MARSEILLE — Guinea, Sierra Leone and Liberia, the three West African countries hardest hit by the Ebola outbreak, are considered vulnerable to another contagious disease, cholera, especially during the rainy season, which lasts through November.

The last serious cholera epidemic, in 2012, seems to have been spread by the travels of fishermen along the coasts of these countries. It affected 30,000 and killed 400 in Guinea and Sierra Leone.

In fact, cholera is not always present on these countries. Since 2012, the situation stabilized and no epidemic has been registered so far this year.

But what would happen if cholera were to return in an area already affected by the Ebola virus? Cholera can be transmitted by body fluids. It can also infect the immediate surroundings of a patient and, at a greater distance, contaminate water sources, making it possible to simultaneously infect a large number of people.

In 2010, the contamination of one river in Haiti was the origin of a huge epidemic that infected more than 700,000 people, killing 8,500.

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Victims of the 2010 cholera epidemic in Haiti — Photo: Marcello Casal Jr/ABr

In case of an epidemic, the first thing to manage is the flood of patients. Diarrheas and vomiting lead to dehydration, which in its more severe forms can end in the patient’s death. Each Cholera Treatment Center with a few dozens beds requires several hundred nursing staff and various personnel working directly with the patients.

Where would we be able to find these workers in countries from which, for fear of Ebola, health personnel have fled? And how could we protect them from a potential contamination from an Ebola patient with diarrhea? Should they also be working dressed as spacemen?

The fight against cholera requires that meetings be organized in neighborhoods and villages to tell the populations how they can protect themselves. But how can these campaigns be set up in a context of general fear and devastating rumors, with teams working to raise awareness being beaten up by villagers convinced that they were responsible for the Ebola epidemic?

Unquestionably, the sum of the two diseases would be a catastrophe in itself, and one would think that major efforts should be underway to prevent it from happening.
Surprisingly, that is not the case. Indeed, a few hundred kilometers east of the area affected by Ebola, a cholera epidemic has begun to spread. The epicenter is located in Ghana, where the threshold of 2,000 cases per week has been reached. From Ghana to Liberia, there’s only Ivory Coast to cross. It’s very little, especially when we think about the porous borders and the importance of human travels in this part of Africa.

We have no idea how to put an end to the Ebola epidemic, and how many lives it will claim. We should at least try to prevent another disaster by intervening urgently to bring the expansion of cholera in neighboring countries under control.

*Renaud Piarroux is a professor and tropical medicine specialist in Marseille.