It began in a village deep in the forests of south eastern
Nothing, it seemed, could stem the child’s fever and vomiting, and he died within days. A week later, the illness killed his three-year-old sister, then his mother, grandmother and a house guest.
The grandmother consulted a nurse before she died. Friends and family gathered for her funeral, and soon the illness was spreading to other villages and towns.
Local health officials were alarmed, but it would take nearly three months from the boy’s death in December to identify the culprit: the dreaded Ebola virus. By then, the disease had reached
In June, the international aid agency Doctors Without Borders, one of the leading responders on previous Ebola outbreaks, warned that the virus was already out of control. But the World Health Organisation disagreed. Doctors said they were told to avoid causing panic. Not until August did the WHO agree that the worst Ebola outbreak on record had become an international public health emergency.
By then, the deadly tide had reached
Ebola’s journey from the quiet
Tens of thousands more could fall ill before the outbreak is brought under control, the WHO has warned. It may already be too late to keep Ebola from becoming endemic to the region - and as of now the virus could show up anywhere in the world, when the next Thomas Eric Duncan steps off a plane.
What you need to know
Ebola is one of the deadliest known viruses, with no specific cure and mortality rates that can reach 90 per cent. Until now, it was mostly found in isolated rural communities, where it killed its victims so quickly that it didn’t have the chance to spread widely.
This outbreak is different. It struck where the difficult-to-conotrol borders of
The most recent previous Ebola outbreaks, in 2012 and early 2013, took place thousands of kilometres away, in the Democratic Republic of Congo and
Wars and consequences
Scientists believe the region’s upheavals have driven the bats from their natural habitats and closer to human settlements. When civil wars broke out in recent decades in
It was, perhaps, only a matter of time before the virus found its way onto the hands of a crawling toddler. Once the boy became ill, his bodily fluids could infect others, becoming more dangerous as his symptoms worsened. “Alarm bells might have gone off had any doctor or health official in the country ever seen a case of Ebola,” the WHO said.
But no one had - and they had neither the training nor equipment to avoid infecting themselves and other patients. Doctors, nurses and midwives began falling ill and dying.
In its early stages, Ebola’s symptoms are similar to any number of tropical diseases. When cases began to appear at the hospital in Gueckedou, the town where Emile’s grandmother went looking for help before she died, doctors suspected a more familiar culprit: cholera.
Hard to identify
The hospital ran tests on nine samples; seven came back positive for cholera, the WHO said. But these patients all had fevers, which is not generally associated with the disease. Could it be malaria? The symptoms still didn’t add up.
As the mysterious illness began popping up in more places, the local health authorities sought the help of foreign professionals, including the WHO and Doctors Without Borders.
Some began to suspect Lassa fever, a viral disease endemic to
Deeply worried, Doctors Without Borders officials forwarded the results of a medical investigation to Dr Michel Van Herp, an epidemiologist with the group and one of the world’s leading experts on hemorrhagic fevers. He suspected Ebola. At the time, there were no laboritories in
Three days later, the WHO published an official notification of a “rapidly evolving” Ebola outbreak in
By this time, the WHO said, it had already shipped supplies of personal protective equipment to
There is no Ebola vaccine to contain an outbreak. Public health officials can only isolate the victims, and then track down their contacts and monitor them for 21 days, to see whether they develop symptoms. These methods have been effective in the past. But by this time, there were hundreds of contacts to trace.
It seemed the only thing more contagious than Ebola were the rumors spread about it. The disease was invented to get the government money, the rumors went. Ebola treatment centres were death traps. Inside, you would be administered green and yellow poison and your organs would be harvested.
In some areas, frightened and angry residents attacked health workers sent to disinfect public places or search for contacts, convinced that the deadly scourge was being brought by the strangers in yellow protective suits who carried loved ones away, never to be seen again.
Doctors Without Borders had to temporarily suspend operations in some Guinean villages when hostile groups of men began blocking the way, sometimes pelting them with rocks. Last month, a team dispatched by the Guinean government to the
It soon became apparent that public messaging wasn’t helping. “Ebola is very serious, it destroys family and nation quick quick quick,” read one poster in
“That kind of message doesn't inspire patients to seek care, because it removes any hope that they might get better,” said Sean Casey of the International Medical Corps humanitarian organisation. When people did start to seek treatment, there weren't enough beds. Only a few new patients were allowed in each morning - to replace those who died in the night.
Among those turned away was a desperately ill, pregnant 19-year-old in the Liberian capital of
One of the most tragic aspects of Ebola is its ability to exploit long-cherished customs and basic human instincts: A good Samaritan’s offer to help an ailing neighbour, a parent’s urge to cradle a sick child, or the wish to give lost loved ones a dignified farewell.
