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First Outbreak Quashed, Ebola Reappears in Mali Outbreak In Mali Eclipses Early Success
(35 minutes later)
The West African nation of Mali, which just beat its first outbreak of Ebola, has confirmed a second one that is larger and more threatening, global health authorities said on Wednesday.The West African nation of Mali, which just beat its first outbreak of Ebola, has confirmed a second one that is larger and more threatening, global health authorities said on Wednesday.
The victim who apparently began the new outbreak was an imam who fell ill in Guinea and traveled to Mali for better treatment at a major private clinic in Bamako, the capital.The victim who apparently began the new outbreak was an imam who fell ill in Guinea and traveled to Mali for better treatment at a major private clinic in Bamako, the capital.
The new cases will add to the mounting total of Ebola victims. In its last update on Nov. 5, the World Health Organization said there had been more than 13,000 confirmed or suspected cases in West Africa since the epidemic began. Some 5,000 people have died. The new cases will add to the mounting total of Ebola victims. In its last update on Nov. 5, the World Health Organization said there had been more than 13,000 confirmed or suspected cases in West Africa since the epidemic began. Some 5,000 have died.
The imam died at the Pasteur Clinic in Bamako on Oct. 27. Because of his status, his body was washed at a large mosque and then returned to Guinea for burial after a funeral at another mosque. The imam died at the Pasteur Clinic in Bamako on Oct. 27. Because of his status, his body was washed at a large mosque and returned to Guinea for burial after a funeral at another mosque.
The Pasteur Clinic failed to diagnose Ebola as the underlying cause of the kidney failure for which it was treating the imam. Kidney failure is a possible complication of late-stage Ebola.The Pasteur Clinic failed to diagnose Ebola as the underlying cause of the kidney failure for which it was treating the imam. Kidney failure is a possible complication of late-stage Ebola.
The outbreak was only detected after a nurse at the clinic fell ill and died, and the chief W.H.O. representative in Mali heard from his counterparts in Guinea that members of the imam’s family were dying. The outbreak was detected only after a nurse at the clinic fell ill and died, and the chief W.H.O. representative in Mali heard from his counterparts in Guinea that members of the imam’s family were dying.
“It was a real failure by the clinic,” the W.H.O. representative, Dr. Ibrahima Soce Fall, said in a telephone interview.“It was a real failure by the clinic,” the W.H.O. representative, Dr. Ibrahima Soce Fall, said in a telephone interview.
Now, the clinic is closed and under quarantine — as are the mosque in Bamako, one or two other Malian clinics where the imam was treated, and the large family compound where the nurse lived. Now the clinic is closed and under quarantine — as are the mosque in Bamako, one or two other Malian clinics where the imam was treated, and the family compound where the nurse lived.
Among the patients quarantined at the clinic are 10 United Nations peacekeepers stationed in Mali who were wounded in fighting in the north.Among the patients quarantined at the clinic are 10 United Nations peacekeepers stationed in Mali who were wounded in fighting in the north.
On Wednesday evening, the Malian health authorities confirmed that one of the clinic’s doctors also had Ebola. On Wednesday evening, Malian health authorities confirmed that one of the clinic’s doctors also had Ebola.
The clinic is now surrounded by police officers. Armored vehicles from the United Nations peacekeeping mission are parked nearby. The clinic is now surrounded by police officers, with armored vehicles from the United Nations peacekeeping mission nearby.
“Most nurses and doctors had gone home when the clinic was quarantined, and I fear the patients will be left without proper care,” said Dramane Maiga, the clinic’s director.“Most nurses and doctors had gone home when the clinic was quarantined, and I fear the patients will be left without proper care,” said Dramane Maiga, the clinic’s director.
Health experts are trying to trace everyone with whom the imam, the nurse and others with suspected cases of Ebola came into contact.Health experts are trying to trace everyone with whom the imam, the nurse and others with suspected cases of Ebola came into contact.
