A fifteen-year-old boy named Nathan Groote, died of Ebola in Liberia today. It’s the first Ebola death in the country since July. In addition to a tragedy for Groote and his family, this is an unfortunate sign. Ebola isn’t going anywhere. We can bolster health systems to respond to it more effectively, but the disease is not about to disappear. Liberia has been declared Ebola-free twice now, in May and in September.

It is becoming clear that “Ebola-free” is merely a temporary state, not a long-term transition.

Groote was the first diagnosed Ebola case in this new outbreak. His father and brother are currently being treated for the virus, and more than a hundred people are now being monitored for symptoms. Liberia has garnered consistent praise from global health authorities for its quick response to Ebola, and this case is no exception. Although the treatment wasn’t successful, Groote was diagnosed quickly and the people he may have infected were identified and are under monitoring.

Ebola’s persistence is deeply frustrating, and can be attributed to a range of factors, few of which are medical. One factor geography. Liberia is bordered by Sierra Leone, Guinea, and Cote d’Ivoire.  Both Sierra Leone and Guinea have dealt with Ebola outbreaks of their own; Guinea has not yet completed the 42-day outbreak-free period required to be declared free of Ebola by the WHO. No matter how well Liberia handles Ebola, it is at the mercy of its neighbors’ ability to control the virus.

Another factor is governance. Good Ebola response requires a government with the skills and the finances to support it. The West African Ebola response has been criticized for losing track of patients who were being monitored for Ebola infection. That is a governance failure; so is the movement of infected people across borders.

Medical factors do exist. We don’t actually fully understand Ebola yet. We do know the virus lingers in surviving patients’ semen, ocular fluid, breast milk and spinal fluid longer after symptoms end – for as long as months. We also know that Ebola survivors have long-term symptoms like joint pain. We don’t know what that means in terms of disease transmission. There has been at least one case of Ebola transmitted sexually by a patient who had recovered from the virus. Recovered patients may well be infecting others in ways that no one anticipated.

If “Ebola-free” is an impossible goal, health care workers and the health care system are more important than ever. They’re our front line. We need to support the structures that make identification, diagnosis, and treatment possible. That means ensuring there are well-paid, well-trained nurses, physicians, and other professionals. It means providing the supplies and equipment that health care facilities need to treat patients, from rubber gloves to laboratory chemicals. It’s not as exciting as sending in a team of virologists as an emergency response to a new virus. But it will keep us safer – from Ebola, and from any other disease that may crop up.

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