IELTS Academic Reading Practice Test 379

Ebola virus disease was first recognised in 1976, when two outbreaks occurred almost simultaneously in central Africa. One was in what is now the Democratic Republic of the Congo and the other in what is now South Sudan. The virus is named after a river in the Congo basin. The strain responsible for most outbreaks kills between a quarter and 90 per cent of those it infects. Before 2014, every known outbreak had been small, and each was generally brought under control within a few months. The virus had been confined to remote rural villages, and each outbreak had burned out before it could travel far.

The West African epidemic began in December 2013 in Meliandou, a village in the forested south-east of Guinea, close to the borders with Sierra Leone and Liberia. The first known patient was a young child who developed a fever and vomiting and died within days; the infection then passed to other members of the household. People in the region travel constantly across frontiers to trade, visit relatives and attend ceremonies, and the virus moved unnoticed into the neighbouring countries. By March 2014, cases had been confirmed in all three countries.

Two features made this epidemic so destructive. The first was that it struck where Ebola had never been seen. Health systems in the three countries were among the weakest in the world, still recovering from years of civil conflict, and they had few laboratories, few doctors and almost no experience of the disease. The second was that the virus reached cities. No previous Ebola outbreak had entered a capital city; this one infected Conakry, Monrovia and Freetown, where crowded housing and constant movement allowed chains of transmission to continue for months.

Ebola is not spread through the air, as influenza is. The virus passes from person to person through direct contact with blood, vomit, faeces, urine, saliva or semen. It enters the body through broken skin, the eyes, the nose or the mouth. This is why those who cared for the sick, and those who handled the dead, were at particular risk. The bodies of people who had died remained highly infectious for days, and funeral rites that involved washing and touching the deceased became one of the most efficient routes of transmission.

Fear travelled faster than the virus. In parts of Guinea, rumours spread that the disease did not exist, that it had been invented to extract money from foreign donors, or that the teams in protective suits were themselves spreading infection. Treatment centres were attacked, and in September 2014 a group of health workers and journalists was killed in a village in the south-east of the country. Patients sometimes left isolation wards, and families hid sick relatives at home, where unprotected caregiving multiplied the number of cases.

The World Health Organization declared a public health emergency of international concern on 8 August 2014, by which time the virus had also reached Nigeria in an infected traveller; Senegal recorded a case later that month. Médecins Sans Frontières, which had warned for months that its teams were overwhelmed, opened treatment units and pressed governments to send staff and supplies. Foreign medical teams eventually arrived, and several countries built temporary treatment centres. Yet in Monrovia, the Liberian capital, demand for beds long outstripped supply, and patients were turned away from units that had no space.

Health workers paid a heavy price. Several hundred were infected and more than five hundred died. The toll would have been lower if gloves, masks, gowns and disinfectant had been available in the quantities needed; in the first months they were not. Many staff worked long shifts in intense heat, and some had received only a few hours of training in how to put on and remove protective clothing. The damage extended well beyond Ebola. Clinics closed, vaccination campaigns were suspended, and patients with malaria, tuberculosis or complications of childbirth stayed away. Researchers later estimated that the disruption to routine services would cause thousands of additional deaths.

Science moved at unprecedented speed. Within weeks of the outbreak being recognised, laboratories had sequenced the virus and confirmed that it belonged to the Zaire strain. No vaccine and no drug had been licensed, so patients received supportive care: fluids, oxygen, treatment for secondary infections and pain relief.

A handful of experimental medicines were given to a small number of patients, but no controlled trial could establish whether they helped. The most important advance came in Guinea, where researchers tested a vaccine using a strategy called ring vaccination, in which the contacts of each new case were immunised. Results published in 2015 suggested that the vaccine protected those who received it.

The epidemic was declared over in Liberia in May 2015, but the virus returned twice more before transmission finally stopped. Sierra Leone was declared free of the disease in November 2015 and Guinea in December 2015, and Liberia followed in January 2016. By then more than 28,000 people had been infected and more than 11,000 deaths had been recorded, a toll larger than that of all previous outbreaks combined. The failure to act sooner became the subject of official enquiries, and the vaccine that emerged from the epidemic is now held in an international stockpile.

