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Driving Ebola Away in Guinea

This article was originally published by Ebola Deeply.

As cases surge in western Guinea, threatening to undermine recent progress in the response effort, Ebola Deeply's Amadou Touré traveled to Forécariah—one of the worst-hit areas in the region. He sat down with Dr. Sakoba Keita, Guinea's National Ebola Response Co-ordinator, for an in-depth interview about the spike in cases, the role of taxi drivers in halting Ebola, and lessons learned from Liberia.

Ebola Deeply: In the last few days, we've all been hearing about this spike in new cases, especially in western Guinea. Where exactly are these new cases, and why is this happening again?

Keita: Yes, in the last few days we've recorded new cases in the western part of Guinea, specifically in the districts of Forécariah, Dubreka, and Boké. We're in the middle of responding and are doing everything we can to monitor the affected areas for new cases. Many of the new cases are in Forécariah. As soon as we noticed new chains of transmission there, we stepped up contact tracing; as a result, we found five new cases in 20 communities in a period of 24 hours.

In Dubreka, a man died from Ebola in the region of Dembayah. Some of the people who attended his funeral also got sick and died. That chain of transmission explains the new cases in Dubreka, and also in Tanene. Further contact tracing is underway in those areas as we speak.

A similar story unfolded in the region of Kamsar—a mining area in the Boké district. Taxi drivers there secretly transported the body of a man who died from Ebola in April. Later, they developed symptoms and they too died, as did some of their family members. Our teams on the ground have been informed and are responding, especially in the community of Filima. Soon, a large delegation from the National Ebola Response Center will visit the affected areas to reinforce vigilance and to assess the situation. We may make new decisions to avoid the same thing happening again in this region, which is very important to our economy.

Ebola Deeply: How many confirmed and suspected cases are there in Guinea right now?

Keita: I have the data up until May 18. There were 36 suspected cases of Ebola, including 16 confirmed cases. Most of them resulted from the Dubreka chain of transmission that I just mentioned. In Forécariah, there are 13 suspected cases, including nine confirmed cases. In Conakry, there are five suspected cases, including two confirmed cases—both of which are believed to have caught Ebola in Boké, not in the capital.

We've learned that the virus moves with people, and so our contact tracing has to reflect human traffic. We're trying to collaborate our efforts with taxi drivers and minibus drivers. Many sick people travel by taxi in order to reach traditional healers. We're asking people not to do that if they have the symptoms of Ebola, and to make contact with the national hotline instead.

However, there is some good news: Kindia—previously a hotspot, close to the border with Sierra Leone—hasn't had a case in some time. The Sierra Leoneans have launched border health patrols, made up of mixed teams of Guineans and Sierra Leoneans. They're going door to door in areas where cases could still be hidden. It's a synchronized program between our two countries.

Ebola Deeply: How do these teams get people to comply with them when they go door to door? There's still so much fear and suspicion.

Keita: Actually, because of that, Guinea decided to offer small gifts of cash—enough to buy market ingredients for dinner—and other household resources. According to the feedback I'm hearing, there hasn't been much reticence. This just applies to households targeted in eight areas of Forécariah district: about 6,500 households in total. We also want them to know that any sick person will be treated for free, whether they have Ebola or not. We want them to know that we are there to help them. Up until now, I haven't heard of any recent problems.

Ebola Deeply: We haven't heard many updates about the vaccine trial that has been taking place in Guinea since early March, led by the World Health Organization (WHO), Medécins Sans Frontieres (MSF), and the Norwegian Institute for Public Health (NIPH). What's the latest on that?

Keita: Yes, that trial started in early March. Now, 1,800 people have taken part in it and have received the VSB-EBOV vaccine. The results will be released in June.

Ebola Deeply: Given this recent surge in cases, how optimistic are you that Guinea can beat Ebola?

Keita: I've learned that infectious diseases are like people in a way: they are born, they grow, and they die. That's their nature. But it's only through the actions of human beings that they can complete that life cycle. It's up to human beings to break it.

But as you know, we've seen several big waves during Guinea's Ebola storm. If everyone adhered to the guidelines for vigilance, Ebola would have been wiped out here within 60 days. But among us, there are people whose behavior is favorable to Ebola. As a result, this disease has been with us for far too long.

Ebola Deeply: Liberia, Guinea's next-door neighbor, was declared Ebola-free on May 9. What can we learn from their response effort?

Keita: We're not in a competition with Liberia. Each country has tackled the epidemic with its own resources, rhythm, and luck; although the virus is the same, the characteristics of the response have varied in each place.

However, in my role as National Ebola Response Co-ordinator, I've been looking for wisdom from all four corners of Guinea. I've talked to experts about the way that Liberia tackled the outbreak, and whether it would be suitable for Guinea.

Here's something that worked: Liberia relied heavily on the cremation of dead bodies as a means of halting the spread of the virus, regardless of whether the dead were Christian or Muslim. The clothes of sick people were burned. People were very reticent about the idea of cremation, but it was still imposed rigorously. That allowed Liberia to dramatically reduce the chances of transmission from dead bodies. The recent persistence of Ebola in Guinea, on the other hand, has been largely due to unsafe burials.

You also have to remember that Liberia had a lot of help; there was a greater international response there, and the country is only a quarter of the size of Guinea. There was a massive drive from international responders there. For instance, one of the blood labs in Liberia was able to test 200 blood samples per day. In Guinea, our five blood labs together can only get through 100 samples per day. In the beginning, Liberia and Sierra Leone were sending blood samples to us in Guinea to test, but then they became better equipped than us.

Liberia also had more Ebola treatment units than us. And many communities in Guinea didn't adhere to health and sanitation measures: that set us back. Community action was key to halting the outbreak in Liberia.

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Amadou Touré is a contributor at Ebola Deeply.

[Photo courtesy of Ebola Deeply]

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