Patient Zero: Ebola breakout traced to two-year-old African

Patient Zero in the Ebola outbreak, researchers suspect, was a 2-year-old boy who died on December 6, just a few days after falling ill in a village in Gueckedou, in southeastern Guinea. Bordering Sierra Leone and Liberia, Gueckedou 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 diarrhoea, but no one knew what had sickened them.

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 recognised 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.

In Gueckedou, 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. 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 Organisation (WHO) said thousands more health workers were needed to fight it. Health care workers have been hit hard by the outbreak: 145 have been infected, and 80 of them have died.

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 modernisation in Africa, and perhaps a warning that future outbreaks — which are inevitable — will pose tougher challenges. Unlike most previous outbreaks, which occurred in remote, localised spots, this one began in a border region where roads have been improved and people travel a lot.

Also, this part of Africa had never seen Ebola before. Health workers did not recognise it and had neither the training nor the equipment to avoid infecting themselves or other patients. Public health experts acknowledge that the initial response, both locally and internationally, was inadequate.

As is often the case in Ebola outbreaks, no one knows how the first person got the disease. A research team that studied the Guinea outbreak traced the disease back to the 2-year-old who died in Gueckedou. He and his relatives were never tested to confirm Ebola, but their symptoms matched it.

But no one can explain how such a small child could have become the first person infected. Sylvain Baize, part of the team that studied the Guinea outbreak, said there might have been an earlier case that went undiscovered. “We suppose that the first case was infected following contact with bats,” he said. “Maybe, but we are not sure.”