Nearly sixteen months after the first suspected Ebola case in Guinea, the country's president Alpha Conde has declared a state of health emergency and shut the borders with Sierra Leone, in an effort to step up the country's fight against the deadly infectious disease that continues to burn through the country.
Guinea caught the world's attention last year when it was identified as ground zero of the Ebola outbreak, which has continued into 2015 and so far claimed the lives of 10,000 people while infecting upwards of 25,000 in three of West Africa's poorest countries: Guinea, Liberia, and Sierra Leone.
While Sierra Leone and Liberia appear to have curbed the spread of Ebola, Guinea is facing issues of resistance, unsafe burials, and unknown chains of transmission, which hinder efforts to combat the deadly hemorrhagic fever. The month of March proved problematic, with the country experiencing the highest surge in cases so far this year and setting the stage for Conde's unprecedented declaration of the 45-day strengthened health emergency in the affected regions.
In the week leading up to March 15, the World Health Organization (WHO) reported 95 new confirmed cases in Guinea; the highest weekly total of confirmed Ebola cases in 2015, up from 58 confirmed cases the week prior. The WHO reported that nearly half of those confirmed cases were located in and around the capital of Conakry, and a rise in cases in the nearby prefectures of Boffa, Coyah, Dubreka, Kindia, and Forecariah.
'There is a whole chain of transmission going on that we, the people involved in the response, are not seeing.'
One of the issues perpetuating the spread of Ebola in Guinea is unsafe burials; an Ebola patient's body is at its most contagious post-mortem, and traditional burial practices contradict with the strict safety measures that constitute a safe burial with an Ebola infected patient. According to the WHO, there were 18 unsafe burials during the second week of March, with weekly rates increasing throughout March, eventually reaching a monthly total of 77.
Another driving force behind the outbreak has been unknown chains of transmission, with almost half of the total reported cases during the March transmission spike identified after the individuals had already died. Additionally, only 28 percent of the new confirmed cases stemmed from registered contacts.
"One of the real challenges for us is that too many of these cases do not come from known contacts," Dr. Margaret Harris of the World Health Organization's Director General's Office told VICE News. "This means that there is a whole chain of transmission going on that we, the people involved in the response, are not seeing and are therefore unable to look after.
"This reflects our failure to engage communities effectively." Harris explained.
The most recent figures from April indicate an increased geographic area of transmission, while two prefectures — Fria and Siguiri — reported at least one confirmed case for the first time in 50 days.
For those working to combat the disease, Guinea has been unique in that, unlike Sierra Leone and Liberia, Ebola has yet to devastate the capital city, which is home to more than one million people. Instead, the virus has smoldered in pockets of transmission all over the country, a country so vast it could easily fit both Liberia and Sierra Leone within it.
The wide geographical spread of the virus throughout the outbreak to remote and often resistant villages has created a daunting logistical challenge for those working to track and treat each case.
It was in the southeast of the country, in the rural village of Meliandou, that researchers believe a young boy, Emile Ouamouno, was the first person to come down with and consequently die from the Ebola virus, in December of 2013.
Currently there are no confirmed Ebola cases reported in Meliandou, or Gueckedou, the prefecture in which it resides.
As Conde announced on Saturday, the outbreak has since shifted to the country's coastal regions, with the exception of a newly confirmed case in Siguri, which borders Mali. Wherever the need may be, he said, measures of restriction and confinement will be taken.
The measures Conde has laid out include: the temporary closure of hospitals with confirmed Ebola cases, while ensuring the patients who remain receive care and nutrition, stricter rules surrounding burial practices, and a warning that anyone who hides the sick or moves bodies from one locality to another be prosecuted under the rule of law.
Hiding bodies, which could stem from a fear of sending a loved one away in an unknown vehicle never to be seen again, or to avoid negative attention that might include quarantine, is one way in which communities have resisted anti-Ebola campaigns. Health care workers report that this resistance is more prevalent in Guinea than in other countries. In September, eight people traveling to spread awareness about the virus in southeastern Guinea were reportedly killed with machetes and stones. And In February, the International Committee of the Red Cross (ICRC) said its workers had been attacked 10 times a month on average in the country in the last year.
While the focus has largely been on the resistance to Ebola campaigns specifically, Frederic Le Marcis, an anthropologist professor at Ecole Normale Superieure de Lyon working in Guinea with the Reaction Project funded by the EU Horizon 2020, explained that it's important to contextualize the current situation with the country's past.
"If you speak about resistance, you imply that people are just not educated, that they don't understand it is Ebola and that is not the point," Frederic Le Marcis told VICE News. "The point is that people are protecting themselves from the predation of the state."
Guinea has been plagued with decades of political instability and corruption. Le Marcis said Conde's recent plan may be effective epidemiologically, but that it reveals the limits of Conde's legitimacy.
Conde has been criticized for downplaying the severity of the disease at the beginning of the outbreak, wasting what many believe was crucial time that allowed for the virus to carry on undetected. It was not until August of 2014, after the government had already confirmed 510 Ebola cases, 377 of which were fatal, that Conde declared a national public health emergency. The number of deaths now totals 2,314 in the country.
The health emergency measures will implement strict guidelines for ending the outbreak, but a shift in cultural practices and patterns of behavior is vital in order to properly contain the disease. Engaging in and with communities all over the country, even in areas not currently struggling with Ebola, is crucial for key players involved in outbreak response efforts.
Timothy La Rose, the chief of communications for UNICEF in Guinea, stressed the importance of staying vigilant in effectively teaching people about Ebola, because all it takes is one infected person to drive or take a taxi to another part of the country to spread the virus.
"The key to ending Ebola is working with communities through community fora and initiatives led by those who are directly affected," La Rose explained.
Follow Abby Ellis on Twitter: @abbyc_ellis