sistema de resposta ás epidemias. E, en xaneiro de 2021, ese sistema enfrontouse á súa primeira proba real.
It started when a nurse in southern Guinea developed a headache, vomiting, and fever. A few days later, she died. As dictated by traditional burial practices, her family prepared her body for the funeral. Within a week, the nurse’s husband and other family members started experiencing symptoms.
Comezou cando unha enfermeira do sur de Guinea empezou a ter dor de cabeza, vómitos e febre. Uns días despois, morreu. Como ditan as prácticas funerarias tradicionais, a súa familia preparou o seu corpo para o funeral. Despois dunha semana, o marido da enfermeira e outros familiares comezaron a experimentar síntomas.
Health officials suspected Ebola much quicker than in 2013 and ordered tests. They came back positive, and Guinea activated its epidemic alert system the next day.
O persoal sanitario sospeitou moito máis rápido que tiñan ébola e solicitou probas. Os resultados foron positivos e Guinea activou o seu sistema de alerta epidémica ao día seguinte.
Then, lots of things happened very quickly. Guinea’s National Agency for Health Security activated 38 district-level emergency operations centers, as well as a national one. Teams of epidemiologists and contact tracers began the painstaking job of figuring out exactly who was exposed and when, generating a list of 23 initial contacts that quickly grew to over 1,100. Advanced rapid testing capacity spun up in the city where the outbreak started. At Guinea’s borders with Liberia and Cote d’Ivoire, public health workers screened more than 2 million travelers. A large-scale vaccination campaign was started. And, finally, more than 900 community mobilizers alerted people of the outbreak and suggested alternative burial practices that were acceptable to the community and reduced the risk of spreading Ebola.
Entón, sucederon moitas cousas moi rapidamente. A Axencia Nacional de Seguridade Sanitaria de Guinea activou 38 centros de operacións de emerxencia a nivel de distrito, así como un a nivel nacional. Equipos de epidemiólogos e rastreadores de contactos comezaron a minuciosa tarefa de pescudar exactamente quen estivera exposto e cando, e xeraron unha listaxe de 23 contactos iniciais que rapidamente creceu ata superar os 1100. Púxose en marcha un sistema avanzado de probas rápidas na cidade onde se orixinou o brote. Nas fronteiras de Guinea con Liberia e Costa de Marfil, o persoal sanitario examinou máis de dous millóns de viaxeiros. Iniciouse unha campaña de vacinación a grande escala. E, finalmente, máis de 900 activistas comunitarios alertaron a poboación do brote e suxeriron prácticas funerarias alternativas que fosen aceptables para a comunidade e reducisen o risco de propagación do ébola.
Thanks to all these measures, the 2021 outbreak ended just four months after it began. Only 23 people contracted Ebola; only 12 died. That's less than 1% of the deaths in the prior outbreak.
Grazas a todas estas medidas, o brote de 2021 terminou apenas catro meses despois do seu inicio. Só 23 persoas contraeron o ébola e só 12 morreron. Iso é menos do 1 % das mortes do brote anterior.
The 2021 outbreak cost $100 million to control— which sounds like a lot but pales in comparison to the global economic cost of the previous outbreak: $53 billion.
Controlar o brote de 2021 custou 100 millóns de dólares, o que parece moito, pero é insignificante en comparación co custo económico global do brote anterior: 53 000 millóns de dólares.
So should every country just copy Guinea’s approach?
Entón, todos os países deberían copiar a estratexia de Guinea?
Not exactly. It is always important to respond to an outbreak quickly, so an early warning system is essential. But beyond that, a successful response can look very different for different diseases in different countries.
Non exactamente. Sempre é importante responder a un brote con rapidez, polo que un sistema de alerta temperá é vital. Pero, máis aló diso, unha reposta eficaz pode ser moi diferente para distintas enfermidades en distintos países.
For example, Brazil quenched an outbreak of yellow fever, which is spread by mosquitoes, primarily by mounting a massive vaccination campaign. That strategy worked well for Brazil because it’s one of the major global producers of the yellow fever vaccine, and its population was accustomed to regular, routine vaccinations.
Por exemplo, o Brasil sufocou un brote de febre amarela, transmitida polos mosquitos, principalmente organizando unha campaña de vacinación masiva. Esa estratexia funcionou ben no Brasil porque é un dos maiores produtores da vacina contra a febre amarela e a súa poboación estaba acostumada a vacinacións periódicas e rutineiras.
But for many diseases, you don't even need a mass vaccination program. In August of 2021, a truck driver tested positive for cholera in Burkina Faso. Health care workers alerted the government that same day and contact tracing began immediately. Cholera is caused by a bacterium, so Burkina Faso gave antibiotics to those exposed or potentially exposed. This extremely fast response stopped the outbreak just a few weeks after it started. Cholera often rears its head in West Africa— in 2021, there were over 100,000 cases and more than 3,700 deaths. Because Burkina Faso was so well prepared, they had zero deaths that year. Zero.
Pero para moitas enfermidades non é necesario un programa de vacinación masiva. En agosto de 2021, un camioneiro deu positivo por cólera en Burkina Faso. O persoal sanitario alertou o goberno ese mesmo día e o rastrexo de contactos comezou deseguido. O cólera está causado por unha bacteria, polo que Burkina Faso facilitou antibióticos ás persoas expostas ou potencialmente expostas. Esta resposta extremadamente rápida detivo o brote ás poucas semanas do seu inicio. O cólera asoma a miúdo a cabeza en África Occidental. En 2021, houbo máis de 100 000 casos e máis de 3700 mortes. Como Burkina Faso estaba tan ben preparada, ese ano non houbo ningunha morte. Cero.
In Chiang Mai, Thailand, health officials piloted a community-owned, community-driven outbreak alert system to monitor animal health— that’s important because some animal outbreaks have the potential to spill over and become human outbreaks. Villagers used an app to alert health authorities about outbreaks in animals. Over the course of 16 months, 36 animal outbreaks were identified.
En Chiang Mai, Tailandia, os servizos sanitarios puxeron a proba un sistema de control de alertas xestionado pola comunidade para controlar a saúde dos animais, o que é importante porque algúns brotes en animais teñen o potencial de propagarse e converterse en brotes humanos. Os habitantes usaron unha aplicación para alertar as autoridades sanitarias sobre brotes en animais. Ao longo de 16 meses, detectáronse 36 brotes animais.
For any outbreak response system to be effective, it needs to be trusted, valued, and ultimately used by communities. That means reaching people where they are, in the language they speak, and aware of the culture, beliefs, and practices with which they live.
Para que un sistema de resposta a epidemias sexa eficaz, as comunidades deben confiar nel, valoralo e, en definitiva, utilizalo. Iso implica chegar ás persoas alá onde estean, no idioma que falen e sendo conscientes da cultura, crenzas e as prácticas coas que conviven.
Perhaps most importantly, we can't expect to do nothing for years and then just swing into action when an outbreak occurs. One of the best ways to save lives is to invest in lasting health infrastructure, 365 days a year, for everyone, especially the most vulnerable among us.
Quizais o máis importante é que non podemos esperar non facer nada durante anos e logo lanzarnos á acción cando se produza un brote. Unha das mellores formas de salvar vidas é investir en infraestruturas sanitarias duradeiras os 365 días do ano para todos, especialmente para os máis vulnerables.