The task will be complex, because the imam fell ill nearly a month ago, on Oct. 17, in Kourémalé, a town that straddles the Guinea-Mali border. The consequences for Mali were not recognized until Nov. 10, when doctors ordered an Ebola test on the dying Bamako nurse. The task will be complex because the imam fell ill nearly a month ago, on Oct. 17, in Kourémalé, a town that straddles the Guinea-Mali border. The consequences for Mali were not recognized until Nov. 10, when doctors ordered an Ebola test on the dying Bamako nurse.
So far, 28 staff members at the Pasteur Clinic, which is not related to the Pasteur Institute in France or any of its African offshoots, have been quarantined, as have 50 people who had contact with the nurse. So far, 28 workers at the Pasteur Clinic, which is not related to France’s Pasteur Institute or its African offshoots, have been quarantined, as have 50 people who had contact with the nurse.
A friend who visited the imam at the clinic has died of unknown causes and is considered a suspected case, although no blood samples are available to test, the W.H.O. said. A friend who visited the imam at the clinic has died of unknown causes and is a suspected case, although no blood samples are available to test, the W.H.O. said.
“We’re still working on the contact tracing,” Dr. Fall said. It is not yet clear how many people may have been exposed to the virus. “We’re still working on the contact tracing,” Dr. Fall said. It is not yet clear how many people may have been exposed.
The mosque connection is worrisome, Dr. Fall added, because it is unclear how many people touched the imam’s body. No one has fallen ill there so far.The mosque connection is worrisome, Dr. Fall added, because it is unclear how many people touched the imam’s body. No one has fallen ill there so far.
The imam traveled in a private car, not on public transportation, and at least four members of his family who were in the car are now ill or dead in Guinea.The imam traveled in a private car, not on public transportation, and at least four members of his family who were in the car are now ill or dead in Guinea.
His first wife has died, as has his daughter. The daughter died on Monday, and Ebola was suspected, but the family declined offers of a safe burial. The imam’s brother, second wife and son are ill and in Ebola treatment centers.
Teams including advisers from the W.H.O. and other health agencies are working at the clinic, the mosque and the border.Teams including advisers from the W.H.O. and other health agencies are working at the clinic, the mosque and the border.
The Malian authorities have not closed the border, which is considered impractical. It is 500 miles long and crossed by many gravel roads. Also, in a holdover from the divisions of French colonialism, it separates many extended families who are used to traveling back and forth. The Malian authorities have not closed the border, which is 500 miles long and crossed by many gravel roads. Also, in a holdover from the divisions of French colonialism, it separates many extended families who are used to traveling back and forth.
In addition, Mali has a longstanding tradition of welcoming both strangers and those with clan connections — a principle known as diatiguiya (pronounced JAH-tih-GEE). In addition, Mali has a tradition of welcoming both strangers and those with clan connections.
The new outbreak is frustrating for the health authorities because they were feeling triumphant about their containment of the country’s first case: a 2-year-old Guinean girl, Fanta Condé, who died in the town of Kayes in northwestern Mali on Oct. 24.The new outbreak is frustrating for the health authorities because they were feeling triumphant about their containment of the country’s first case: a 2-year-old Guinean girl, Fanta Condé, who died in the town of Kayes in northwestern Mali on Oct. 24.
The authorities had quarantined 108 people who were briefly in contact with Fanta on buses from Guinea, at a family compound in Bamako and at the hospital in Kayes where she died. None had fallen ill, not even the three relatives who took her to Mali from Guinea on Oct. 19, and all 108 were to be released from quarantine by Friday. When the new, unrelated cluster was first suspected on Monday, Dr. Rana Hajjeh, who directed the Centers for Disease Control and Prevention team in Mali that worked on the first case, described it as “Murphy’s Law” — the principle that anything that can go wrong will go wrong, at the worst possible time.
When the new, unrelated cluster was first suspected on Monday, Dr. Rana Hajjeh, who directed the Centers for Disease Control and Prevention team in Mali that worked on the Fanta Condé case, mentioned it in an email and described it as “Murphy’s Law” — the tongue-in-cheek principle that anything that can go wrong will go wrong, and at the worst possible time.