Ebola victims become more infectious as the disease progresses; a corpse, still full of infected body fluids, is like a “viral bomb,” experts say.
On about May 10, a woman famous for her traditional healing powers was buried in Koindu, a
The funeral drew mourners from near and far. At least 14 women were infected, among the healer’s following, said Stephen Gire, a research scientist at
The women probably handled the body, which tradition holds must be washed before burial. But many others would have placed their hands on the body. Health authorities believe as many as 365 Ebola deaths can be traced back to that one funeral.
One of those infected showed up two weeks later at a Sierra Leone government hospital in Kenema after a bloody miscarriage. She was among the country’s first confirmed Ebola cases, but she survived.
The hospital collaborates with foreign laboratories to study Lassa fever, so doctors and nurses were alert to possible danger and avoided contaminating themselves. But they were soon overwhelmed, working round the clock to treat as many as 90 people at a time, Gire said. One after another, they too fell ill. Many died.
Among those who died was Dr Sheik Humarr Khan,
Two American missionaries who contracted the virus while working at a
To the experts at Doctors Without Borders and a few other organisations, it was clear early on that this outbreak was different. The Geneva-based group issued its first public warning on March 31, saying the "unprecedented" geographic spread was greatly complicating the response.
For months, it lobbied behind closed doors to get regional governments and international health authorities to acknowledge what seemed obvious to its experts: The outbreak was out of control and would need many more resources than they could muster on their own.
But when the organisation said as much publicly on June 23, it was criticised for doing so. "People were saying, 'Look ... you are fueling the panic. It's not good," said Brice de le Vingne, the group’s operations director. "We met resistance at many levels, including the WHO."
Others also sounded the alarm. "Members of our team from very early on were shouting from the rooftops that this was not like other outbreaks," said Gire, who worked with researchers at the Kenema hospital. "The WHO wasn't listening. They were still trying to communicate to the public that it was under control."
Officials at WHO acknowledged a difference of opinion. "I don’t think we ever said we don’t want to cause a panic, but I don’t think we agreed that things were out of control, either," said Daniel Epstein, a spokesman.
It would be another month before the caseload started to climb exponentially, he said. By then, the virus was racing through
Bodies in the streets
Airlines and transportation companies refused to service the affected countries, making it increasingly difficult to bring in supplies and personnel. Bodies were left in the streets for days because there weren’t enough teams in biohazard suits to collect them. Soon people would be buying forged death certificates in a bid to get loved ones a "decent" burial.
In the midst of the chaos, a Liberian Ministry of Finance official with
As the caseload continued to grow, Dr Margaret Chan, the WHO’s director-general, convened an emergency committee of experts, which on August 8 declared the outbreak a public health emergency of international concern, finally triggering a worldwide hunt for resources.
The next month, the UN Security Council unanimously approved a resolution declaring Ebola a threat to international peace and security, and calling on member states to urgently send help. But it was late. "The disease got out of hand, and everyone came in after that," said
The countries' leaders resorted to increasingly desperate measures, putting entire districts under quarantine. Clashes erupted when Liberian security forces sealed off a sprawling seaside slum in
The move, which was imposed against the advice of the WHO and Doctors Without Borders, fueled a pervasive mistrust of government structures and helped drive Ebola further underground.
"People will say, 'It's typhoid," said Bishop Amos Sesay, who is part of a team that traces the contacts of Ebola victims in the Paynesville neighbourhood, outside
If relatives of Marthalene Williams hadn't insisted that she had malaria, their Paynesville neighbor, Thomas Eric Duncan, might not have helped carry her into a taxi or accompanied them as they searched the capital for a hospital or clinic that would take her.
Four days later, on the afternoon of September 19,
It’s not known whether
Killer in the home
From there, he got a ride in a private car to the northeast
Troh, who is a
Jallah, who also works in a nursing home, lives in a nearby flat complex. She brought her children over one night when she and her husband were both working. Another night, she brought
On September 25, Jallah’s mother took him to
Three days later, Jallah went over to take care of
Worried, she drove to a nearby Wal-Mart and bought him a brown comforter, which he crawled under while still wearing two shirts, shorts and socks. She thought at first that he might have malaria, or some other tropical disease, but not Ebola.
Then she took his temperature - 38 - and noticed that he was using the bathroom frequently. Most troubling of all, she had seen redness in his eyes that alarmed her. "I told him it was not right."
So she called 911. When paramedics arrived, they headed straight toward
She didn’t mention Ebola because, she said, "I wasn’t sure - I’m not a doctor."
She followed as paramedics loaded
At the hospital, the staff directed them to
"The nurse at the station said, 'You cannot go in there," Jallah recalled. "I said, 'Can I give him the blanket?' She said no."