It’s nine months into the biggest Ebola outbreak in history, and the situation is going from bad to worse. The outbreak simmered slowly in West Africa from December, when the first case was retrospectively documented, through March, when it was first recognized by international authorities. Now, terms like “exponential spread” are being thrown around.

Already, the number of cases (about 5,800 as of Sept. 22) and deaths (2,800) has dwarfed the numbers from every reported Ebola outbreak in history. And the case count is doubling every three weeks. Here’s where we stand:

On the ground

Even experienced disaster responders have been shocked at how bad Ebola has gotten. Jackson Naimah, a Doctors Without Borders worker in Monrovia, Liberia, described the situation in his home country, noting that patients are literally dying at the front door of his clinic because it lacks beds, personnel and supplies:

“One day this week, I sat outside the treatment center eating my lunch. I saw a boy approach the gate. A week ago his father died from Ebola. I could see that his mouth was red with blood. We had no space for him. When he turned away to walk into town, I thought to myself that this boy is going to take a taxi, and he is going to go home to his family, and he will infect them.”

When health care workers aren’t available, or when patients are too fearful to take loved ones to a clinic, it falls to those closest to the ill to nurse them. This has wiped out entire families. As Benjamin Hale wrote in Slate, the virus is “prey[ing] on care and love, piggybacking on the deepest, most distinctly human virtues,” turning caregivers into victims as it passes among siblings and parents, from one generation to the next.

Health care workers are dying because they lack basic protective equipment, or because they have been so overwhelmed by taking care of the ill and dying that they make potentially fatal errors.

Fear and misinformation are as deadly as the virus itself. Liberia’s largest newspaper featured a story describing Ebola as a man-made virus being purposely unleashed upon Africans by Western pharmaceutical companies. Reports abound of doctors and other workers being chased away, sometimes violently, by fearful families. Eight Ebola workers were recently murdered in Guinea.

The response

To date, nongovernmental organizations have largely been leading the fight. Doctors Without Borders (its French name is Medicins Sans Frontieres) has led the international battle against Ebola, but where its workers have had success in the past, they have been completely outrun now for months. MSF President Joanne Liu has made multiple appeals to the United Nations, begging for additional assistance, noting on Sept. 16:

“As of today, MSF has sent more than 420 tons of supplies to the affected countries. We have 2,000 staff on the ground. We manage more than 530 beds in five different Ebola care centers. Yet we are overwhelmed. We are honestly at a loss as to how a single, private NGO is providing the bulk of isolation units and beds.”

The plea has fallen on sympathetic ears, but the response has been slow and insufficient. The United States now has promised 3,000 military personnel and up to $750 million in aid. Yet the World Health Organization has called for a minimum of $1 billion, and even that would keep infections contained only to the “tens of thousands.”

Journalist Laurie Garrett, who wrote about Ebola in her 1995 book, “The Coming Plague,” denounced the international response and lack of coordination in Foreign Policy, noting that the world “just doesn’t get it” when it comes to Ebola.

The virus

If there can be a faint silver lining to this outbreak, it’s that researchers have been able to study the evolution of the virus in a way no previous Ebola epidemic has allowed. With thousands of cases documented to date, investigators have been able to track mutations in the virus’ genome. They’d found hundreds even before the publication of a paper in Science in August. In a tragic footnote, five of the authors have now died of Ebola.

While we know the virus is mutating, what these mutations are doing in patients remains unknown. Genomic data is only as good as the epidemiologic information that goes along with it, such as patient location, outcome of infection, symptoms exhibited, familial transmission patterns, etc. Given that the outbreak has been so explosive and understaffed, much of this data may be lost, and it’s estimated that almost half of those infected probably aren’t even reporting to hospitals.

One thing we do know is that the risk of this outbreak spawning an airborne Ebola virus is still tiny. Virologist Vincent Racaniello has pointed out that viruses historically do not mutate to a novel route of transmission and that “there is no reason to believe that Ebola virus is any different from any of the viruses that infect humans and have not changed the way that they are spread.”

The big concerns

Models suggest this outbreak will go on for months at a minimum. The U.S. Centers for Disease Control last week forecast as many as 1.4 million cases by January, although that did not account for the recent increase in U.S. and other efforts.

Besides the incredible potential number of lives lost, a huge concern is the destabilization of affected countries and those around them. WHO Director-General Margaret Chan has called this outbreak “a social crisis, a humanitarian crisis, an economic crisis and a threat to national security well beyond the outbreak zones.”

While 5,800 cases may not be a lot in the grand scheme of things, hospitals and clinics have been crippled, and mortality rates for other problems may be affected, too. Patients with different diseases and women looking to enter hospitals and clinics to give birth or bring in ill children with non-Ebola-related ailments have been turned away. Crops are not being harvested or transported, making hunger an issue equal or greater to Ebola in many areas.

Finally, all of this is about only the West African outbreak. Ebola also re-emerged in the Democratic Republic of the Congo in August; to date, there have been at least 60 cases and 35 deaths there.

The coming months

Even with massive international intervention, the situation will worsen before it improves. The influx of funds and assistance from the United States and other countries is certainly welcome, but it remains to be seen exactly how they will be allocated, who will be in charge and how coordination will be established.

This will be a long-term effort and, even after this Ebola outbreak has been extinguished, additional doctors and nurses will need to be trained to replace those who have been lost in this epidemic.

Some Ebola victims will survive, but they and their families may face harsh stigma in their hometowns. It may take a year, but this fire from the pit of hell eventually will be extinguished. At what cost to human life, we do not yet know.

Tara C. Smith, an associate professor of epidemiology at Kent State, blogs at Aetiology. She wrote this for Slate.

First Published: September 28, 2014, 4:00 a.m.