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.

• published: 10 Sep 2014
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