Ebola's Not Done with West Africa

 NICK STOCKTON  |  SCIENCE  |  07.23.15  |  7:00 AM

OFFICIALLY, IT’S CALLED the Ebola Outbreak of 2014. But it’s 2015 now, and the disease is still infecting people. For the past two months, that rate was about 15 people a week. But in the past two weeks, the rate has doubled.

This is bad. Not last summer-bad—when weekly infection rates were in the hundreds—but bad enough that relief agencies have begun to worry about a resurgence. And even a trickle of infections is a wear on the aid workers, government authorities, and most of all, communities living in months of fear. “I was here in 2014. If you would have told me in 2014 I would see 30 cases of Ebola every week I would not have believed it,” says Marc Forget, Doctors Without Borders’ relief coordinator for Guinea.

What’s behind the continued spread? Depends on where you go. In Guinea and Sierra Leone, Ebola never died, and the new cases are a continuation of the same strain that first emerged in December of 2013. In Liberia—which declared itself ebola-free on May 12—experts believe the new outbreak was transmitted through sexual intercourse, from latent viral bodies that were alive in a man’s sperm.

In some ways, it’s tougher to stamp out a flicker of disease than it was to handle an apocalypse-sized outbreak. “If you have a big disease center, you have the ability to isolate as many patients as you can,” says Forget. It might not be apparent who is giving the disease to whom, but you can be pretty sure that everyone is in the same place.

On the final sprint, aid workers have to track down every single case, and make sure every person that the infected case came into contact with have been identified. “We track each case and try to get ahold of all the people they contacted while sick, and then follow each of them for 21 days,” says Forget. Despite all the resources in place, about a third of all new cases are coming from people without known prior contacts. “So these are contacts that we either weren’t able to identify, or who ran away and were hiding,” he says.

As an example, Forget brings up a case that came in just a few days ago. “A young medical student was working in a private clinic on the side,” he says. While there, the student encountered a few infected kids and caught Ebola. Then he went home to his big room inside a big communal cluster of homes. “There you have 33 people who were in contact.” The man, who was diabetic, started to feel sick, and thinking he was experiencing symptoms of his prior condition went to a clinic. The workers there gave him diabetes-specific tests.

Still feeling sick the next day, he went to a much larger university hospital—through triage, examination, and the endocrinology ward. Eventually his symptoms were identified as Ebola, but not before he came in close-enough-to-transmit contact with 65 people. And counting. “Even if he was in contact with 80 people, and we got 75, there are still five people we didn’t identify,” says Forget.

Even though the disease was so prevalent, people are still hesitant to out themselves as having been potentially exposed. “If they have symptoms and people know they will be restricted,” says Forget. Not just for the 21 days, but socially the stigmatization can last for much longer.

More than that, people in the affected region are tired of the disease—much more tired than you are of seeing it reappear in the headlines. Not just because of the uncertainty and fear, but also for the way it has affected the economy, education, and other basic structures of society. “I would just like people not to forget about Ebola because it’s not done,” says Forget. “If you are here you can’t stop paying attention.”

So, by the numbers: 19 months, 27,741 infections, 11,284 dead. And counting.