Plugging the Source: Ebola in Guinea
WHY YOU SHOULD CARE
Figuring out the mystery of Ebola’s patterns in this tiny country might help the rest of the world get a grip on a tragic epidemic.
By Emily Cadei
In the nightmare that is Ebola, perhaps the greatest mystery lies where it all started, somewhere deep in a forest in a country that many Westerners barely know exists.
It was in March that the first outbreak of the disease was reported in Guinea, the Francophone nation of 12 million wedged in the heart of West Africa. No one knows why, but as the epidemic ripped through the region, the country managed for months to escape the worst of the virus’ ravages. Now that appears to be changing, with cases of Ebola on the rise. Here too, the reasons are murky, creating a mystery that some scientists think may hold answers to controlling a disease that has killed more than 5,000 people so far.
To date, the country, which only recently emerged from decades of authoritarian rule, has had roughly a third as many infections as its neighbors, Sierra Leone and Liberia, where the epidemic has spiraled out of control. But any thoughts of an “early miracle” are fading fast; around Guinea’s capital, Conakry, infection rates have gone up from a handful each week earlier in the year into the teens and 20s in recent months, according to World Health Organization data. The head of the U.S. Agency for International Development, Dr. Rajiv Shah, meanwhile, is most concerned about the stubbornly steady transmission rates in Guinea’s difficult-to-reach forest region and rural areas. Speaking at a panel in Washington, D.C., last week, he estimated that “there are anywhere from 300 to 500 current active cases there.” The question now is whether Guinea can leverage its early success into slowing this new increase.
If you know where a case is, you can figure out … how to contain it, how to isolate it. If you don’t, then you’re flying blind.
Dr. Rajiv Shah, head of the U.S. Agency for International Development
The country certainly has geographic advantages over its West African neighbors: Its urban centers are actually much farther away from the epicenter of the outbreak than Sierra Leone and Liberia’s. The first Ebola case is believed to have been contracted in a sparsely populated region at the nation’s southeastern edge last December, says Dr. Guénaël Rodier, an official at WHO who has been back and forth to the country this year. It’s easier to track Ebola’s spread in those types of environments than in congested, urban ones. And “contact tracing,” in which workers keep tabs on every person who’s been around the sick individual, is key to stopping the epidemic, says Rodier.
“If you know where a case is, you can figure out how to get there, how to trace contacts, how to contain it, how to isolate it,” Shah said last week. “If you don’t, then you’re flying blind.”
Infrastructure also gave Guinea an early advantage over its West African neighbors. Sierra Leone and Liberia, of course, are just coming out of civil wars that have ravaged all sorts of institutions. While Guinea’s health system is far from world-class, it has a strong chain of command among health officials, a more robust cadre of local health workers and a well-organized branch of the Red Cross, according to people who’ve been on the ground.
It helps that officials began working with a range of groups, local and domestic, to combat Ebola’s spread early on. The Guinean government and its Red Cross were quick to welcome help from foreign organizations like Doctors Without Borders to establish treatment facilities. Sierra Leone and Liberia, in contrast, “believed they had a greater capacity to deal with this” and delayed allowing the group to come in, says Clementine Fu, a doctoral student in epidemiology at Johns Hopkins University, who spent her summer in Guinea researching the virus’ spread for the Red Cross. Early action allowed the Guinean government to move more deliberately and avoid some of the panicked reactions of its neighbors, like declaring curfews and quarantining whole sections of towns. That only fanned fears.
Fast Facts: Republic of Guinea
Population: 12 million
Head of state: President Alpha Condé
Official language: French
Religion: 85 percent Muslim, 8 percent Christian
Population below the poverty line: 47 percent
Major exports: bauxite, alumina, gold, diamonds, coffee
In a good chunk of the country, Guinea has succeeded in gaining community trust, educating the public and combatting misinformation. Ten of its 34 districts haven’t reported a single case of the virus, according to the WHO; in contrast, it’s touched every district in Liberia and Sierra Leone. The organization credits higher public awareness about Ebola, highlighting, in one August report, the role of community leaders who successfully cooperated with some 26 villages. Outreach hasn’t gone perfectly, though. Overcoming local communities’ lack of trust of their government and other officials has been a challenge throughout West Africa, including Guinea. In a particularly ugly incident in September, villagers in southern Guinea attacked and killed a team of eight officials, health workers and journalists trying to raise awareness about Ebola’s spread.
The test for Guinea, then, is whether it can expand its early successes to the parts of the country where new infections are climbing — around the capital and rural southwest — or whether it, too, will lose control. “We are still not finished with the problem in Conakry,” acknowledges Rodier. “We don’t want it to become Monrovia,” the capital of Liberia. That requires continuing to carefully track the disease, and some intensive community-based work to make “drastic measures” aimed at protection acceptable, says Shah.
But Shah thinks it will also take more sustained international leadership, along the lines of what the United States has been able to do in Liberia, where infection rates have dropped sharply in recent weeks. France, Guinea’s former colonizer, is stepping up. The French government opened a new treatment center, for example, in a hard-hit part of the forest region on Nov. 14. The United States also expanded its rapid response team in Guinea earlier this month. Possibly these efforts will help Guinea, but whatever course Ebola takes there, it likely will confound the experts. Six months after health officials thought Guinea’s Ebola was under control, the light at the end of the tunnel is much dimmer.