Since the Ebola outbreak first started in February, there have been almost 20,000 confirmed cases with about 7,500 deaths, making it the worst outbreak in history. While the new cases are now confined to Guinea, Liberia and Sierra Leone, the epidemic is far from over; 1,500 more people have been diagnosed in the past 21 days. The Centers for Disease Control (CDC) anticipates "a long, hard fight" before Ebola is completely eradicated. What is it about this outbreak that makes it so hard to stop?
To slow the spread of the disease, medical professionals must isolate the victims and track each case, testing and questioning every person who has come into contact with him or her during the contagious period. The CDC previously compared this process to putting out a forest fire, but, based on the challenges that healthcare workers have faced on the ground, now director Tom Frieden says it is more like putting out "many, many brush fires," each of which needs swift and thorough action. If that sounds challenging, resource-intensive and time-consuming, that's because it is.
In the 10 months since the outbreak started, the CDC and other international medical organizations have developed protocols to handle Ebola cases. The CDC calls this Incident Management, which gives each healthcare worker a specific task in order to make each step of the containment and treatment process as streamlined as possible, said Kristen Nordlund, a spokesperson with the CDC.
With well-supported workers in the right places who are completing specific tasks—like finding everyone with whom a victim may have come into contact—each case can be thoroughly contained and treated. These departments rely on structure and organization to systematically prevent Ebola from spreading.
"The three affected countries [Guinea, Liberia and Sierra Leone] did not have very strong public health systems in place before this outbreak, and this has overwhelmed them," Nordlund said.
Better communication, both within countries and internationally, as well as more stringent infection control requirements for healthcare workers have also been key to curbing the outbreak, Nordlund said, much of which has improved over the past few months.
Consistent reports and check-ins are how outbreaks like this have been eradicated in the past, says Daniel Epstein, a spokesperson for the World Health Organization (WHO), but now it's a more difficult challenge because of the sheer scale of this epidemic.
There's also no shortage of volunteers to track down all the people a patient has come into contact with, he told Motherboard. "The things still hampering volunteers are simple logistics, getting enough staff to train them, mobility—these places often remote, and it's far to go from one village to the next," Epstein said.
Donations have enabled the WHO to buy cars and motorcycles to transport volunteers. But some of the same challenges remain, such as the need to properly bury victims. "We know that it's customary in these cultures to wash the body of the deceased, but we also know that the body is highly infectious at this point," Nordlund said.
The WHO and others have disseminated information about proper burials to dissuade families from conducting funeral practices that may cause further infection, and they have been pretty effective. But there are still too many risky burials; Sierra Leone, which still has the highest number of cases, did not meet its December 1 goal of safe burials for 70 percent of victims.
To make burials safer, healthcare workers need to be able to intervene before family members expose themselves to infection, which requires a large number of healthcare workers in many different places as well as continued efforts at educating the public about Ebola's symptoms and transmission.
There are signs that these countries are fighting Ebola more effectively
There are signs that these countries are fighting Ebola more effectively, Nordlund said, but challenges remain. Health care workers are still struggling to contain Ebola's spread in cities like Freetown, Sierra Leone. When people move across borders between countries with high infection rates, tracking down the people who may have come into contact with a patient becomes extremely challenging. Some hospitals still don't have enough beds to safely treat infected patients, Nordlund said, and not all regions have sufficient number of medical personnel to do the necessary follow-up with those who may have been exposed.
The number of reported cases is fluctuating in Guinea and decreasing in Liberia, according to the WHO; the increase has slowed in Sierra Leone and cases are now mostly restricted to the country's western region. That's good news, but it doesn't mean these countries—or other countries, for that matter—are out of the woods yet.
"I think, going forward, the challenge is to get to zero [infected patients] because until we get to zero in these countries, they won't be able to fully move on rebuilding their health care system and making sure as a society, they can get back to work and back to making progress," Frieden, the CDC chief, said in a recent press release. And until we get to zero cases, there's still a chance that infected travelers can cross borders into places without strong protocols in place, spreading the disease further.
"There is always the possibility that there will be travel-associated cases, like we saw in the United States and Spain, as well as cases the border countries," Nordlund said. She emphasized that CDC workers were on the ground in these border countries to handle any new cases, and many countries have strict protocols in place, so the disease unlikely to spread to its prevalence of a few months ago. But it still may take a while to eradicate Ebola completely, she said. "We do not have a prediction for when this outbreak will be over, but we know that it will be a long, hard fight."
That doesn't mean just stopping Ebola's spread—that means no infections, anywhere. "That's the goal we're striving toward," WHO's Epstein said. "We'll know if we were successful 42 days after the last infected case. We hope it will happen in 2015, but we can't predict it."