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The Ebola outbreak in West Africa involved the introduction of new forms of social and physical separation that aimed to curtail the spread of the disease People changed the ways they lived to avoid contact with those who might be sick A suite of governmental instruments was introduced, ranging from by-laws and public health campaigns to the use of specialist treatment centres and military force These events transformed social connections and affected possibilities for trust in intimate, governmental, and therapeutic relations Drawing upon fieldwork in Sierra Leone, Liberia, and Guinea, this article explores these forms of separation and social distance ethnographically, with a focus on material objects, touch, and spaces of separation In doing so, we contribute to discussions on the constitution of trust and distance within social relations, and the ways in which separation can enable certain kinds of closeness Our analysis offers insights for those seeking to understand the impact of the ongoing COVID-19 pandemic on the ways that people relate to, and care for, others © 2020 The Authors Journal of the Royal Anthropological Institute published by John Wiley & Sons Ltd on behalf of Royal Anthropological Institute

During the West African Ebola Virus Disease (EVD) epidemic from 2014 to 2016, a variety of technologies travelled considering the context of the emergency: a highly contagious fast-killing disease outbreak with no known remedy and a rapidly increasing number of cases. The Ebola-Tx clinical trial tested the efficacy of Convalescent Plasma (CP) as a treatment for EVD in Guinea. This paper is based on ethnographic research in the Ebola-Tx trial and focuses on the introduction of a mobile plasma collection centre, referred to as the ‘Plasma Mobile’, equipped with plasmapheresis and pathogen inactivation technologies, as well as how the transfer itself of this technology entailed complex effects on CP donors as trial participants (i.e. providers of the therapeutic product), directly involved staff and more broadly on the trial implementation as a whole. The transfer led to the emergence of a dimension of hope as CP donors hoped that the plasma would cure and, as providers of the therapeutic, hoped it would decrease their stigmatization and the economic impact of the disease. We conclude that, in light of the intricate effects that the transfer of such health technology can entail–in the localization to the specific context, as well as in the consequences they can have on actors involved in the implementation of such technologies–global health technologies should be put at the services of next epidemic and pandemic (preparedness) on condition that they are accompanied by an understanding of the technologies’ own cultural meanings and social understandings., Author summary The Ebola-Tx trial tested the efficacy of Convalescent Plasma (CP) as a treatment for Ebola Virus Disease (EVD) in Guinea during the 2014–2016 West African outbreak. As part of the trial, a bus equipped with plasmapheresis and pathogen inactivation technologies, referred to as the ‘Plasma Mobile’, was used to collect plasma from Ebola survivors, hence recruited as CP donors. Previous studies on clinical trials during the EVD outbreak in West Africa showed positive impact triggered by the introduction of technologies such as improvements in work conditions and care. In our ethnographic research on the Plasma Mobile as transferred technology, we show that technologies contributed to bringing less stress and mistrust in the (highly sensitive issue of the) use of blood products. The organization of the technology in the Plasma Mobile aimed at avoiding mistakes and improving staff performance. In sum, we describe the effects of technologies in staff and CP donors, including the hope for new and improved futures for donors and EVD patients. These results may shed light upon epidemic preparedness, for instance on the need for providing cultural meaning and social understandings to the transfer of technologies.

The multimammate mouse (Mastomys natalensis) is the reservoir for Lassa virus (LASV). Zoonotic transmission occurs when humans are directly or indirectly exposed to fluids of the multimammate mouse, such as urine, saliva, and blood. Housing characteristics and domestic organization affect rodent density in and around households and villages, and are likely to be a risk factor for Lassa fever in humans where the reservoir exists. We use semi-structured interviews (N = 51), a quantitative survey (N = 429), direct observations, and a rodent ecology study to provide new insights into how the organization of domestic spaces brings together humans and rodents and creates pathways for infection in rural settlements in Bo District, Sierra Leone. Rodents were frequently reported inside houses (92.4% of respondents), in which we predominantly trapped M. natalensis (57% of trapped rodents) and Rattus rattus (38% of trapped rodents). Building design and materials provide hiding and nesting places for rodents and lead to close proximity with humans. Patterns of contact are both unintentional and intentional and research participants reported high levels of contact with rodents (34.2% of respondents) and rodent fluids (52.8% of respondents). Rodents are also perceived as a serious threat to food security. These results present detailed knowledge about how humans live with and come into contact with rodents, including the LASV reservoir. Our results argue for further collaborative research in housing and environmental modification such as ceiling construction, food storage, and sanitation as prevention against zoonotic LASV transmission.

