Dan Lucey, MD, MPH, 22 May 2015
On May 20 the World Health Organization (WHO) reported that Guinea had reported a sharp increase to 27 new cases of Ebola Virus Disease (EVD) from 9 cases the previous week.
The current longest-ever Ebola epidemic is thought to have started in early December 2013 in the forest regions of Guinea, near the border with Liberia and Sierra Leone. Why is it still persisting now, 18 months later?
The most recent weekly WHO update reports at least three explanations i.e., inadequate “key response performance indicators” for Guinea.
- Persons are still being diagnosed with Ebola only after they have died “in the community” and thus without having received any treatment in an “Ebola Treatment Unit” or “Community Care Centre” or other facility for persons with EVD. Thus, they likely exposed, and possibly infected, other persons before their death.
- Unsafe burials are still occurring (25 in the preceding week), meaning that contact with the body fluids of the corpse risks infecting other persons.
- The percent of new cases from registered contacts is still far from 100% i.e., only 19% during the preceding week until May 17. Of the 27 patients, only 5 were registered contacts of a prior case. Thus, how these other 22 patients were infected as part of a chain of Ebola virus transmission is unknown.
In order to prevent the Ebola virus from becoming endemic in the human population in Guinea will require sustained innovation to overcome the three problems above. Such innovations might in part be learned from successes in Liberia and Sierra Leone. For ‘cultural’ reasons, however, innovative ways to implement public health measures in a comprehensive and sustained nationwide way will likely be needed in Guinea if it is not to become the first nation with Ebola virus endemic in the human population, with serious implications for Guinea and other nations near and far.
By Dan Lucey, MD, MPH, May 2015