Psychology of Ebola Crisis Reveals Biological Weapon Potential

What doctors and health agencies learnt from Kikwit will be largely driving the response of authorities today - but have all the correct lessons really been grasped? Particularly as regards the psychological dimension of an epidemic, where panic can be even more contagious, with wider effects?

Psychology of Ebola Crisis reveals biological weapon potential - a viral suicide bomb?

Raj Persaud and Nicholas Morris

252 people died from Ebola during the 1995 Kikwit 7-month outbreak in the Democratic Republic of the Congo; to date this remains the most significant of recent Ebola incidents, not including the current Western Africa outbreak. Kikwit provides in large part what is now known about this killer infection.

What doctors and health agencies learnt from Kikwit will be largely driving the response of authorities today - but have all the correct lessons really been grasped? Particularly as regards the psychological dimension of an epidemic, where panic can be even more contagious, with wider effects?

Kyle Olson, President of The Olson Group - a US consulting firm specializing in public safety and emergency management planning, who has written on Ebola in the past, comments that the current outbreak in West Africa demonstrates that this virus in a mobile, urban population, versus the remote villages where it was traditionally found, places major demands on public health resources.

A further psychological analysis of this incident was published in the academic journal 'General Hospital Psychiatry' in 2008. Key lessons were learnt from the fact many hospital staff fled, lessons which could assist in the current outbreak.

But one vital question the Kikwit paper also posed following that incident was; could this virus be used as a biological weapon?

The authors pointed out there remains great fear of Ebola's transmission through 'aerosolization', which refers to it spreading through fine spray. This has particularly significant implications in terms of its possible use as a biological weapon.

It's the combination of high mortality rate and 'weaponization' potential which, in fact, renders this such a medically important virus.

The study entitled, 'The 1995 Kikwit Ebola outbreak: lessons hospitals and physicians can apply to future viral epidemics', reports that it is known that terrorist groups such as Aum Shinrikyo (a Japanese cult which perpetrated sarin attacks) have tried to obtain Ebola viruses intending to deploy them as biological weapons. They had also attempted an attack with anthrax which might have been successful except they used an attenuated instead of an active form.

The US Centers for Disease Control and Prevention - the main American agency for handling outbreaks such as Ebola, published in their academic journal, 'Emerging Infectious Diseases', a paper entitled 'Aum Shinrikyo: Once and Future Threat?' by Kyle Olson.

This article reports that in 1993, a group of 16 of the Japanese cult doctors and nurses went to Central Africa specifically in order to learn as much as possible about, and bring back samples of, Ebola virus. Olson also reports that in early 1994, cult doctors were quoted on Russian radio as discussing the possibility of using Ebola as a biological weapon. However, there is no evidence they were successful in acquiring the virus.

Psychiatrist Dr Ryan Hall, Affiliate Assistant Professor, University of South Florida, and one of the co-authors of the Kikwit study comments that although the 'weaponization' of Ebola probably remains a concern for the authorities, an additional worry might be "virial suicide bomb".

This involves putting someone infected with Ebola on a crowed city bus, metro, or in the middle of a super market, when already oozing and bleeding. The actual death toll resulting would in all probability be low, but the panic factor being extremely high, renders this an ideal weapon for terrorism.

Kyle Olson responds that a truly weaponized Ebola would utilize mechanical methods (essentially an aerosol or spraying device) to distribute the virus among an unsuspecting population. He cautions that the absence of an airborne component does limit the exposure, but, he contends, consider an infectious person on a crowded subway car at rush hour...

Authors of the Kikwit study, Dr Ryan Hall, Dr Richard Hall and Marcia Chapman, report that overall, 20-25% of the victims in the Kikwit outbreak were health care workers, and the psychological impact of several aspects of the epidemic, including the spread of fear, should not be underestimated, according to this analysis.

For example, once some of the hospital staff in the Kikwit outbreak, and their family members developed Ebola, general panic spread through the city. Many patients and staff fled the hospital.

Staff who volunteered to work in the Kikwit outbreak found that quarantine conditions produced severe psychological stress. The combination of separation from normal support from friends and relatives, along with natural apprehension over contracting Ebola, fear they would infect their family and witnessing deaths of close colleagues, were not just very emotional losses but also constant reminders of the risk they themselves were taking

In the Kikwit outbreak from the Congo, clinical staff even developed psychosomatic symptoms similar to those seen in Ebola patients.

But it wasn't just the spread of the virus that caused problems - the contagion of fear meant that families of hospital staff dreaded that they were infected. Neighbours, becoming wary of being infected by the health care workers, stoned them and their families; on occasions burning their homes down.

Such families were also not able to purchase food because people refused to take, in their view, potentially infected money them.

One grave psychological problem and key lesson from outbreaks such as Kikwit, the authors of the Kikwit study from the University of South Florida, report, is that it is common for clinicians, who have previously agreed to work with the infected, to later question this decision and commitment during life-threatening viral epidemics.

Kyle Olson argues that understanding and managing cultural, psychological and other factors (including social media) are as significant in fighting the spread of the disease, as having modern hospitals and effective hygiene.

He also contends that some members of the medical community may become victims of their own hubris if they assume they understand everything about managing Ebola. He notes that a key concern in almost every major city around the world is that most clinical personnel have never seen Ebola, and are, at best, only theoretically familiar with the symptoms. Kyle Olson reports that emergency room medical personnel in Washington and New York City have received new training on recognizing Ebola over the past several weeks.

He concludes: take nothing for granted.

It's this wider psychological impact which means that even now there are probably those who are thinking of deploying Ebola as a biological weapon, who are paying close attention to the current spread of the virus, and the contagion of fear.


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