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Sierra Leone: How Ebola Fools Even the Experts

Experts on the ground in Sierra Leone tell how Ebola can fool people even now, a year into the worst epidemic ever.
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Everyone knew the three-year-old boy was at high risk. His mother had died from Ebola and the young children of victims are very likely to catch the virus.

So the local Sierra Leonean officials, backed up by a Centers for Disease Control and Prevention team, checked the family daily.

“We were trying to get these family members to tell us things like whether they had a headache or muscle ache,” said Beth Ervin, one of the CDC epidemiologists working in the village. She’s one of an estimated 150 Americans working for the U.S. government or nonprofit groups to help the country fight an epidemic that’s infected more than 24,000 people and killed more than 10,000 of them.

Sixteen of the Americans working in Sierra Leone are back in the U.S. this week. One, an unidentified clinician, is in critical condition at the National Institutes of Health, fighting Ebola.

Another 15 Americans working alongside the patient at the nonprofit Partners in Health are in isolation because they rushed to his aid, apparently before they knew he had Ebola, and may have been exposed. Several British and Danish volunteers were evacuated to their countries for the same reason.

CDC’s investigating just what happened. But it shows that Ebola can fool even the experts.

“She said everyone was fine."

Ebola is still spreading in Sierra Leone, despite concerted efforts. The World Health Organization reported 55 new cases last week alone. Ervin is seeing first-hand just how hard it’s going to be to eradicate.

Rule No. 1: find and isolate patients, so they cannot infect everyone else. Rule No. 2: track down every single person with whom a patient has been in contact, watch them and whisk them away to isolation and treatment the moment they show any possible symptom.

Outside Freetown, Ervin and colleagues were keeping an eye on the 10 relatives of the 32-year-old mother who died Feb. 26th, including her three-year-old son.

“I saw him Monday, Tuesday, Wednesday, Thursday,” said Ervin, a 29-year-old Tennessee native who just started full-time with CDC. “He was always in a sweatshirt and always being held. Whenever we came, he was sleeping. They would bring him out and just hold him.”

It was mostly the grandmother holding the child, she says — the mother of the young woman who died.

Beth Ervin, a CDC epidemiologist, talks with Ebola surveillance officers: Tomeh Bangura, Ebola Surveillance Officer, Chernoh Yayah Jagitay, Ebola District Surveillance Officer and Abu Bakarr Sesay, Ebola District Surveillance Officer near Freetown, Sierra Leone.
Beth Ervin, a CDC epidemiologist, talks with Ebola surveillance officers: Tomeh Bangura, Ebola Surveillance Officer, Chernoh Yayah Jagitay, Ebola District Surveillance Officer and Abu Bakarr Sesay, Ebola District Surveillance Officer near Freetown, Sierra Leone.Krystal Mason / CDC

The CDC team, working with a local officer, knew they had to keep their distance. They couldn’t touch anyone being kept in isolation. And they didn’t have the point-and-shoot thermometers that could have told them if the child or the grandmother had a fever. They could only take the grandmother’s word for it that both were healthy.

And she insisted they were.

“She said everyone was fine,” said Ervin.

The district surveillance officer wasn’t buying it.

“I look at their eyes for signs of illness and weakness; also if they appear pale or are moving slowly,” said Abu Bakarr Sesay, a medical student turned epidemiologist for Sierra Leone’s department of health.

Sesay went back on his own at 6.30 one evening. The little boy was having convulsions. He called an ambulance.

“The grandmother even insisted up until the ambulance arrived that she was okay,” Ervin said. But when she saw the ambulance was taking away her grandson, she hopped in, too. And the child’s 19-year-old older brother, who was vomiting, went also.

By the next morning, the three-year-old and his grandmother were both dead. That’s how fast Ebola can kill.

And it shows just what CDC, WHO, Doctors Without Borders and various other charities are up against.

“When people get sick, they don’t even automatically think of Ebola,” said Dr. Matt Karwowski, a pediatrician and CDC Epidemic Intelligence Service officer working in Sierra Leone’s Bombali district. There are so many other diseases that cause similar symptoms, from cholera to the ever-present malaria.

“Here in the United States…we all learn about germ theory of disease,” Karwowski told NBC News. “That is completely alien to some people in Sierra Leone. People don’t have a concept of how disease is spread.”

And they may not view a headache or muscle aches as anything serious.

“This could be coming back to fear,” Ervin says. At the height of the epidemic, she said, “People would leave their houses and never come back.” No one ever knew what happened — people were dying so fast, their deaths or burial places were never even recorded.

“That scared people. The ambulance scares people,” Ervin added. “Whenever the ambulance comes, people cluster around, everyone is asking things.”

The 19-year-old is still fighting for his life.

“Every time we saw him and talked to him, he would joke with us and say, ‘I’m fine — no problem,’” Ervin said. “He was very tired the last time we saw him and he just came out and said, ‘I’m fine’ and went back in.”

Now his 24-year-old aunt and 12-year-old sister are also infected and being treated.

Ervin agrees it’s frustrating. “All you can do is say the same thing over and over, about how this is important,” she said.

"As we get closer and closer to zero, every last contact matters.”

Karwowski says he tried to convince people that early treatment can save them, and spare their families.

“I believe that people who come to attention early truly do have better odds than ever of surviving this,” he said. “Yet at the same time, I can appreciate how terrifying it must be to admit to these symptoms, knowing that you’ll be taken away from your loved ones for at least for a period of time.”

It’s even harder to communicate across not just the cultural barriers, but the physical ones.

Karwowski has been forced to interview Ebola patients about who they may have been in contact with — speaking to them across a space guarded by two chain-link fences, as they lay in treatment units.

“You are pretty much shouting,” he said. “They are weak, they are exhausted. You can see how scared they are.” He was trying to get details from them, as he stood sweating in 100-degree heat and layers of suffocating dust.

“We had to tie up loose ends,” Kawowski said. “As we get closer and closer to zero, every last contact matters.”

Two days later, he learned, the patients to whom he’d been shouting questions had died. “It takes your breath away,” he said.