In an Ebola treatment unit, the protective suit is the last line of defence. The virus is not carried through the air in the way that influenza is; the danger lies in splashes of vomit, blood or diarrhoea reaching the eyes or mouth, or in a contaminated glove touching the face. The suit therefore works on a simple principle: no skin and no mucous membrane may be left uncovered, and nothing that has touched a patient may touch the wearer. A tear in a glove, a gap at the ankle or a mask that has slipped can undo the protection of everything else. Everything about the garment, from the fabric to the way it is removed, follows from that rule.

Most suits are made from non-woven polypropylene, a fabric in which fibres are bonded together by heat, pressure or chemical treatment rather than woven on a loom. Some are laminated with a thin plastic film to make them impermeable, while cheaper gowns are made of a single layer of the same material and are intended to be worn once. Manufacturers test the material against bloodborne pathogens using a standard method in which a virus that infects bacteria, known as a bacteriophage, is suspended in liquid and pressed against the fabric under pressure for several minutes. The fabric passes only if no virus can be detected on the other side. Seams are the weak point, because needle holes leak, so the best suits have taped or welded joins.

Putting the outfit together begins with the head. A hood covers the hair, ears and neck. Goggles, or a face shield, protect the eyes from splashes. A respirator over the nose and mouth filters particles, although it is worn less for Ebola, which is not airborne, than to guard against other infections and to keep gloved fingers away from the face. The body is covered by a one-piece coverall, and an apron may be added over it. Two pairs of gloves are worn, the inner pair taped to the sleeve, and rubber boots or boot covers protect the feet and ankles. The result is a person with no exposed skin.

The same fabric that keeps liquids out also keeps water vapour in. Sweat cannot evaporate, so the wearer's body temperature climbs; in tropical heat, a health worker in a full suit can approach the limits of heat tolerance within an hour. Treatment units therefore limit the time anyone spends inside a ward, often to around 45 minutes, and staff rotate. Some wear cooling vests or ice packs beneath the suit, and all must drink heavily before and after a shift. The heat is not merely unpleasant: it causes headaches and dizziness, and it makes careful work harder to carry out. Research has recorded rising core temperatures in volunteers wearing protective clothing, even when they were resting.

Removing the suit is far more dangerous than putting it on. The outer surface is by then covered in virus, and a single mistake — a glove brushing a wrist, a hand touching the face before it has been washed — can transfer infection. Protocols therefore break the process into a long series of numbered steps, each followed by hand hygiene with a disinfectant. In the large treatment units a trained observer, sometimes called a buddy, read the steps aloud and watched every movement. Suits are peeled off inside out so that the contaminated surface ends up enclosed. Investigations suggested that many infections among health workers in West Africa occurred during this final stage of a shift.

The suit also changes the relationship between carer and patient. Goggles fog, hearing is muffled, and thick gloves make every movement clumsy. A patient cannot see the face of the person treating them, only a mask and a visor, which is frightening when someone is already gravely ill. Some units wrote staff names in large letters on the front of suits, or added photographs, so that patients could tell who was who. Communication with colleagues is equally awkward, and instructions have to be shouted through a mask. The effect on the staff is considerable too: they are isolated from colleagues, unable to touch anyone comfortably, and visibly alarming to children.

Protective clothing is regulated as personal protective equipment, and in Europe suits intended for use against dangerous biological agents must be certified to a standard, EN 14126, that specifies tests for resistance to contaminated liquids and to micro-organisms. Certification, however, tests the fabric and the seams, not the person wearing them. A certified suit that is the wrong size, worn without taping, or removed in a hurry offers much less protection than the laboratory results suggest. Guidance has also varied between agencies and has been revised several times, for example over whether the head and neck should be covered by a hood attached to the coverall or by a separate piece.

Compared with drugs or vaccines, protective clothing attracts little research funding, and much of the evidence comes from laboratory tests and from small studies of volunteers at rest rather than from wards. Important questions remain open: whether airier fabrics can be made that still resist liquid, how long a person can safely work in a suit at 35 degrees Celsius, and whether the observer who supervises removal genuinely reduces mistakes. Designers are experimenting with sealed single-piece suits, with built-in cooling and with transparent panels that allow a patient to see a face. None of these has yet replaced the simple, uncomfortable coverall on which health workers have relied for decades.

