Mistakes That Fueled Ebola Spread Are Preventing Its Containment One Year Later

By Emma Farge

DAKAR, March 23 (Reuters) - Lapses that fueled the Ebola outbreak after it was first discovered a year ago are dogging the final stages of the fight against the virus as fatigue and complacency set in, delaying the end of the deadly epidemic.

Three doctors were discovered to be infected with Ebola at a hospital in Guinea's capital Conakry last week in what health reports and government officials blamed on a failure to implement basic measures for infection control.

Errors such as these were commonplace at the beginning of the outbreak as ill-prepared medical staff, often without protective equipment, failed to detect Ebola symptoms, turning hospitals into incubation chambers for the virus.

Now, after more than $2 billion in aid and the deaths of more than 10,200 people in West Africa, the same mistakes are resurfacing.

"There's a lack of vigilance," said Dr. Jean-Pierre Lamarque, regional health advisor for the French foreign ministry. "We are one year into the epidemic and people are letting their guard down."

The discovery of the infections led to the identification and monitoring of up to 150 new high-risk contacts in Conakry just as Guinea, where the outbreak was first detected 12 months ago, appeared to be finally turning the corner.

Ebola has smoldered and then flared up anew in Guinea several times. The minutes of a meeting held by former colonial power France's coordination team last week described the situation in Conakry as "pre-explosive" as they wait to see how many of the contacts will develop the disease.

Similar oversights dogged the effort to eliminate Ebola in Liberia, which now has just one known case left. One of the last Ebola patients visited a public hospital several times in late January without being correctly diagnosed, causing the number of high-risk contacts to briefly spike.


Ebola cases in Sierra Leone have dropped sharply from a peak of more than 500 in December to around 50 cases a week, helped by British military assistance. Still, officials say some people are chafing at Ebola rules and breaking them.

In Freetown's Kingtom cemetery, mourners complain that Ebola protocols for burials involving plastic bodybags and pallbearers in coveralls, which are applied universally, go against the last wishes of their loved ones.

Hundreds protested outside the main Freetown mortuary this month when a prominent opposition politician was buried the official way, even though he did not die of Ebola. The government plans a three-day lockdown to try to identify sick being kept in their homes and to reinforce anti-Ebola messages.

"People are slacking up. The new cases are all to do with the violation of rules - contacts leaving their homes, unsafe burials," said an official in Sierra Leone's Ebola response team, explaining the decision to implement a lockdown.

Before last year, Ebola outbreaks had mostly occurred in isolated rural locations but this epidemic has spread across borders to Nigeria, Mali and Senegal.

The biggest remaining hotspot is a wedge of land immediately behind a 150-km (95-mile) strip of coastline between Conakry and Freetown. In this region, many people who have been in touch with Ebola patients can move relatively freely back and forth across the shared border, officials say.

The WHO says joint surveillance teams will tackle cross-border transmission but some say not enough has been done and this remains a blind spot.

"There are lots of people who talk about it but you have to really look for evidence of this on the ground," said Jerome Mouton, Guinea country manager for Medicins Sans Frontieres (MSF).

MSF, a leading medical charity, was the first to raise the alarm over Ebola and on Monday said the slow international response created an avoidable tragedy.

In Guinea, there continues to be a mix of suspicion and outright violence towards healthcare workers, Mouton said. Seven months from a presidential election, some expect it to intensify.

"Certain people don't seem to want it over and they don't want the government to take the credit for ending it," said Philippe Maughan, senior Ebola operations manager at ECHO, the European Commission's humanitarian aid branch.

President Alpha Conde has already pushed back the deadline to zero cases from early March to mid-April - a target that the WHO regional director Dr. Matshidiso Moeti still calls "very ambitious." (Additional reporting by Saliou Samb in Conakry, Umaru Fofana in Freetown; Stephanie Nebehay in Geneva and Misha Hussain in Dakar; Editing by Sonya Hepinstall)

Ebola is highly infectious and even being in the same room as someone with the disease can put you at risk
Not as far as we know. Ebola isn't contagious until symptoms begin, and it spreads through direct contact with the bodily fluids of patients. It is not, from what we know of the science so far, an airborne virus. So contact with the patient's sweat, blood, vomit, feces or semen could cause infection, and the body remains infectious after death. Much of the spread in west Africa has been attributed to the initial distrust of medical staff, leaving many to be treated at home by loved ones, poorly equipped medics catching the disease from patients, and the traditional burial rites involving manually washing of the dead body. From what we know already, you can't catch it from the air, you can't catch it from food, you can't catch it from water.
Cancelling all flights from west Africa would stop the spread of Ebola
This actually has pretty serious implications. British Airways suspended its four-times-weekly flights to Liberia and Sierra Leone until the end of March, the only direct flight to the region from the UK. In practice, anyone can just change planes somewhere else and get to Britain from Europe, north Africa, or the Middle East. And aid agencies say that flight cancellations are hampering efforts to get the disease under control, they rely on commercial flights to get to the infected regions. Liberia's information minister, Lewis Brown, told the Telegraph this week that BA was putting more people in danger. "We need as many airlines coming in to this region as possible, because the cost of bringing in supplies and aid workers is becoming prohibitive," he told the Telegraph. "There just aren't enough seats on the planes. I can understand BA's initial reaction back in August, but they must remember this is a global fight now, not just a west African one, and we can't just be shut out." Christopher Stokes, director of MSF in Brussels, agreed: “Airlines have shut down many flights and the unintended consequence has been to slow and hamper the relief effort, paradoxically increasing the risk of this epidemic spreading across countries in west Africa first, then potentially elsewhere. We have to stop Ebola at source and this means we have to be able to go there.”
Temperature screening at airports is an effective way to stop those who have the disease from travelling
The screening process is pretty porous, especially when individuals want to subvert it. Wake up on the morning of your flight, feel a bit hot, and you definitely don't want to be sent to an isolation booth for days and have to miss your flight. Take an ibuprofen and you can lower your temperature enough to get past the scanners. And if you suspect you have Ebola, you might be desperate to leave, seeing how much better the treatment success has been in western nations. And experts have warned that you cannot expect people to be honest about who they have had contact with. Thomas Eric Duncan, the Ebola victim who died in Texas, told officials he had not been in contact with anyone with the disease, but had in fact visited someone in the late stages of the virus, though he said he believed it was malaria. The extra screening that the US implemented since his death probably wouldn't have singled out Duncan when he arrived from hard-hit Liberia last month, because he had no symptoms while travelling.
Border staff should stop people coming in to the country who are at risk
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They're not doctors, and it's a monumental task to train 23,500 people who work for the UK Border Agency how to correctly diagnose a complex disease, and spot it in the millions of people who come through British transport hubs. Public Health England has provided UK Border Force with advice on the assessment of an unwell patient on entry to UK, but they can't be expected to check everyone.
Screening at British airports should be implemented to stop unwell people coming in from affected areas
As mentioned before, the UK, especially London, is a major transport hub. Unlike the US, most of those coming from west Africa will have crossed through Europe, so infected people could be coming from practically anywhere, not just flights directly from those countries. This would require the UK to screen every returning traveller, as people could return to the UK from an affected country through any port of entry. This would be huge numbers of low risk people, at vast, vast expense.