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 Three doctors were discovered to be infected with Ebola at a
hospital in Guinea's capital Conakry last week in what health
reports and government officials blamed on a failure to implement
basic measures for infection control.
Errors such as these were commonplace at the beginning of the
outbreak as ill-prepared medical staff, often without protective
equipment, failed to detect Ebola symptoms, turning hospitals into
incubation chambers for the virus.
Now, after more than $2 billion in aid and the deaths of more than
10,200 people in West Africa, the same mistakes are resurfacing.
"There's a lack of vigilance," said Dr. Jean-Pierre Lamarque,
regional health advisor for the French foreign ministry. "We are one
year into the epidemic and people are letting their guard down."
The discovery of the infections led to the identification and
monitoring of up to 150 new high-risk contacts in Conakry just as
Guinea, where the outbreak was first detected 12 months ago,
appeared to be finally turning the corner.
Ebola has smoldered and then flared up anew in Guinea several times.
The minutes of a meeting held by former colonial power France's
coordination team last week described the situation in Conakry as
"pre-explosive" as they wait to see how many of the contacts will
develop the disease.
Similar oversights dogged the effort to eliminate Ebola in Liberia,
which now has just one known case left. One of the last Ebola
patients visited a public hospital several times in late January
without being correctly diagnosed, causing the number of high-risk
contacts to briefly spike.
FRUSTRATION WITH RULES
Ebola cases in Sierra Leone have dropped sharply from a peak of more
than 500 in December to around 50 cases a week, helped by British
military assistance. Still, officials say some people are chafing at
Ebola rules and breaking them.
In Freetown's Kingtom cemetery, mourners complain that Ebola
protocols for burials involving plastic bodybags and pallbearers in
coveralls, which are applied universally, go against the last wishes
of their loved ones.
Hundreds protested outside the main Freetown mortuary this month
when a prominent opposition politician was buried the official way,
even though he did not die of Ebola. The government plans a
three-day lockdown to try to identify sick being kept in their homes
and to reinforce anti-Ebola messages.
"People are slacking up. The new cases are all to do with the
violation of rules – contacts leaving their homes, unsafe burials,"
said an official in Sierra Leone's Ebola response team, explaining
the decision to implement a lockdown.
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Before last year, Ebola outbreaks had mostly occurred in isolated
rural locations but this epidemic has spread across borders to
Nigeria, Mali and Senegal.
The biggest remaining hotspot is a wedge of land immediately behind
a 150-km (95-mile) strip of coastline between Conakry and Freetown.
In this region, many people who have been in touch with Ebola
patients can move relatively freely back and forth across the shared
border, officials say.
The WHO says joint surveillance teams will tackle cross-border
transmission but some say not enough has been done and this remains
a blind spot.
"There are lots of people who talk about it but you have to really
look for evidence of this on the ground," said Jerome Mouton, Guinea
country manager for Medicins Sans Frontieres (MSF).
MSF, a leading medical charity, was the first to raise the alarm
over Ebola and on Monday said the slow international response
created an avoidable tragedy.
In Guinea, there continues to be a mix of suspicion and outright
violence towards healthcare workers, Mouton said. Seven months from
a presidential election, some expect it to intensify.
"Certain people don't seem to want it over and they don't want the
government to take the credit for ending it," said Philippe Maughan,
senior Ebola operations manager at ECHO, the European Commission's
humanitarian aid branch.
President Alpha Conde has already pushed back the deadline to zero
cases from early March to mid-April – a target that the WHO regional
director Dr. Matshidiso Moeti still calls "very ambitious".
(Additional reporting by Saliou Samb in Conakry, Umaru Fofana in
Freetown; Stephanie Nebehay in Geneva and Misha Hussain in Dakar;
Editing by Sonya Hepinstall)
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