When an epidemic of a lethal infection breaks out, offers of help arrive faster than almost anything else. In 2014, as Ebola spread through Guinea, Liberia and Sierra Leone, thousands of doctors, nurses and students volunteered, and some travelled to the region without any organisation to receive them. Their motives were admirable. Yet whether volunteers should be used at all in such emergencies divides those who study disaster response. Two quite different groups are usually confused in this debate: the foreign specialist who flies in for a few weeks, and the local volunteer who lives in the affected community and works without pay.

The argument for outside help is largely one of arithmetic. The three countries had almost no trained clinicians to spare; a hospital in a capital city might employ fewer doctors than a small European clinic. Treatment units could not have been staffed without outsiders, and laboratory technicians, logisticians and burial teams were equally scarce. Volunteers also arrived quickly. Governments and international agencies are slow to recruit and deploy, whereas individuals and charities can move within days. In the first months of the epidemic, when official responses were still being organised, volunteer teams were often the only care available to isolated communities.

Yet the arrival of volunteers also brings costs. Many of those who came had no experience of treating infectious disease and only a few days of training in the use of protective equipment, and a number became infected themselves. Treating an infected volunteer requires an evacuation by air, a specialist bed and a team of nurses, resources that may be diverted from the patients the volunteer came to help. Others arrived without a sponsor and had to be housed and fed by hospitals already at breaking point. Poorly prepared volunteers can also damage trust: a foreigner who does not speak the language and does not understand local funeral customs may do more harm than good, however good the intentions.

The obligations do not end when a volunteer comes home. Returning health workers needed insurance, medical follow-up and, in some cases, compensation for lasting illness. Several faced weeks of quarantine and considerable social pressure; in the United States, health workers who had treated Ebola patients were placed under restrictions that many people considered disproportionate. Whatever the merits of individual cases, the episode showed that volunteers carry risks that their employers rarely acknowledge in advance. Charities that recruit volunteers rarely budget for any of this, and the volunteer may be left to negotiate with an insurer alone.

The second group is easily overlooked. Community volunteers in the three countries went from house to house looking for people with symptoms, traced their contacts, carried messages about hand-washing and safe burial, and staffed the triage tents outside clinics. It was largely local volunteers who persuaded families to give up the tradition of washing the dead. Their contribution has received far less attention than that of the foreign clinicians, yet without it the treatment units would have had little effect. They were also the most exposed: they worked without proper equipment, and many died. Theirs was the least visible and most dangerous work of the epidemic. In Sierra Leone, some community health workers stopped work to protest about allowances that had not been paid for months.

The difference between a volunteer and a professional is not only skill but accountability. A paid clinician works within a system that assigns tasks, checks competence and takes responsibility for mistakes. An unaffiliated volunteer does not, and in a chaotic emergency the result can be what disaster specialists call a second disaster: well-meaning people and donations that clog the systems they came to support. For this reason, aid agencies now expect volunteers to be registered, trained, insured, vaccinated and attached to a named team before they travel, and medical teams arriving from abroad are expected to be self-sufficient for their first month.

My own view is that volunteers should be welcomed, but only on terms that protect them, the patients and the local staff. That means training before departure, insurance and evacuation cover, and a clear place in a single coordinated plan. It also means resisting the temptation to use volunteers as a substitute for paid staff. The response in 2014 relied heavily on unpaid community workers because there were too few salaried ones, and the lesson is not that volunteers are dispensable but that governments had underfunded their health services for decades. A volunteer should fill a gap, not become the system. Volunteers who are properly supported do not weaken a health service; they expose how much it needs.

The debate, then, is often framed as a choice between compassion and caution, and that is a false choice. A doctor who flies into a crisis without equipment, training or a team is not a hero but a liability; a health service that depends on goodwill is not a system at all. Send volunteers, by all means, and send them properly supported. But do not ask them to do the job that governments have failed to pay for. What matters is not whether the people who arrive are paid, but whether they are prepared, supervised and supported while they are there.