Traditional methods of fighting disease are not working in West Africa

The Ebola outbreak in West Africa, which continues to ravage countries like Liberia, Sierra Leone and Guinea, has so far proved resistant to traditional methods of combating epidemics, notably contact tracing.

LOS ANGELES, CA (Catholic Online) - Lt. Rebecca Levine, an officer with the U.S. Public Health Service, has seen that contact tracing, a process which helped stop diseases such as SARS and smallpox, does not seem to be working in West Africa.

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Contact tracing is a relatively simple procedure; find everyone who has had close contact with an infected individual and track them for 21 days. If any of these contacts become infected, isolate them from the community and repeat the process.

However, this method only works if a list of contacts and their addresses are provided, when Levine arrived to help fight the disease at Sierra Leone, she found that the database she was to work with was "in shambles."

In all, only 20%-30% of all contacts had a usable address, which meant that local contact tracers would have a nearly impossible task before them.

"They were really unfamiliar with what contact tracing was," she said. "And they didn't have the resources they needed."

The United Nations has reported that only 16 of 44 zones in West Africa have sufficient contacts tracing-and this inability to perform the common method is a major reason that the Ebola outbreak continues to grow.

"There's a lot of infection out there. Contact tracing breaks down. Then you have a real problem." said Dr. Bruce Aylward, assistant director-general of the World Health Organization WHO.

Donald Thea, an infectious disease epidemiologist at the Boston University School of Public Health, who has worked in Africa for more than 25 years is not surprised that contact tracing is failing.

During his time in Africa he found that many people have no addresses, move a lot, and take their doors and locks to save money, so many streets end up with undecipherable addresses.

Locals are also uncooperative and distrust health care workers, often reacting violently when they come around to collect infected loved ones.

"The community perceives this as a death sentence," he said. "Relinquishing your loved one is tantamount to death."

And health care workers have very little to offer people as an incentive to cooperate.
"With smallpox, we could offer people a vaccine, a carrot in essence to induce them to be cooperative. With Ebola, we have nothing," Thea said.

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