Aquarius Population Health

On 7 November, the WHO announced that Sierra Leone was officially ‘Ebola-free’. Guinea will not be so lucky.  As of today, it is now a certainty that Guinea’s fight against Ebola will continue into its third year.

This is because of the way the WHO decides that a country is Ebola-free.  The international health body’s policy is to count 42 days – twice the maximum incubation period of the virus – from when the last patient to receive treatment is confirmed either Ebola-negative or safely buried.  There was still one patient being treated for Ebola as of 11 November, and even if that patient were confirmed negative, adding 42 days takes us to 24 December 2015, exactly 2 years since the beginning of the outbreak.

While we don’t know when exactly Emile Ouamouno, the index case in this Ebola epidemic, acquired the deadly virus, the 24th of December is the last possible date that he could have been infected (the minimum incubation period of Ebola is 2 days between infection and showing symptoms).  In other words, by Christmas Eve 2013, it was all but certain that Emile had already been infected by the Ebola virus.  As a consequence, it is now equally certain that Guinea’s Ebola outbreak will continue into its third year.


Emile was two years-old when he developed a fever and vomiting on Boxing Day, 2013.  He died three days later, and has been identified as the first known case of Ebola in the region.  His sister and mother also subsequently developed Ebola and died.  It has been widely reported that Emile was born in Gueckedou, Guinea.  His birth country now faces the stark reality of being both the initial crucible for the outbreak and the only remaining country still battling the deadly virus.

Over the weekend, Sierra Leone’s residents spilled onto the streets in the first publicly sanctioned street party for a year and a half.  Earlier in the year, on 3 September, Liberia was declared free of Ebola virus transmission as well.  Liberia will also end its 90-day, ‘heightened surveillance’ period on 2 December.

This leaves Guinea alone in West Africa, fighting Ebola, and donor and media fatigue as well.  The cases that are still occurring are no less heart-breaking than they were nearly two years ago; they are, perhaps, more so, given these patients are the ones who would have been saved had local governments more quickly admitted to the outbreak, and had the international community more quickly coordinated their response.  Because this did not happen, Guinea still has many Ebola cases and many high-risk contacts being followed-up.

One such case occurred last week.  A 25-year-old Ebola-positive mother died after giving birth to her baby, who was also Ebola-positive.  The new-born was, at the latest WHO update, still fighting for life in an Ebola Treatment Centre (ETC) in Conakry, but the outcome for Ebola-positive babies is almost always death.  Babies under one with Ebola die 9 times out of 10, and new-borns born to Ebola positive mothers die in nearly 10 out of 10 cases, or nearly 100% of the time.   The young Guinean mother’s two other children are also Ebola-positive, and receiving treatment in an ETC.

Quite apart from any personal family tragedies is the logistical work that is still being done in Guinea.  There are still 382 contacts being traced throughout the country.  These are people who have had contact with an Ebola case.  Of these contacts, the WHO identifies 141 people as high-risk –close family members who provided care for, or shared meals with, a person subsequently diagnosed with Ebola.  For Guinea to be declared free of Ebola like its two southern neighbours, all current patients would have to be declared Ebola-negative (or safely buried), and all 382 contacts being traced would have to be followed for 21 days, without a single case reported.  In other words, the 42-day clock starts after the last case in Guinea is treated.   If a single Ebola case is confirmed – from the list of contacts, or from elsewhere – the clock restarts at zero.

Guinean frontline workers are fighting a deadly disease in an emergency outbreak situation for the 22nd month in a row – and that fight is now set to continue into its third year.  Saturday’s news is wonderful for the residents of Sierra Leone.  And the country’s President, Ernest Bai Koroma says he will announce two public holidays to celebrate – and commemorate – the end of the epidemic and the national and international efforts that led to this day.

However, while Sierra Leone is deservedly celebrating their all-clear from the WHO, spare a thought for the Guinean people who will still be battling Ebola two years on from the beginning of the outbreak, alone and at ground zero of this world-changing epidemic.

In total, there have been over 28,000 cases, and over 11,000 deaths, from Ebola in Guinea, Sierra Leone, and Liberia.

Rebecca Glover, Research Associate