It’s a dramatic picture — rows of empty white tents, the Ebola treatment units built just as the epidemic was waning in the Liberian capital, Monrovia. It looks so hopeful — maybe the international response is finally beginning to make a difference in an epidemic that’s sickened 19,000 people and killed at least 7,000 of them.
It’s an appealing thought.
But then reports come from Kono, the diamond mining district of next-door Sierra Leone. That’s where horrified aid workers discovered an outbreak overwhelming an under-equipped clinic, with 87 dead in the space of a few weeks.
Dr. Dan Kelly, a founder of the nonprofit Wellbody Alliance who’s been working in Sierra Leone since the epidemic began, came back after a break in November to find chaos.
“Nurses were too scared to go into the holding area,” Kelly told NBC News. “They were throwing water at the patients, sliding food across the floor to the patients. There was no place to decontaminate. There were all these dangerous activities happening.”
“Nurses were too scared to go into the holding area."
Kelly and colleagues alerted the World Health Organization, U.S. Centers for Disease Control and Prevention, and the British military, which has taken responsibility to help in Sierra Leone like the U.S. military has for Liberia.
The International Committee for the Red Cross sent ambulances, and people piled in to get out of there. “I was begging people to calm down,” Kelly said. He was trying to pull healthier people out of ambulances holding confirmed Ebola patients when one man started arguing with him. “He said, ‘I know if I come down from the ambulance you are going to send me into a holding center and I would rather sit next to a positive Ebola patient than go back into that place,’” Kelly said.
“He and two other patients decided to stay in the ambulance and off they went. It was bad. It’s better now.”
And so it is, but that outbreak is a reminder of just how fragile any victory is over this Ebola epidemic. The virus shifts quickly, easily steps ahead of slow-moving international aid efforts. That’s why the WHO says the epidemic won’t be under control until the middle of next year.
“I’m hopeful about stopping the epidemic, but I remain realistic that this is going to be a long, hard fight," CDC director Dr. Thomas Frieden, just back from visiting the three worst-hit countries, told reporters Monday.
Usually, Ebola outbreaks are put out quickly, after at the most a few hundred cases. This one’s so much worse that even the most optimistic aid experts say they’re on the fence about whether even controlling it by mid-summer is a realistic goal.
“If the international community continues to expand support for containment activities in West Africa, then it is possible that there will be only a small number of new cases of Ebola occurring each week by the middle of 2015. However, it appears unlikely that there will be zero new cases occurring by summer,” says Kathryn Jacobsen, an epidemiologist at George Mason University.
“I think it is entirely possible that we will have ended Ebola by next summer and it’s also entirely possible that we don’t,” adds Dr. Emmanuel d’Harcourt, senior health director for the International Rescue Committee. “It could go either way.”
In Liberia, the U.S. military rushed to build Ebola treatment units, tented clinics where the sickest could be kept away from everyone else and given the care they need. Most are standing empty now.
"We have a lot more Ebola treatment unit beds than we need at present," said Dr. Darin Portnoy, the vice president of Medecins Sans Frontiere’s (MSF) international board. “What we really need is for the international response to focus on what is going on outside the Ebola treatment units,” Portnoy told NBC News.
Outbreaks are still flaring up in rural areas, and it can take days for word to get out.
“We need rapid response teams and the capacity to go out to these areas. Some of these are very difficult to reach,” Portnoy added. “They need to go to these areas, support those affected, provide care and then help with contact tracing, with education about safe burial practices, and they need to build trust with those communities.”
It’s trust more than anything that’s needed right now, D’Harcourt argues. If people don’t trust what their governments, the WHO and aid workers are telling them about how not to spread Ebola, it will continue to spread.
"If you see a train about to hit someone, do you get the trauma unit ready or do you get them out of the way?”
“This is kind of high noon for us,” he said.
“Everybody acts as if either treatment or some new idea is going to conquer Ebola. We know how to conquer Ebola, but it’s not easy to do well.” It requires identifying and isolating patients quickly and burying bodies safely. The instinct may be to treat patients, and that’s important, he said, but that won’t affect the spread.
“Treatment has its role but it’s not the heart of the matter,” D’Harcourt said. “My choice would always be to prevent. If you see a train about to hit someone, do you get the trauma unit ready or do you get them out of the way?”
Each flare-up is a chance for the epidemic to take hold again, until everyone in the region knows how to prevent Ebola’s spread, the experts all agree. “As long as Ebola is occurring anywhere in the region, these flare-ups may continue to occur,’ Jacobsen said.
“It is very, very, very possible not to get Ebola,” said D’Harcourt. That’s where efforts will really matter, he said.