You can now read 10 articles in a month for free on BostonGlobe.com. Read as much as you want anywhere and anytime for just 99¢.

The Boston Globe

World

Experts plot how Ebola stealthily stalked Africa

A toddler’s death, weeks of confusion, a horrifying realization

Liberians read a chalkboard on the Ebola outbreak in Monrovia on Saturday. Guinea closed its borders with Sierra Leone and Liberia to try to curb the virus.

Ahmed Jallanzo/EPA

Liberians read a chalkboard on the Ebola outbreak in Monrovia on Saturday. Guinea closed its borders with Sierra Leone and Liberia to try to curb the virus.

NEW YORK — Patient zero in the Ebola outbreak, researchers suspect, was a 2-year-old boy who died Dec. 6, just a few days after falling ill in a village in Guéckédou, in southeastern Guinea. Bordering Sierra Leone and Liberia, Guéckédou is at the intersection of three nations, where the disease found an easy entry point to the region.

A week later, it killed the boy’s mother, then his 3-year-old sister, then his grandmother. All had fever, vomiting, and diarrhea, but no one knew what had sickened them.

Continue reading below

Two mourners at the grandmother’s funeral took the virus home to their village. A health worker carried it to still another, where he died, as did his doctor. They both infected relatives from other towns. By the time Ebola was recognized, in March, dozens of people had died in eight Guinean communities, and suspected cases were popping up in Liberia and Sierra Leone — three of the world’s poorest countries, recovering from years of political dysfunction and civil war.

In Guéckédou, where it all began, “the feeling was fright,” said Dr. Kalissa N’fansoumane, the hospital director. He had to persuade his employees to come to work.

On March 31, Doctors Without Borders, which has intervened in many Ebola outbreaks, called this one “unprecedented” and warned that the disease had erupted in so many locations that fighting it would be enormously difficult.

Now, with 1,779 cases, including 961 deaths and a small cluster in Nigeria, the outbreak is out of control and getting worse. Not only is it the largest ever, but it also seems likely to surpass all two dozen previous known Ebola outbreaks combined. Epidemiologists predict it will take months to control, perhaps many months, and a spokesman for the World Health Organization said thousands more health workers were needed to fight it.

Some experts warn that the outbreak could destabilize governments in the region. It is already causing widespread panic and disruption. On Saturday, Guinea announced that it had closed its borders with Sierra Leone and Liberia in a bid to halt the virus’s spread. Doctors worry that deaths from malaria, dysentery, and other diseases could shoot up as Ebola drains resources from weak health systems. Health care workers, already in short supply, have been hit hard by the outbreak: 145 have been infected, and 80 of them have died.

“Early on, there was a false sense of confidence that it was controlled . . . and then it flared up worse.”

Dr. Thomas Frieden, director of the CDC 
Quote Icon

Past Ebola outbreaks have been snuffed out, often within a few months. How, then, did this one spin so far out of control? It is partly a consequence of modernization in Africa, and perhaps a warning that future outbreaks — which are inevitable — will pose tougher challenges. Unlike most previous outbreaks, which occurred in remote, localized spots, this one began in a border region where roads have been improved and people travel a lot.

In this case, the disease was on the move before health officials even knew it had struck.

Also, this part of Africa had never seen Ebola before. Health workers did not recognize it and had neither the training nor the equipment to avoid infecting themselves or other patients. Hospitals in the region often lack running water and gloves, and they can be fertile ground for epidemics.

Public health experts acknowledge that the initial response, both locally and internationally, was inadequate.

“That’s obviously the case,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. “Look at what’s happening now.”

He added, “A couple of months ago, there was a false sense of confidence that it was controlled, a stepping back, and then it flared up worse than before.”

Health experts have grown increasingly confident in recent years that they can control Ebola, Frieden said, based on success in places like Uganda.

But those successes hinged on huge education campaigns to teach people about the disease and persuade them to go to treatment centers. Much work went into getting people to change funeral practices that involve touching corpses, which are highly infectious.

But in West Africa, Ebola was unknown. In some areas, frightened and angry people have attacked health workers and even accused them of bringing in disease.

“Early on in the outbreak, we had at least 26 villages or little towns that would not cooperate with responders in terms of letting people into the village, even,” said Gregory Hartl, a spokesman for the World Health Organization.

The outbreak has occurred in three waves: The first two were relatively small, and the third, starting about a month ago, was much larger, Hartl said. “That third wave was a clarion call,” he said.

Loading comments...

You have reached the limit of 10 free articles in a month

Stay informed with unlimited access to Boston’s trusted news source.

  • High-quality journalism from the region’s largest newsroom
  • Convenient access across all of your devices
  • Today’s Headlines daily newsletter
  • Subscriber-only access to exclusive offers, events, contests, eBooks, and more
  • Less than 25¢ a week