UN: 30 ‘Surprise Cases’ of Ebola a Week Mean Outbreak Far from Over

The United Nations special envoy for Ebola warned today that the outbreak that has taken more than 11,000 lives in Liberia, Sierra Leone, and Guinea is far from over, with 30 people a week being diagnosed with the disease on average.

The UN warned that, while the figure appears low compared to the number this time last year, the fact that most cases are people not on watch lists indicates the threat is much larger than it appears.

“Probably about one third of these people are not coming from the contact list, which means they are surprise cases, and that’s a big worry,” said David Nabarro, the UN’s special envoy for Ebola on Monday. Thirty cases a week from watch lists would be “a major, major outbreak,” he noted, but the fact that contact tracing is failing to find most of these cases indicates that hundreds more can be occurring far from the eyes of medical professionals.

The “surprise” cases indicate that efforts to track down and quarantine Ebola patients and anyone that has come into contact with them are highly unsuccessful. In Sierra Leone, where the outbreak has yet to let down since arriving in March 2014, authorities now face the challenge of tracking down every contact of a 32-year-old woman and eight-year-old child who escaped medical treatment outside of Freetown this week. While the patients have been returned to custody, authorities are struggling to find all those who came into contact with the two unrelated patients. “Our contact tracers and surveillance officers are meanwhile tracking the level of contacts the two would have made during the period of their escape,” said a spokesman for the National Ebola Response Center in the nation.

Ebola patients often flee out of fear that being taken into medical custody amounts to a death sentence. According to the district coordinator of Ebola response in Port Loko, a Sierra Leonean community, many missing cases are the product of community trust in “traditional healers,” herbalists, and witch doctors that generations of Sierra Leoneans have trusted over Western doctors. The official, Raymond Kabia, stated in an interview that outright fear of quarantine has forced medical experts to reinvent quarantine and allow patients to remain home with medical supervision. Taking a patient away before quarantining a community, he states, is a “wrong approach; we are sending the wrong signal, because people are running away from these homes before they are even quarantined.”

As Sierra Leone continues to struggle against Ebola, Liberia–recently declared Ebola-free–is working to trace a new outbreak that broke its 49-day Ebola-free streak. A 17-year-old boy was found dead of Ebola in his home, far from the borders with Guinea and Sierra Leone. Experts state, however, that genetic tests found that the virus that killed him is of the same strain as that causing the major outbreak, “consistent with this cluster representing a continuation of the ongoing Ebola outbreak in West Africa, as opposed to a separate introduction from reservoir population.” Two other members of his family have tested positive for Ebola, and contract tracing efforts are ongoing.