DAKAR – A top U.N. official in the fight against Ebola found just three patients at one treatment center he visited this past week in Sierra Leone. Families in Liberia are no longer required to cremate the remains of loved ones to halt the spread of the virulent disease. And in the streets of Guinea’s capital, it is rare to see the formerly ubiquitous plastic buckets of bleach and water for washing hands.
Ten months after health officials realized they were facing an unprecedented Ebola outbreak in West Africa, experts and officials agree the tide is turning, although previous lulls have proved short-lived.
There is still no vaccine or licensed treatment — nor is it clear whether the international community has actually learned any lessons from an epidemic that killed at least 8,675 people.
On Saturday, a British nurse who contracted Ebola while working in Sierra Leone — the first person to be diagnosed with Ebola on British soil — was discharged from a hospital after making a complete recovery. Pauline Cafferkey had spent three weeks in an isolation unit in London.
Previous disease outbreaks, including SARS and bird flu, prompted calls to build strong health surveillance systems and to reinforce agencies like the World Health Organization. But little has changed.
After the 2009 swine flu pandemic, WHO commissioned an independent review, which recommended creating a $100 million emergency fund for health crises and beefing up rapid-response health experts. Neither has been done.
The human toll of Ebola can be starkly seen in one plot of land in Liberia’s capital where only Ebola victims are buried now. Cards placed on sticks and stuck into the ground carry the names of those who died. Families hope they will be replaced with concrete gravestones someday.
“It will be necessary to understand whether this outbreak could have been responded to quicker with less cost and less suffering,” the U.N.’s Ebola chief, Dr. David Nabarro, told the General Assembly last week.
Julius Kamara, a father to two girls who remain home instead of going to school, said sometimes the plastic buckets in Sierra Leone’s capital for hand-washing are now empty. Restrictions on movements are being lifted, but gatherings are banned and bars and clubs are closed. “We are all looking forward to when life can get back to normal,” he said. Sierra Leone plans to reopen schools in March, following Guinea, which opened them last week. Liberia is set to reopen schools on Feb. 2.
“The epidemic has turned,” Ismael Ould Cheikh Ahmed, the new head of the U.N. Mission for Ebola Emergency Response, recently declared. The number of cases in Guinea and Sierra Leone is at its lowest since August, and in Liberia is the lowest since June.
Still, he and other officials caution that they lack critical information about the cases that do remain. Only about half of new cases in Guinea and Liberia are from known contacts.
No such statistics even exist for Sierra Leone, where deaths are still being underreported because families want to carry out burials in accordance with tradition, which involves touching bodies — one of the quickest ways to spread Ebola.
“There are still numbers of new cases that are alarming, and there are hot spots that are emerging in new places that make me believe there is still quite a lot of the disease that we’re not seeing,” said Nabarro.
Nearly every agency and government stumbled in its response to Ebola, which is now expected to cost the three most affected countries at least $1.6 billion in lost economic growth in 2015.
Brice de le Vingne, director of operations for Doctors Without Borders, said the Ebola outbreak exposed a vacuum in global health leadership.
Officials must also think about changing risky cultural practices in future epidemics, said Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine and co-discoverer of the Ebola virus. “I think we underestimate how incredibly difficult it is to change behavior,” he said.
Health officials also agree that time was wasted on nearly every aspect of the Ebola response. It took too long to build treatment centers. The countries that sent soldiers to West Africa — Britain and the U.S. — did not fully commit to the effort, said de le Vingne. Still, he is optimistic the unprecedented scale of the Ebola outbreak will prompt change, and that future outbreaks will be detected more quickly.