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Ebola epidemic: Interview with a health expert on the ground

For the first time in West Africa, a case of Ebola was confirmed on 21 March, three weeks after the first alert of a possible viral haemorrhagic fever emerged from Guinea’s Forest region. Animals such as fruit bats, rodents and monkeys, abundant in the adjacent rain forest, are believed to have served as ‘reservoir’ for the virus. However, once it passed from an infected animal to a human-being, the virus is now ready for human-to-human transmission. Though frightening and very lethal, relatively simple precautions can break the cycle of transmission and stop the epidemic from spreading. Dr Jean-Louis Mosser, health expert from the European Commission’s Humanitarian Aid and Civil Protection department (ECHO), is in the Guinean capital, Conakry, where he has been participating in crisis meetings and guiding ECHO’s response. He gives us a state of affairs.

At the end of March, the number of suspected cases had reached 127 and the death toll stood at 83 in Guinea. Suspected cases were also reported in Liberia. It had taken people by surprise. Considering that this region had never suffered from Ebola before, when the first unusual deaths occurred in February, health services initially suspected Lassa fever, which is another haemorrhagic more common in West Africa. But when many health staff became ill and died, it made people wonder. Ebola tends to affect those who take care of the patients and dispose of the bodies and it has a much higher mortality rate than other haemorrhagic fevers. Until Ebola was confirmed these people were not wearing the required protective gear, which is why many got infected.”

Several countries have announced the closure of their borders with Guinea? There seems to be a sense of panic?

“Indeed, some people in the street were wearing masks. This is useless, because as a general rule, the virus is not transmitted through air. But the President addressed the nation on Sunday evening and this seems to have calmed spirits, somewhat. Ebola may be very lethal, but it can be stopped by isolating patients and protecting those who have direct contact with them. In the end, all suspected cases can be traced back to the same cluster of patients who were infected through someone in Guéckédou. Even if surveillance needs to be reinforced, the closure of borders is not appropriate and not recommended by international health regulations.”

Are we to expect an epidemic that spirals out of control across the region?

“Most people were contaminated in the first few weeks, when safety measures at the health facilities had not yet been taken. Since a week rigorous procedures are in place: all patients are being isolated, health staff have been given protective outfits, and people who have had a ‘suspected’ contact with one of the patients are being traced and held under surveillance for the potential incubation period. As this period can last up to 3 weeks, we can still expect some cases over the next few days. But once the necessary protection barriers are in place – and granted, this is not always an easy task – we can expect the epidemic to start leveling off, as it has in previous outbreaks.”

What is being done to deal with  the epidemic?

“There are not that many partners willing and experienced enough to get involved. But fortunately, a few major actors have come in and are working on the three priority axes: Firstly, epidemiological surveillance which also involves the tracing of cases and lab testing. Secondly, management of cases which includes the setting up of isolation wards, the protection of health staff and family but also psychological support for the families, some of which have been decimated. Finally, effective awareness raising is vital to stop rumours, deliver hygiene recommendations and ensure the safe burial of patients. Community volunteers have a very delicate task. On all three fronts we have strong partners at work, a multi-sector team from the World Health Organization, emergency teams from Médecins Sans Frontières, and the Red Cross family with their network of community volunteers. There are also cash and in-kind contributions from UN agencies and other partners.”

Guinea has seen many epidemics over the last year, is this pure co-incidence?

“There is no link between the cholera, measles and Ebola epidemics. Cholera is common in West Africa and linked to poor water and sanitation; measles outbreaks are also frequent due to the low vaccination coverage. This Ebola outbreak is a first. What is true is that the state of the health system is very fragile as the country has very limited resources. Few actors are present, making it more difficult to bring outbreaks under control. My job is to support international partners who are providing a fast and adequate response to help the government bring these epidemics under control and limit the number of casualties.”

Anouk Delafortrie
Regional Information Officer for West Africa
EU Humanitarian Aid and Civil Protection (ECHO)

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