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 Throughout the two-year Ebola epidemic, thousands of West African
survivors have been shunned by their communities, prompting
governments to sponsor messages stressing their complete recovery in
a bid to counter fear and paranoia.
But the case of Scottish nurse Pauline Cafferkey – the first known
Ebola survivor to have an apparently life-threatening relapse – has
revived concerns about the health of some 17,000 survivors in Sierra
Leone, neighboring Guinea and Liberia.
Doctors and health officials in Sierra Leone told Reuters that a
handful of mystery deaths among discharged patients may also be
types of Ebola relapses, stirring fear that the deadly virus may
last far longer than previously thought in the body, causing other
potentially lethal complications.
Diagnoses have not been made, partly because of a lack of relevant
medical training and insufficient equipment for detecting a virus
that can hide in inaccessible corners of the body - such as the
spinal fluid or eyeball. In Cafferkey's case, the virus in her brain
caused meningitis.
Dr. Dan Kelly, founder of non-profit organization Wellbody Alliance
who has worked on Ebola in Sierra Leone, estimates that relapsing
Ebola might affect 10 percent of all recovered patients.
He said this was based on two cases, including Cafferkey's, where
the live virus was detected among the roughly 20 survivors treated
in Europe and the United States. Other experts have declined to give
an estimate, saying it is too early to tell.
"One case reminds me of Pauline but we were unable to find a
laboratory willing to test the patient before the patient died," he
said. "In West Africa it (relapsing Ebola) is mostly undiagnosed,
hardly treated and people are certainly dying of it."
Confirmation of such relapses would prolong for a third year the
struggle to defeat a virus that has killed nearly 11,300 people and
ravaged the economies of some of the world's poorest countries.
Guinea is the only nation in West Africa that still has new
confirmed cases. Liberia has been declared Ebola-free while Sierra
Leone has gone 25 days without a case. But Ebola survivors continue
to die under mysterious circumstances, health officials say.
Doctors at Freetown's 34 Military Hospital said they had seen two
Ebola survivors return for treatment weeks after being discharged
complaining of respiratory problems, including one this month. Both
later died.
Officials at King's Sierra Leone Partnership also confirmed one
possible relapse case in a patient with a weakened immune system in
Freetown a week after recovery. Sierra Leone's National Ebola
Response Center said further research on such "anomalies" is
underway.
The findings may deepen the suffering of survivors, who are already
fighting against stigma.
"Until there is a conclusive study, we can never be sure about this.
And to be safe we must isolate them," said Freetown resident Alagie
Kamara.
SURVIVOR TRAUMA
Brima Amidu, a student who survived Ebola, said his landlord has
doubled his rent, in a move he believes is intended to drive him
out.
"They (Western medics) treated us and if this happens to them what
does it mean for us?" he said, referring to Cafferkey's relapse ten
months after recovery.
Survivor Philip Koroma said counseling with a Christian group had
helped him cope with ostracization. But one fellow survivor, Fatmata
Conteh, was detained by police after she stoned a neighbor for
calling her names, he said.
"All this is trauma. If they don't find a way to solve the problem,
people could die of it," said Koroma.
There are signs that stigmatization is increasing amid evidence
survivors can harbor the virus in semen for at least nine months.
Liberia's last known case in June is thought to have been via sexual
transmission.
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Oretha, a prostitute in the red light district of Liberia's capital
Monrovia, said that reports of sexual transmission had left her and
other girls afraid.
"Some of our friends died. That made us be careful and use condoms.
Any man that talk 'flesh to flesh', I go from them," she said, in
the local Creole dialect.
In Sierra Leone's northern districts of Kambia and Bombali, new
cases in recent weeks were immediately blamed on survivors.
"I'm deeply concerned by this. It is important that we all put aside
fear and ignorance, and understand the facts about Ebola," said
President Ernest Bai Koroma.
PARIAH, LEPER AND OUTCAST
Derek Gatherer, a virus expert at Britain's Lancaster University who
has closely tracked Ebola, noted that "many survivors will not
recover their former lives anyway, because of the consequences of
the disease - both medical and social."
As well as stigma, many survivors complain of fatigue, joint pain
and anxiety attacks.
Some aid workers say that discussing findings on the persistence of
the Ebola virus could put survivors in danger. Armand Sprecher,
public health specialist at medical charity Medecins Sans Frontieres
(MSF), said a survivor already risked being treated "like a pariah,
leper and an outcast".
"We risk making their lives miserable if we miscommunicate the
actual risk we are dealing with here," Sprecher said.
Both Sierra Leone and Liberia are introducing programs to help
screen survivors to see if they harbor the virus. "Operation Shield"
in Sierra Leone begins regularly testing the semen of willing
survivors this month.
In Guinea, where there are three known cases, government support for
survivors is very basic.
Unlike earlier in the epidemic, Ebola victims and their contacts now
benefit from a trial vaccine.
The World Health Organization is working with governments of the
three countries to develop a survivor care plan.
"The Ebola response has already had to adapt to the extraordinary
nature of this outbreak," said Adam Kucharski, an expert on
infectious disease epidemiology at the London School of Hygiene &
Tropical Medicine.
"The possibility of transmission long after apparent recovery poses
yet another challenge."
(Additional reporting by Kieran Guilbert for the Thomson Reuters
Foundation, Saliou Samb in Conakry, James Harding Giahyue and
Alphonso Toweh in Monrovia, Kate Kelland in London and Tom Miles in
Geneva; Writing by Emma Farge; Editing by Daniel Flynn and Susan
Thomas)
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