In a dusty street of the Senegalese capital Dakar, a hand emerges from behind the door of a run-down house to grab a bundle of baguettes from an aid worker as police officers watch.
Behind the door, 33 people are being kept in quarantine after a 21-year-old student from neighboring Guinea came to stay there at his uncle’s house a fortnight ago. With him, he brought the deadly Ebola virus.
The student is now in isolation in a Dakar hospital, his condition improving, according to the health ministry. So far, authorities say no other Ebola cases have been confirmed.
But Dakar, a city of 3 million people, is anxiously awaiting the end of the three-week quarantine, the incubation period of the disease, on around Sept. 20, to see if the young man’s arrival has kindled an epidemic in a fifth West African country.
Nearly 2,100 people have already died from Ebola in Guinea, Liberia, Sierra Leone and Nigeria as poorly equipped healthcare systems have struggled to cope with one of the most lethal illnesses known to man.
Containing the outbreak in Senegal, an international transport and aid hub, is critical to halt its spread. Yet the student’s case illustrates the difficulty of stopping the disease in a region where community ties reach across borders, and government resources are stretched to breaking point.
The student slipped surveillance in Guinea on Aug. 15 after his brother died of Ebola, which he contracted in Sierra Leone, and then his mother and sister fell sick.
“His uncle told him to wait but he came here from Guinea without uncle’s blessing,” a frightened girl inside the compound, who asked not to be named, told Reuters by telephone. “God willing, it’ll be the end of the isolation period soon and we’ll all come out.”
Senegal is now trying to track the student’s steps since the crossed the border and trace anyone who had contact with him. His family in the crowded Parcelles Assainies suburb of Dakar is among 67 contacts already under surveillance, according to the World Health Organization.
Those quarantined inside the house include a two-month-old baby, the young girl said. People under surveillance are being tested morning and night for fever and none have shown symptoms so far, Senegalese authorities say.
Foreign aid workers and diplomats speak mostly in positive terms of Senegal’s efforts to avert contagion. The government has allocated 300 million CFA francs ($600,000) to a national crisis team and Health Minister Awa Marie Coll Seck, spearheading the effort, is a professor of infectious diseases.
But many in the country of 13 million worry it will prove impossible to trace all the student’s contacts between evading authorities in Guinea and appearing in a Dakar hospital nearly two weeks later.
The student, who has not been named, concealed his close contact with his sick brother. Once he started showing symptoms of fever, vomiting and diarrhea, the student took a taxi to a local clinic – since shut down – where unsuspecting workers treated him for malaria.
When this treatment proved ineffective, he went to a hospital in the Fann neighborhood of Dakar, where doctors were also exposed. He was only detected after Guinea informed Senegal on Aug. 27 that an Ebola contact had disappeared after a final conversation with his dying mother.
In Dakar, some fearful residents have stopped their usual warm handshakes in the street, and try to avoid contact on packed public transport. Many now shun inhabitants of Parcelles Assainies.
“They run from us like vampires,” said Adama Kabatou, 20, who lives next door to the Guinean family. His aunt, peeling onions on a wooden bench opposite the house, said no-one buys her vegetables: “When I tell people our shop is at the Parcelles crossroads, they don’t come. It’s a ruined neighborhood.”
Harder than Nigeria
Epidemiologists say it too soon to say if Senegal will suffer an epidemic. Some look to Nigeria, where the arrival of infected Liberian American Patrick Sawyer by airplane from Liberia in July has so far resulted in 19 cases, including seven dead. Hundreds of people have been placed under surveillance.
The Guinean student’s journey to Dakar is potentially even more threatening, involving a cross-country journey of more than 1,000 km from Forecariah in southwestern Guinea, near the Sierra Leone border.
Ebola, which has proven fatal in around half the cases in the current outbreak, is spread through the body fluids of the ill. It is not clear if the student was already contagious on the road, in which case there could be many other undiscovered contacts.
“The bad news is that he was here for too many days with a high number of exposures,” said Jorge Castilla-Echenique, epidemiologist at the European Commission’s Humanitarian Aid and Civil Protection Department in Dakar.
“The good news is that in a survivor the risk [of contagion] tends to be lower than in someone who dies.”
It is not clear why the young man, a third-year student at Conakry University on his summer break, travelled to Senegal, a country his housemate said he had never previously visited.
Guinean health ministry sources say that after he left Forecariah, an “active hub” of the disease, he passed through several unaffected districts on his way to the border. In a stroke of bad luck, Senegal closed the frontier on Aug. 21, just a few days after the student crossed it.
“We’re trying to trace the student’s itinerary. We know that he left Guinea and did one stopover and changed vehicle,” Doctor Mamadou Ndiaye, director of prevention in Senegal, told Reuters.
In interviews with officials, the young man was reluctant to give them his exact itinerary and details of people he had met, said one diplomat briefed by authorities. It is not clear why the young man was unwilling to cooperate.
Ndiaye said the student travelled by ‘bush taxi’, – typically, old Peugeot 504 estate cars transporting seven passengers jammed together for hours, sweating in the heat.
An initial test of the student by Senegalese doctors came out negative, a diplomat said. But a second test, revealed to ministry officials in the early hours of Aug. 29, was positive and health minister Seck announced it that morning.
Yet even the day after the announcement, a Reuters witness at the house said there was no surveillance in place. Neighbors say a young woman slipped away under cover of darkness last week, though a police officer monitoring the site denied this.
Though his health has improved, the student still tested positive for the virus in a check up on Sept. 3 and he remains in isolation.
“People should know that if it were not for this boy’s state of health, he would be before the courts,” Senegalese President Macky Sall told state television. “You cannot be a carrier of sickness and take it to other countries.”
On the streets of Dakar, locals are angry at the student for bringing Ebola to Senegal. Some vent their frustration on the Guinean community, many of them shopkeepers like the student’s uncle, running stalls selling items like sugar and soft drinks.
“There was no Ebola in Senegal. It was a Guinean and we should have killed him,” said Talla Dieye, who runs a small coffee stand in the Parcelles neighborhood.