In late May, a woman was admitted to the Kenema Government Hospital’s maternity ward in Sierra Leone after a bloody miscarriage. Augustine Goba, director of the hospital’s diagnostic laboratory and my longtime collaborator, ran a series of sensitive molecular tests and detected the first case of Ebola infection in the hospital, and one of the first confirmed cases in the country. Dr. Sheik Humarr Khan, Sierra Leone’s leading virologist, and other medical staff members isolated the patient and wore gloves, gowns and masks while treating her. She survived and made a full recovery, and no one else was infected.
Had this patient been one of the first cases of Ebola in West Africa, the hospital’s rapid diagnosis and expert handling might have helped control the outbreak quickly. But by May, the epidemic had already been spreading for six months, with hundreds of cases in neighboring Guinea and Liberia. When the hospital’s outreach team traveled to the patient’s village, they found that 14 people had already been infected, with what turned out to be two distinct versions of the virus. With each week, the number of confirmed cases in Sierra Leone grew, to 31, then 92, then 147, until the virus emerged in nearly every district of the country.
Kenema was well positioned to detect and treat Ebola because of its experience combating another deadly virus, Lassa, a project I started working on in 2008. As the hospital’s reputation for treating Lassa fever spread, more patients with unexplained fevers began to travel there. Rapid diagnosis of more people not only helped treat individual patients, but it could also uncover other unexpected pathogens hiding in the population, thus warning of outbreaks before they became global threats. Just weeks before Ebola entered Sierra Leone, Dr. Khan and I joined colleagues from around the world in Nigeria to inaugurate the African Center of Excellence for Genomics of Infectious Disease, a new venture that would enable monitoring of dangerous microbes across West Africa.
The Ebola outbreak put our plans on hold. Soon after Dr. Khan returned to Kenema, the hospital became overwhelmed. He and the nurses were treating up to 80 patients at a time, working 16-hour days. In the United States, my colleagues and I struggled to get aid and novel treatments to them, while we worked on sequencing the virus’s genome. Help did not come in time. While drafting a paper on the viral samples from Kenema, we began receiving devastating messages. Seven members of our team had become infected with Ebola. The constant flow of severely ill patients made it impossible for hospital staff members to protect themselves. Over the next few months, around 40 contracted the disease, including Mbalu Fonnie, a head nurse, who had worked there for 25 years, and Dr. Khan. By the middle of the summer, they were both dead.
It did not have to be that way. If diagnostic facilities like those at Kenema had been more widely available, the virus could have been caught as it emerged. A team of trained individuals, perhaps 50 people, could have been sent to the site of the outbreak before it spread, and stayed for 50 days after the last infection. Working with the local community, they could have isolated and treated the sick, buried the dead, traced each person’s contacts over the incubation period, performed outreach and education services, and ensured food supplies, all while keeping themselves safe from infection. With the virus confined to one village, this large-scale 50-50 approach would have been a modest investment for the world.
Instead, the virus was allowed to escape the first village, and then to spread into four more countries. That missed opportunity has cost the lives of many people, including my good friends. Failure to contain the virus now will be cataclysmic. Based on World Health Organization numbers, more people became infected with the Ebola virus in August than in all the earlier months of this epidemic combined. The W.H.O. predicts that Ebola may afflict 20,000 people before the outbreak ends, but that is only if the world mounts a prompt and enormous response. If we fail, that number will become 40,000, then 80,000, with no end in sight. Meanwhile, the virus is evolving as it spreads from human to human, raising the risk of it becoming even more contagious.
As the virus reaches new villages and now large cities, the challenge of full-scale containment increases by orders of magnitude. We need governments and international organizations to immediately send out response teams to all sites with active cases, and to train many more people on the ground.
At the same time, we need to find creative solutions. Nigerian celebrities, through the Nollywood Workshops’ Lens on Ebola campaign, are helping to spread health information on Facebook; we need more large-scale public service campaigns like this. Our own scientific team publicly released genome sequencing data so groups around the world could use them for better diagnostics, vaccines and therapies. The National Institutes of Health, the Centers for Disease Control and Prevention and the W.H.O. are now accelerating drug candidates and vaccines to clinical trials. These organizations are also pursuing the use of the blood of Ebola survivors, which contains antibodies to the virus, to treat those afflicted.
Had Ebola not intervened, Mr. Goba and Dr. Khan would have spent this summer with me at Harvard and the Broad Institute, training in advanced molecular diagnostics for genomic surveillance. Instead, Dr. Khan is gone. Mr. Goba remains on the front line in Kenema.
We must end this outbreak, both to honor the memory of those who have died, and to aid those still in the path of the virus. And then we must make sure that it never happens again.
Pardis Sabeti, a geneticist and infectious disease researcher who is on the faculty of the Broad Institute and Harvard University.