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Story Publication logo December 24, 2014

Sierra Leone: On the Front Lines of Ebola's Most Pressing Mystery

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The current Ebola outbreak has been seen through the lens of terror and failure, but the untold...

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Alex Moigboi was panicking. He was preparing to enter the Ebola ward wearing just a pair of gloves and a plastic gown over his scrubs. It was totally inadequate—like a firefighter entering a burning building wearing a pair of Ray-Bans—and Alex knew it. But he couldn't find the rest of the protective gear he needed: goggles, a Tyvek waterproof suit.

Alex was angry, crying, desperate. But his patients, piled three to a bed in the ward, needed him. He steeled himself to go inside. Alex later became one of dozens of health workers who died from Ebola here at Kenema Government Hospital this summer.

But others who entered the wards lived.

Mohammed Sankoh Yillah, an outreach worker, spent days in the Ebola ward caring for his sister, nurse Mbalu Fonnie. After Fonnie died in July, Yillah tested positive for the virus. He was transported to another hospital for treatment, but asked to come back to Kenema to die.

His wish was granted; he came back.

But Yillah survived.

Today Yillah sits with four colleagues in an office, discussing a new research project. The study is collecting information about survivors like him. The hope is that the study might help explain why he and others beat Ebola, while their friends and colleagues—Alex, Mbalu—did not.

Epidemiologist Lina Moses runs the meeting. Her colleagues back at Tulane University, she says, hope to analyze blood samples from survivors; she collected 29 such samples here in November. "What they want to know in the laboratory," she says, "is what kind of antibodies Mohammed Yillah has that helped him to survive Ebola."

A lot of people want to know the answer to that question; scientists only have hints about why some live while others don't. They know, for instance, that the body's first-responder immune cells seem to malfunction in those who don't make it, triggering a massive internal overreaction to the virus. These patients suffer from fever, dehydration, organ failure and, finally, death.

But in those who survive, the first-responder cells manage to enlist the "adaptive" immune response that makes cells and proteins to attack specific viruses. Those who survive make antibodies to the virus—proteins tailor-made to recognize and destroy Ebola itself.

Survivors like Yillah can make Ebola antibodies for years after they recover, and are therefore thought to be immune to the virus. That's why they're being deployed all around the Ebola response; Yillah himself cares for children who are suspected of having the disease.

His antibodies also might, one day, help future patients. The Tulane study of survivor samples will search for antibodies that could serve as templates for better Ebola therapies and vaccines. The drugs would work like ZMapp, the experimental antibody cocktail used to treat a handful of patients in this epidemic. But ZMapp is based on antibodies made in mice; this drug would be modeled on antibodies made by human Ebola survivors.

Moses hopes to do much more with the study, if she can get the funding. There are 1,257 Ebola survivors in Sierra Leone—more in one country than have survived all previous Ebola outbreaks combined. Moses hopes to work with the survivors for years, to understand how the disease has affected them; they face discrimination, poverty and ongoing health problems.

Moses is friends with many of the survivors in Kenema; though she is based at Tulane, she manages a project here on Lassa fever—like Ebola, a hemorrhagic illness. Moses spent most of this year in Kenema, during the worst of the outbreak. Her colleagues—doctors, nurses, lab technicians—had been trained to fight Lassa. She watched them enter the Ebola wards day after day; first as caregivers, then as patients.

On the day in June that Alex prepared to go into the ward in his paltry gear, Moses saw him. She ran to her lab to collect the rest of the protective equipment he needed. As a result, Alex didn't become infected that day.

That happened later. Every day the nurses went into the wards in those early months—May, June, July—they risked their lives. Many stopped showing up. Only the most dedicated, like Alex, continued to try.

When Moses found out that Alex was infected, she hoped for the best: "You think that the really good people are going to pull through," she says.

Why that didn't happen for Alex is a question that, Moses hopes, her research will help to answer one day.

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