The doctors are counting days. They need 42. That many days without a new infection and they can be confident this Ebola virus outbreak – the worst the world has seen – is finally over. Only then does a new count begin, waiting for the next outbreak to strike. There is no cure.
The spread of highly contagious and deadly Ebola in the west African nations of Guinea, Sierra Leone and Liberia since March has quickly become the nightmare medical workers most fear. Initial misdiagnosis. Early reluctance by local authorities to take the threat seriously. Poor containment. Exhausted doctors and nurses falling ill. Creeping suspicion among locals about the motives of foreign medical staff. An ever-growing death toll.
The raging fevers and bleeding ears of Ebola victims touches off a kind of primal panic. Since the disease was first discovered in central Africa in 1976, and before this latest outbreak, Ebola has killed only 1590 people in 24 reported instances, according to the World Heath Organisation.
I say "only" to compare the toll from Ebola to the millions of lives lost to disease like HIV/AIDS. Malaria is thought to kill more than 2000 people worldwide each day. Dengue fever is presently rampant in Sri Lanka – accounting for 60 per cent of all cases across the globe in the past six months. In Saudi Arabia, a new respiratory illness suspected to be contracted from camels which may well be airborne has killed more than 320 people since it emerged in the past two years.
But Ebola somehow stands apart as more alarming. More than 720 people are estimated to have succumbed in this west Africa outbreak, highlighting the potential of the virus to rapidly spread. Sweat, spit or even hugging a dead loved one can pass on the infection, and about two-thirds of those who have contracted Ebola in the past few months have died. In previous outbreaks, the death rate has run closer to 90 per cent.
"It's not just the sheer number of patients, it's the many locations," explains Myrto Schaefer, head of the Australian medical unit for Medecins Sans Frontieres. Ebola has never been found before in west Africa, and previous outbreaks have typically been in rural areas. This time, the virus is in cities.
The name Patrick Sawyer became infamous last week, a Liberian man who collapsed on arrival at Lagos airport in Nigeria on July 20 after travelling via Ghana and Togo. He died seven days later with a confirmed case of Ebola.
Authorities have since evacuated the private hospital in Lagos where Sawyer had been isolated. The Nigerian health ministry has 59 people who had contact with him on a watch list – but the airline he flew with was slow providing a passenger list. So much information needs to be shared, and quickly, to contain the spread. The virus can take as long as 21 days to manifest. Men who survive the illness can transmit it in their semen weeks after recovering.
Ebola is a thoroughly modern disease that can exploit all the chaos of the interconnected world. Like SARS or the H1N1 swine flu scare in 2009, the spectre of global pandemic quickly rises. Liberia has now closed most of its official border crossings. Sierra Leone has declared a state of emergency. But sealing off an entire country is fraught. People constantly trade between the nations, which share cultural and language ties. European nations have tested people who have recently travelled from the region but all have proved negative.
The breathless media coverage about potential pandemics is regularly overblown. The WHO has warned the situation in west Africa is not out of control. Yet equally, there is great risk in not taking the threat seriously. One of the problems in this latest outbreak, which began in Guinea, is the lack of education about the virus. This has allowed conspiracy to take hold, particularly about foreign doctors.
Medical teams have been attacked, accused of "sorcery" and deliberately spreading the disease. (And when the CIA impersonates doctors in an attempt to catch Osama bin Laden, it's little wonder such rumours get around.) Decontamination teams turn up in protective suits like alien invaders, spray disinfectant, but still people die. Trust is in short supply. The need to carefully and quickly dispose of infected bodies is clashing with local burial customs, where the dead are usually held and venerated.
One local journalist told of villagers hiding patients, stoning hospitals and barricading themselves away. The consequences of this suspicion can be deadly. The WHO thought it had a measure of control in Guinea, but last week said the surge in new cases "demonstrates that undetected chains of transmission existed in the community".
But suspicion is not only in local communities. Governments don't always co-operate with each other, let alone foreign organisations eager to help in a crisis. Getting enough health workers is a massive challenge.
On the most recent figures, more than 120 new cases of Ebola have been reported in west Africa in the past week. Liberia's health minister declared "we desperately need all the help we can get". As for the doctors counting the days, they haven't even got past one.
Daniel Flitton is senior correspondent