Skip to main content

Ebola contacts in Africa go missing

By Elizabeth Cohen, Senior Medical Correspondent
August 25, 2014 -- Updated 2151 GMT (0551 HKT)
  • Preliminary data shows health officials are missing 40 to 60% of contacts for Ebola patients
  • Many Ebola patients don't want to name names out of fear
  • Just one contract left un-traced could start new line of Ebola transmission

(CNN) -- Earlier this summer, Kelsey Mirkovic, a disease detective with the Centers for Disease Control and Prevention, entered a hut with her team in Gueckedou, Guinea, to speak with a man who had Ebola.

Their mission: to get the names of everyone he'd had contact with while he was ill, so that they could stop those people from spreading the disease.

"Who lives with you here? Who has eaten off the same plate as you? Who has bathed you and taken care of you?" they asked him.

Just his wife, the man answered.

Mirkovic and her team knew that wasn't true.

Life in Liberia during the Ebola outbreak
Is there a cure for Ebola?
Liberian Ebola quarantine spawns chaos
Patients arriving at largest Ebola clinic

They knew he had children, and they knew that in West Africa, families and even neighbors eat off the same plate and bathe and care for sick people. They explained to the man how important it was to stop Ebola, and that his friends and family would be treated with respect.

Their pleas didn't work.

Mirkovic saw this scene play out over and over again. One of her colleagues at the CDC who's worked in Liberia says preliminary data shows they could be missing 40 to 60% of the contacts of known Ebola patients.

"This is one of the hardest parts of the response," said Dr. Brett Petersen, a medical officer with the CDC.

Mirkovic agrees. She says she understands why Ebola patients don't want to name names: There was a rumor going around the communities she worked in that getting on a contact list meant you would die -- and the deaths would happen in the same order as they appeared on the list.

"I understand they're scared," she said. "But it's very frustrating."

The Ebola outbreak in the West African nations of Guinea, Sierra Leone, Liberia and Nigeria has killed nearly 1,500 people. Just one contact left un-traced could go on to start a whole new line of Ebola transmission.

"It's like fighting a forest fire. If you leave behind even one burning ember, one case undetected, it could reignite the epidemic," Dr. Thomas Frieden, the director of the CDC, told reporters at a press conference earlier this summer.

"Contact tracing is a formidable challenge," said Dr. Margaret Chan, director-general of the World Health Organization. "In some areas, chains of transmission have moved underground. They are invisible. They are not being reported."

There's no solid number of how many contacts have gone missing. Petersen said the CDC arrived at the 40 to 60% number because in some communities, each sick person has only listed an average of two contacts -- and households commonly have five or six people.

Mirkovic, an officer with the CDC's epidemic intelligence service, said when she and her team felt patients weren't being honest, they would try to get information from neighbors or community leaders.

Sometimes that helped, and sometimes it didn't.

"Unfortunately, there's nothing we can do," she said. "We can't force them" to give contacts.

The World Health Organization estimates that 10% of contacts will go on to develop symptoms of Ebola. Occasionally, some of these Ebola cases go missing as well.

"Many families hide infected loved ones in their homes," according to a WHO press release issued Friday.

Mirkovic, who left Guinea in the end of July, said she felt that the situation might improve as health care workers gain more trust in the community.

But there's another problem with that: the availability of workers to follow up with contacts.

For example, in Sierra Leone, there are 2,000 contacts that need following, but the group Doctors without Borders says they've only been able to follow up with about 200 of them.

The group's teams in Sierra Leone and Liberia are "stretched to the breaking point" as the epidemic is "spiraling out of control," the group wrote in a press release.

READ: Borders closing over Ebola fears

Deadliest outbreak: What you need to know

What happens when you survive Ebola?

CNN's John Bonifield contributed to this story.

Part of complete coverage on
The largest Ebola epidemic in history began with the simple act of caring for a child. Soon, it spread from the remote village in Guinea.
November 4, 2014 -- Updated 1427 GMT (2227 HKT)
The worst-ever outbreak of Ebola virus is stretching the medical capacities of Guinea, Liberia and Sierra Leone.
October 28, 2014 -- Updated 2011 GMT (0411 HKT)
Before the deaths soared into the thousands, before the outbreak triggered global fears, Ebola struck a toddler named Emile Ouamouno.
October 13, 2014 -- Updated 1151 GMT (1951 HKT)
What happens when you get Ebola? CNN's Miguel Marquez explains.
October 25, 2014 -- Updated 1952 GMT (0352 HKT)
Health experts are fast-tracking tests for various vaccines, and hope to have millions of experimental doses by next year.
September 30, 2014 -- Updated 2354 GMT (0754 HKT)
Ebola is a scary infectious disease but the first thing you should know is that it's not very contagious. Here is how it spreads.
October 20, 2014 -- Updated 1646 GMT (0046 HKT)
These questions and answers will give you the latest information on the deadly virus and what's being done to stop its spread.
October 21, 2014 -- Updated 1532 GMT (2332 HKT)
Up to three Ebola-infected travelers might board an international flight each month in West Africa, according to a new study, and potentially spread the deadly virus.
October 21, 2014 -- Updated 0145 GMT (0945 HKT)
There's no cure for Ebola. So why have some patients walked away healthy while others in the West died?
October 20, 2014 -- Updated 1025 GMT (1825 HKT)
A doctor at a government-run Ebola treatment center in Monrovia is too busy to mince words.
October 20, 2014 -- Updated 1133 GMT (1933 HKT)
Two children orphaned by Ebola play in the empty corner of a Liberian orphanage. Their parents died last month, and none of the extended family is willing to claim them.
October 14, 2014 -- Updated 1655 GMT (0055 HKT)
Public health experts are asking whether the CDC is partly to blame for problems with Ebola in the U.S. Here are 5 things they say the CDC is getting wrong.
October 18, 2014 -- Updated 1959 GMT (0359 HKT)
The lack of solid protocol on what to do with Ebola victims' pets and what little is known about the risk has caused one dog to be euthanized and another quarantined.
October 14, 2014 -- Updated 0558 GMT (1358 HKT)
Rosie Tomkins takes a look at the protective suits that are worn by some Ebola medical workers in Africa.
October 13, 2014 -- Updated 1252 GMT (2052 HKT)
What's the protocol for health care workers if they suspect a patient has the virus
December 21, 2014 -- Updated 2226 GMT (0626 HKT)
Click through our gallery as we track the Ebola outbreak in West Africa.
A look at CNN's complete coverage on the Ebola crisis.