The Washington PostDemocracy Dies in Darkness

The real worry isn’t Ebola in New York. It’s Ebola in Mali.

(Laris Karklis / The Washington Post)
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Despite the panic over a doctor with Ebola in New York City, a case half the world away may be more dangerous in the long run. On Thursday, Mali's health minister confirmed that the country has its first confirmed Ebola case: A 2-year-old girl in the western Kayes region who had recently traveled to neighboring Guinea. The toddler is now reported to have died from the disease.

While the diagnosis of Craig Spencer, a doctor who had treated Ebola patients in Guinea, dominated headlines in the U.S., the fight against Ebola in West Africa is already stretched, and opening another front in Mali could be a big problem. "On a global scale, this case in Mali is a much more strategic advantage that the virus got," Amesh A. Adalja of the Infectious Diseases Society of America said in an interview.

The hope, of course, is that this single case won't turn into an outbreak. Senegal, a nearby West African nation, had its first confirmed Ebola case in late August, but officially declared free of Ebola on Oct. 17. The Sengalese government had tracked 74 close contacts of the patient, and none had shown any sign of the disease, and the World Health Organization praised it as "a good example of what to do when faced with an imported case of Ebola."

Meanwhile in Nigeria, a single contagious Ebola patient managed to infect a further 19 people. The country was able to isolate these people and treat them before the disease spread. While eight died, the virus was ultimately contained, and WHO declared the country Ebola free on Oct. 20. Nigeria won considerable praise for its response to Ebola. “Nigeria acted quickly and early and on a large scale,” John Vertefeuille, from the U.S. Centers for Disease Control and Prevention (CDC), told AFP this week. “They acted aggressively, especially in terms of contact-tracing.”

These cases are encouraging, because they seem to show that that Ebola can be contained. Nigeria in particular, shows how a well-functioning health care system can be used to track and isolate a number of Ebola cases (existing infrastructure in place used to monitor for cases of polio was a particular help in the country). For a wealthy country like the United States, it's a good sign, and the circumstances of the New York case are also in Americans' favor: Just three people have been entered into quarantine, and none are showing symptoms. The worst-case scenario would likely be that one of these people has Ebola.

In Mali, however, things might not be so simple. It's worth remembering that a study in the New England Journal of Medicine identified the Ebola outbreak's ground zero patient as another 2-year-old, this time in Guinea. This child died on Dec. 6, 2013, but not before passing on the infection to his mother, sister and grandmother. At the time of writing there have been more than 1,500 cases in Guinea alone.

The ground zero case in Guinea, of course, came before Ebola panic and the associated safety precautions were set up, but it should still cause concern. Infants and toddlers may be particularly prone to spreading the disease due to their need for close care (in contrast, Senegal's only Ebola case, who managed to infect no one else, was a 21-year-old man). Worse still, the baby girl in Mali is reported to have been bleeding from her nose while she traveled from Guinea on a bus that stopped in several towns in Mali. WHO is now warning that a large number of people may have been exposed to the girl while she was infectious.

Finding and containing these people may not be a simple task. Like Liberia, Guinea and Sierra Leone, Mali is poor, with a low GDP per capita and a weak health care system. Speaking of the region's capacity to handle new Ebola cases, Adalja said: "These countries are really fragile and can’t absorb these types of cases without causing a lot of calamity to their systems."

Mali has also suffered from serious security problems, and since 2012 the central government has battled an Islamist insurgency in the North of the country. "Access to health care is still a critical issue for people in the north of Mali," Christoph Luedi, head of the Red Cross delegation in Mali, said in November 2013. "Conflict continues to have an effect on the functioning of health facilities, which struggle mightily to meet people's needs without outside support."

WHO is now sending a group of experts to Mali to bolster a team of three workers, a representative told The Post. So far, 43 contacts of the infected infant have been isolated, including 10 health-care workers in Kayes. With the aid of international experts, Mali had been preparing for an outbreak in recent months, training staff and readying special facilities. It may well need more help, however. On Oct. 10, Markatie Daou, a Mali health ministry spokesman, told Bloomberg that his ministry had received $672,000 to prepare for Ebola, but added that it wasn't nearly enough.

Ebola cases in New York and Dallas are understandably scary for Americans, but the American health-care system is well-equipped to fight it. Ultimately, it's the case in Mali that should be watched closely: Ebola simply can't be beaten until the outbreaks in West Africa are contained.

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