Skip to main content

Ebola contacts in Africa go missing

By Elizabeth Cohen, Senior Medical Correspondent
updated 5:51 PM EDT, Mon August 25, 2014
  • 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
Ebola outbreak
The burial leader. The hospital gatekeeper. The disease detective. All telling powerful, stories from West Africa.
updated 2:55 PM EDT, Tue September 16, 2014
With no proven vaccine or treatment currently available, and a case fatality rate of up to 90%, alarm bells are ringing across the globe.
updated 8:53 AM EDT, Tue September 16, 2014
The Ebola virus is fast-spreading throughout the small West African country.
updated 9:23 AM EDT, Fri September 12, 2014
An inability to do complete contact tracing is a major reason that the Ebola outbreak continues to spiral out of control.
updated 9:04 PM EDT, Fri September 12, 2014
Some of the nation's top infectious disease experts worry that this deadly virus could mutate and be transmitted just by a cough or a sneeze.
updated 3:51 PM EDT, Mon September 1, 2014
At the gravesite in a northern Liberia village, there is no ceremony, no mourning, no family members, and no final goodbyes.
updated 11:18 AM EDT, Mon August 25, 2014
Hundreds of people are dead as the worst Ebola virus outbreak in history sweeps through West Africa.
updated 9:51 PM EDT, Fri August 22, 2014
Jeremy Writebol talks about his mother Nancy's miraculous recovery after being diagnosed with Ebola in Liberia.
updated 11:20 AM EDT, Mon August 25, 2014
Two American missionaries infected with Ebola were given an experimental drug. Their recoveries seem to offer hope for others.
updated 5:53 PM EDT, Mon August 25, 2014
Despite information campaigns, fear is spreading even more quickly than the virus itself.
updated 11:49 AM EDT, Wed August 13, 2014
There are nine of us from the Centers of Disease Control and Prevention in Lagos, Nigeria.
updated 3:49 PM EDT, Fri August 22, 2014
Hear one survivor's story about what it's like to get through the disease.
updated 7:22 AM EDT, Thu August 14, 2014
Questions about whether unproven treatments are appropriate to use, and who should get them, are inspiring passion and resentment.
updated 11:18 AM EDT, Mon August 11, 2014
CNN's Dr. Sanjay Gupta describes how the Ebola virus can spread and why so many people have become infected.
updated 2:37 PM EDT, Sat September 20, 2014
Click through our gallery as we track the Ebola outbreak in West Africa.
updated 10:12 AM EDT, Tue August 12, 2014
The worst outbreak of Ebola may have started with a 2-year-old patient in a village in Guinea, according to a report.