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The Guinean health authorities announced the resurgence of Ebola less than a month after the death of the first official victim, who was a nurse from Gouécké, at the end of January.
When Ebola last appeared in Guinea in 2013, it took three times as long before “the victims who succumbed to a mysterious disease in Guinée Forestière” – as reported by the local press at the time – were actually identified as victims of the haemorrhagic fever.
At the time, the samples had been sent to the Pasteur Institutes in Dakar and Lyon for analysis. This time, the tests took place on the spot.
The Agence Nationale de Sécurité Sanitaire (ANSS) – headed by doctor Sakoba Keïta, who was the national coordinator for the fight against Ebola from 2014 to 2016 – quickly came together with support from health minister Rémy Lamah, already at the helm during the first epidemic. A joint mission was then deployed to Nzérékoré, the capital of the south-eastern region, from which the disease originated, as it did in December 2013.
Identifying the chain of contamination
Among the list of priorities was establishing the chain of contamination, since the disease had resulted in the deaths of five out of the nine identified cases as of 16 February.
Could the nurse from Gouécké be patient zero? Even if this first recorded victim developed symptoms after the hospitalisation of her mother-in-law, who died in January, the latter “presented very few symptoms that are typical of Ebola” says doctor Adama Kaba, regional health director of Nzérékoré, whom we contacted.
“None of the women in the village who performed the old woman’s funeral cleansing developed the disease,” he continues. “On the other hand, some of the people who attended the nurse’s funeral fell ill. For the time being, and until there is evidence to the contrary, the nurse is patient zero.”
This nurse was hospitalised in a facility in Nzérékoré, then at the indigénat, where she died. Her body was then buried in Gouécké. The challenge now is to identify and follow up on all the contact cases along this journey.
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“We have listed all the contact cases, about a hundred, 80% of which reside in the sub-prefecture of Gouécké. Their health is currently being monitored by agents. We have started raising awareness through local radio stations and have called on the ANSS and other partners who are arriving to support us in the response,” explains doctor Kaba.
Gatherings banned, markets closed and vaccines expected
A series of measures have been announced. In a statement read on the evening of 15 February on state media, President Alpha Condé banned any gatherings of more than five people in Nzérékoré. In the sub-prefecture of Gouécké, markets will also be closed for a month.
Among other provisions are the following:
- the Red Cross will now provide dignified and safe burials for suspected or confirmed cases;
- checkpoints have been set up, as well as measures to check body temperatures;
- and isolated households will receive food to limit travel.
The authorities have also said that vaccines will be made available. While a trial vaccine has been introduced thanks in part to research carried out in Guinea, the stockpile there that dates from the end of the first epidemic in 2016 has expired.
Georges Alfred Ki-Zerbo, the World Health Organisation (WHO) representative in Guinea, says that the residents of Conakry are eagerly awaiting new doses of the vaccine.
“We are in contact with the regional office in Brazzaville and the headquarters in Geneva to secure vaccines that will strengthen the response,” he said, assuring that the WHO is also fully mobilised. “The first steps have been taken to activate the emergency management system, as part of the WHO programme set up following previous Ebola epidemics in West Africa,” he continued.
Nous avons fait livrer du matériel logistique pour la mise en œuvre des directives du Gouvernement concernant la gestion de la maladie à virus Ebola. Ce matériel est composé d'EPI. Ce transport d’urgence a été facilité par le Système des Nations Unies en Guinée. pic.twitter.com/1r6iiodzyJ
— Agence Nationale de Sécurité Sanitaire (@anss_guinee) February 16, 2021
Translation : We have delivered logistical material in order to implement the government’s directives concerning the management of the Ebola virus disease. This material is composed of PPE. This emergency transport was facilitated by the United Nations system in Guinea.
Several health problems
Even though the Guinean authorities’ response to the Covid-19 pandemic proves that they have learned from the experience of the first Ebola epidemic, it is important to remain prudent, warns the WHO representative.
“Guinea is facing a very complex health situation. These new cases of Ebola come on top of the Covid-19 context, yellow fever which is raging in Koundara – near the border with Senegal – and the outbreaks of polio that are being contained through vaccination campaigns,” says Ki-Zerbo.
“There are many health problems and the health system remains fragile. We need to learn all the lessons and above all not forget the lesson about community involvement in the first infected households: we need to make sure that communities’ perceptions, their sensitivity and their approaches to solutions are taken into account.”
An inclusive approach is all the more important since, during the first Ebola epidemic, people were initially reluctant to observe certain social-distancing measures. Burial rituals, traditionally carried out by family members of the deceased, had often continued despite the dangers posed.
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