7 April 2015, World Health Day: Over the past few weeks there has been a moderate increase of new cases of Ebola in Guinea, Liberia and Sierra Leone. Far from the dramatic figures of late 2014, but certainly not close to the “zero cases” target that the 3 countries hoped to achieve a few weeks ago.
It is difficult to pinpoint the reasons: I just returned from Conakry, where about 57 new cases were confirmed this week (49 the past week, an increase of over 10%) and a number of other cases were under observation, and I noticed there that to some extent the preventive measures were starting to be less strict than before.
Hand washing is always compulsory in all public places, offices, schools, but it was somehow perceived as an unnecessary measure since Ebola cases were dropping. Probably households lowered their guard as well. Plan and other international agencies have been intensely disseminating preventive messages and still work on public awareness - I wonder how much prevention is really becoming a permanent habit for everyone.
New urban surge
This new moderate surge of new cases has different features: it seems to be more “urban” than before – the new cases detected in Guinea were in most part located in the surroundings of Conakry, a new case in Liberia was detected in Montserrado, not too far from Monrovia.
The modalities of infection are still the same, with unsafe burials being still one of the major causes, but there’s also an increased number of Ebola cases diagnosed post-mortem. This might possibly be due to decreased attention to the symptoms, and it has significant consequences meaning the undiagnosed bodies are buried with traditional ceremony, where possibilities of infections are extremely high.
In addition, there is evidence of at least one case of infection through sexual contacts with a survivor of Ebola. Medical evidence shows that the virus survives in body fluids for some weeks after the illness is declared healed.
Burial traditions still strong
In Guinea, unsafe burials are still being practiced. While certainly less cases have been observed and reported, it is clear that local traditions are still relatively strong, both in urban and rural settings.
The number of cases in Guinea is growing again, at a time when local authorities, international donors and agencies are looking at the recovery phase. But is the emergency really over?
On 28 March the President of Guinea Alhpa Conde declared 45 days of special increased prevention measures, including screening, road-posts to check cars - especially taxi drivers, often transporting patients and increased hygiene measure in schools and hospitals. Just a few days ago, I was travelling through Conakry, and I noticed several police cars checking drivers on the main road to the airport.
I visited Liberia about 2 weeks ago. The high hopes to reach 42 days with no new cases were dashed when a new case was identified not far from Monrovia on the 25th day. Again, urban setting, physical contacts, lower attention to prevention, and back to square one.
This is really the time where social mobilisation and preparedness for possible new cases are absolutely critical.
Rainy season fear
The rainy season is approaching: in some areas of Liberia and Guinea rains have started already, and by May heavy rains will be recorded, especially in Liberia. Roads will be flooded, it will be difficult to reach hospital and clinics, electricity will not be available for long periods, and water infrastructure - including sewage, will be disrupted. In Liberia, some of the counties where Plan is working will not be reachable by car anymore. The already weakened health systems in the affected countries will be put to further stress which they have little capacity to withstand.
This is the time for a renewed effort to prevent a new disaster: increased hygiene measures, increased screening, and increased social mobilisation are the key factors in putting forward a robust response to this new surge.