Op-Ed: Should you be worried about Ebola? It depends on where you live

By Abraar Karan, Internal medicine resident in the Hiatt Residency in Global Health Equity at the Brigham and Women’s Hospital and Harvard Medical School.

The latest outbreak of the deadly hemorrhagic virus Ebola has claimed more than 1,800 lives in Congo and been declared a Public Health Emergency of International Concern by the World Health Organization. But how worried should other nations be about its spread?

It depends. The danger of Ebola does not lie solely in the disease itself, but in the socioeconomic conditions of the places affected. People who contract Ebola are three to four times less likely to die from it if they are treated in a high-income country such as the United States rather than in places like the Democratic Republic of the Congo or western Africa, where the 2014 epidemic occurred.

International news coverage of the Ebola epidemic often focuses on the chance of it spreading to wealthy countries. But even if that were to happen, the disease wouldn’t be as deadly. In a study examining Ebola survivors who were treated in the United States and Europe, the mortality rate was only 18.5% compared to 50% to 90% in past Ebola outbreaks in Sub-Saharan Africa (the current outbreak has a mortality rate of nearly 70%). Why such disparity? Because it is not Ebola alone that is catastrophically deadly; it is the combination of Ebola and poverty.

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Another critical manifestation of poverty in the Congo Ebola epidemic has been the significant violence from rebel warfare. Violence has been a primary driver of the current epidemic and has prevented public health forces from safely testing and treating patients at scale. The inextricable links between violence and poverty have been well studied and proven: Poor places are more prone to violent conflict and violence further impedes the ability to efficiently address disease outbreaks.

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