After five months and more than 900 deaths, the ongoing Ebola virus outbreak in West Africa maintains a tight grip on the countries of Guinea, Sierra Leone, and Liberia, with fatalities also confirmed in Nigeria.
New infections and deaths are mounting by the day — more than 100 people tested positive for the virus between Saturday and Monday alone — and resources are overstretched throughout the region as international organizations and local health officials try to tackle the unprecedented epidemic that spans from remote villages located hours apart to more densely populated urban centers.
With the relative infrequency of Ebola outbreaks, there's a shallow pool of people experienced in treating the disease to begin with. Aid workers, volunteers, and Ebola experts alike are running multiple deployments to the region, sometimes lasting for months at a time. On top of that, local healthcare workers have been highly vulnerable — at least 60 have died from the virus throughout the region, contracting the hemorrhagic fever after taking care of infected patients.
"There are 120 experts from the World Health Organization (WHO) on the ground, but we need more, there are many different localities affected," Tarik Jasarevic, a WHO spokesperson currently in Guinea, told VICE News. He noted a new response plan launched by the organization last week to help address this issue. "We need to have experienced people who know how these things should be done."
In addition to personnel being stretched thin, for the first time ever Ebola has shown itself capable of spreading via air travel. In a region where cross-border travel is common, countries have struggled to contain the virus, despite it being difficult to transmit. This speaks to one of the more taxing aspects of coordinating a response and a process that is crucial to breaking the chain of infection: contact tracing.
Contact tracing, or identifying and monitoring people who have come in contact with an infected individual throughout the incubation period, is a common practice for any disease outbreak.
Ben Neuman, a virologist at the University of Reading in the UK, told VICE News that in contact tracing you need to look for any person who has been in contact with the infected individual. In the case of Ebola, he said you're probably looking to identify 20 to 30 people who closely interacted with the person over the virus's 21-day incubation period.
'It's not easy, especially since a lot of Ebola victims are actively on the run.'
Not all of those people are in need of monitoring, as a victim is only contagious once they show symptoms of the virus. They are most likely to spread the disease during the last few days of the illness and, if they don't survive, around the time of death. Once you take all of that into account, Neuman explained, maybe one person will actually get infected.
Carolina Lopez, the emergency manager and field coordinator for Doctors Without Borders (MSF) in the outbreak's epicenter in Guinea, told VICE News that her contact tracing teams monitor anyone who was directly in contact with an Ebola-stricken person. This typically includes individuals who were taking care of the victim or cleaning their bodily fluids, bathrooms, or clothes.
According to Jasarevic, since the beginning of the outbreak there have been approximately 9,000 contact persons identified, 2,000 of whom are being followed for the current 21-day period. "It's huge work," he added.
When you talk about the task of monitoring 2,000 people in dozens of different localities across multiple countries, coordinating contact tracing efforts becomes especially tricky. "It's not easy, especially since a lot of Ebola victims are actively on the run," Neuman said.
Some countries have gone a step beyond contact tracing. In Sierra Leone, for example, troops have been deployed to monitor patients and their families, specifically to keep them in line with monitoring and quarantine efforts.
Lopez currently works directly with a Guinean official and a WHO representative to coordinate contact tracing in the Guéckédou area, located near the borders with Sierra Leone and Liberia. They oversee contact tracing teams consisting of supervisors who travel to affected villages and check in on contact persons, as well as local workers embedded in the communities.
"Community participation is key," said Jasarevic, explaining that these workers are usually respected individuals who can help alert officials when someone has died of Ebola and identify who was in close contact with that person.
When someone tests positive for the virus, Lopez and her teams immediately open a case investigation to follow the transmission chain. They look for anyone who has had contact with the victim from around the day they died. The identified contact persons can go about their daily routine, but they are asked not to leave the area as the team keeps tabs on them for the 21-day incubation period.
During that time period, contact persons are regularly interviewed about Ebola symptoms such as headaches and vomiting. This information is relayed to team supervisors who make frequent check-ins at the villages, which can require hours of driving from one locality to another — treks made even worse as the rainy season impacts on road conditions.
One problem in the initial stages of tracking is people who have left the area by the time an investigation begins. This can be a result of fear, or the frequent movement and border crossing that occurs in the area. "People move so much, plus people are scared about Ebola and so they hide themselves," said Lopez.
In many cases, even when someone is being monitored by the contact tracing team, they may try to conceal symptoms to avoid having to seek treatment. Lopez said because victims are dying even after they sought out medical care some people think if they go to a treatment center "they won't see their families again."
"We try to make people understand that it's simple to come to a treatment center and your chances to survive are higher if you come early to a treatment center," she said.
'The sad thing is, the death rates are low right now. It takes a month for the infection to kill and a lot of other people are currently in the early stages.'
According to Lopez, monitoring contact persons and getting them to treatment centers as soon as they start showing symptoms is the most important function of contact tracing and the key way to break the infection chain.
When workers are facing extreme difficulties communicating with residents — typically after a village sees its first case of Ebola — a communications team is deployed to track down and educate people on the virus and the importance of treatment. Lopez said this is now likely to happen in central Guinea, where new cases are cropping up in some localities for the first time.
While some of the newly affected areas are putting up a challenge, Lopez explained she has been feeling a lot better about the outbreak situation in recent weeks — at least in Guinea, where control efforts began earlier than elsewhere. According to her, the next month will consist of similar work, but their coordinated efforts are starting to pay off as communities become more open to treatment and prevention measures.
Statistics seem to support Lopez's view. While Guinea was the original site of the outbreak, the number of cases has slowed and now been surpassed by Sierra Leone and Liberia. Regardless of this potential improvement in Guinea, Lopez said the situation still needs to be monitored closely.
"We have to see this outbreak as regional, we have to look at Guinea, Liberia, and Sierra Leone until it stops in all of these places," she said, especially considering the amount of movement in the region. "We have to look for a solution together."
Neuman said the outbreak in general seems to be at the point where it might be burning itself out. He said he expects transmissions will drop off by the fall, meaning the outbreak could be declared over by the end of 2014. Yet, even if that's the case and response from here on out is perfect, he said we should expect at least 300 more deaths based on the current infection cycle.
"The sad thing is, the death rates are low right now. It takes a month for the infection to kill and a lot of other people are currently in the early stages," he said. "The things with this is infections tally up at the beginning, but deaths pile up at the end."
Follow Kayla Ruble on Twitter: @RubleKB
Photo via Flickr