MALI thought it had got off lightly. As the Ebola epidemic claimed thousands of lives across the border to the south in Guinea, Sierra Leone and Liberia, Mali recorded just a single case of the virus. It was carried by an infected two-year-old girl, who had been brought by her grandmother from Guinea, travelling 1,200km (745 miles) by bus and taxi with the feverish child. She died in hospital in the city of Kayes on October 24th (see WHO situation report here).
About one hundred people who had come into contact with the girl were traced and isolated. Three weeks later, on November 10th, the Malian authorities held a ceremony to mark the release from observation of a first batch of contacts—a group of 29 people in a family compound in the capital, Bamako, that had briefly hosted the sick child during her journey. None had developed symptoms. Ministers and officials told television reporters that vigilance was still needed, but at least the family in Bamako was free of Ebola; it seemed likely that others who had been in contact with the girl in Kayes would soon be declared Ebola-free.
Whether because they did not know, or because they did not want to say, the dignitaries said nothing about a new outbreak that was developing nearby at the country’s top private hospital, the Polyclinique Pasteur. A nurse had fallen ill with Ebola-like symptoms and had been isolated the same evening at the ceremony. He died the following night. This second outbreak is more serious. So far it has claimed several lives, involves many more contacts and raises questions about the preparedness of the Malian authorities even as foreign medical agencies rushed in to help. The nurse probably contracted the disease from an elderly imam, who had fallen ill with an undiagnosed disease in Guinea on October 17th and was brought by car to the Polyclinique Pasteur on October 25th, travelling with four other family members. A battery of tests was conducted, but not for Ebola. He died of kidney failure, a known complication of late-stage Ebola, on October 27th (see WHO situation report, here).
A friend who visited him in hospital died from an undiagnosed disease. The assumption is that both died of Ebola. Many hands then touched the body of the imam as it was released from hospital, carried to a mosque in Bamako and washed—all within walking distance of the national laboratory and the nerve centre of the Ebola response efforts—before being taken for burial in his native village of Kourémalé on the border with Guinea. Two relatives have died so far and several others are ill; a woman who washed his body also passed away, as has a member of her family.
The question for health officials is how far the disease has taken hold in Bamako, a city of 3m people, where it has incubated in recent weeks. What is the risk that Bamako might become the next Freetown or Monrovia? Weaknesses are being exposed daily in a country only recently torn by civil war. Many still don't believe that Ebola is Mali's problem. Malians still shake hands and share tea from the same cup. There is little public information available, and what there is focuses on near-certainty of death (good treatment can bring down mortality rates from 90% to 40% or less) and warnings against eating bush meat (the biggest danger is contact with infected people). At a new Ebola treatment centre, one doctor spoke about the anti-malarial and antibiotics drugs that would be available (they are no use against Ebola itself but may deal with other problems) but was vague on simple but life-saving treatment, such as intravenous fluids and oral rehydration salts.
At the mosque where the imam’s body had been washed, a team of workers in full biohazard garb were cleaning the site with chlorine bleach disinfectant on November 14th; according to a local man, it was the first time it had been cleaned. People walked in and out, and children ran about. A teenager who commanded a huge group of onlookers asked what was going on, “you think there is Ebola here?” As your correspondent drove away, a large group of little children chased after the car chanting “Ebola! Ebola!”