Lassa fever is a viral haemorrhagic fever caused by an arenavirus. The disease is endemic in West African countries, including Guinea. The rodents Mastomys natalensis and Mastomys erythroleucus have been identified as Lassa virus reservoirs in Guinea. In the absence of a vaccine, rodent control and human behavioural changes are the only options to prevent Lassa fever in highly endemic areas. We performed a 4 year intervention based on chemical rodent control, utilizing anticoagulant rodenticides in 3 villages and evaluating the rodent abundance before and after treatment. Three additional villages were investigated as controls. Analyses to assess the effectiveness of the intervention, bait consumption and rodent dynamics were performed. Anthropological investigations accompanied the intervention to integrate local understandings of human–rodent cohabitation and rodent control intervention. Patterns of bait consumption showed a peak at days 5–7 and no consumption at days 28–30. There was no difference between Bromadiolone and Difenacoum bait consumption. The main rodent species found in the houses was M. natalensis. The abundance of M. natalensis, as measured by the trapping success, varied between 3.6 and 16.7% before treatment and decreased significantly to 1–2% after treatment. Individuals in treated villages welcomed the intervention and trapping because mice are generally regarded as a nuisance. Immediate benefits from controlling rodents included protection of food and belongings. Before the intervention, local awareness of Lassa fever was non-existent. Despite their appreciation for the intervention, local individuals noted its limits and the need for complementary actions. Our results demonstrate that chemical treatment provides an effective tool to control local rodent populations and can serve as part of an effective, holistic approach combining rodent trapping, use of local rodenticides, environmental hygiene, house repairs and rodent-proof storage. These actions should be developed in collaboration with local stakeholders and communities., Author summary In the absence of a Lassa fever vaccine, rodent control is the primary prevention option. An effective rodent control intervention must understand human behaviour towards the rodent such as: human–rodent interactions, cohabitation, and local rodent control measures. We conducted a rodent control intervention at community level in a Lassa Virus endemic area in Upper Guinea (Guinea) accompanied by an anthropological study on people’s perceptions and recommendations on the intervention. Based on our results we seek to broaden the rodent control intervention by including environmental hygiene, house repairs and rodent-proof storage. Chemical treatment has proven effective for rodent control but other factors involved in human-rodent interactions should also be addressed. Our findings highlight the need for Lassa fever prevention and rodent control initiatives to work in collaboration with communities and undertake a holistic approach towards rodent control.

Introduction During the 2014 Ebola Virus Disease (EVD) epidemic, the Ebola-Tx trial evaluated the use of convalescent plasma (CP) in Guinea. The effectiveness of plasmapheresis trials depends on the recruitment of plasma donors. This paper describes what motivated or deterred EVD survivors to donate CP, providing insights for future plasmapheresis trials and epidemic preparedness. Methods This qualitative study, part of Ebola-Tx, researched and addressed emergent trial difficulties through interviewing, participant observation and focus group discussions. Sampling was theoretical and retroductive analysis was done in NVivo 10. Results Willingness or hesitance to participate in plasma donation depended on factors at the interface of pre-existing social dynamics; the impact of the disease and the consequent emergency response including the trial set-up. For volunteers, motivation to donate was mainly related to the feeling of social responsibility inspired by having survived EVD and to positive perceptions of plasmapheresis technology despite still unknown trial outcomes. Conversely, confidentiality concerns when volunteering due to stigmatization of survivors and perceived decrease in vital strength and in antibodies when donating, leading to fears of loss in protection against EVD, were main deterrents. The dynamic (dis)trust in Ebola Response Actors and in other survivors further determined willingness to participate and lead to the emergence/decline of rumours related to blood stealing and treatment effectiveness. Historic inter-ethnic relations in the health care setting further defined volunteering along socio-economic and ethnic lines. Finally, lack of follow-up and of dedicated care further impacted on motivation to volunteer. Conclusions Ebola-Tx was the first trial to solicit and evaluate blood-product donation as an experimental treatment on a large scale in Sub-Saharan Africa. An effective donation system requires directly engaging with emergent social barriers and providing an effective ethical response, including improved and transparent communication, effective follow-up after donation, assuring confidentiality and determining ethical incentives., Author summary During the 2014 West-African Ebola Virus Disease epidemic, the Ebola-Tx clinical trial in Guinea aimed to determine whether the administration of Ebola antibodies from the blood plasma of Ebola survivors could increase Ebola patients’ survival rate. Ebola-Tx was the first trial to solicit and evaluate blood-product donation as an experimental treatment on a large scale in Sub-Saharan Africa. In this qualitative study, part of the Ebola-Tx study, we report on factors of motivation and demotivation influencing Ebola survivors to donate their plasma. Understanding these factors is essential as the successful recruitment of this specific subgroup, providing the therapy itself, directly impacts the effectiveness of such a trial. We show that organizing an effective and ethical donation system requires directly engaging with emerging social barriers at the interface between pre-existing social dynamics, the impact of the disease, and the consequent emergency response including the trial set-up. These results provide insights that can be useful for future plasma trials but also for emergency clinical trials as part of general epidemic preparedness.

Matthias Borchert, MD MSc PhD, is a medical epidemiologist. After clinical work in Hamburg, he joined the German Volunteer Service as a District Medical Officer in rural Burkina Faso. Later, he joined the Heidelberg Department of Tropical Hygiene and Public Health, the Antwerp Institute of Tropical Medicine, the London School of Hygiene and Tropical Medicine and the Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin. He has an MSc in epidemiology and a PhD on ‘Epidemiology and Control of Marburg Haemorrhagic Fever Epidemics in Central Africa’. He teaches epidemiology, statistics, safe motherhood and control of viral hemorrhagic fevers. His research interests are safe motherhood and viral hemorrhagic fevers in sub-Saharan Africa. He has contributed five times to Ebola/Marburg outbreak response. Almudena Marí Sáez is a postdoctoral fellow at Institute of Tropical Medicine and International Health Charité - Universitätsmedizin Berlin. She is working on Lassa fever in Guinea and Sierra Leone: rodent control, and seasonality of human exposure to rodents – a project supported by a research grant from the German Research Foundation (DFG BO3790/1-1). She has been involved in Ebola response in Guinea and Liberia as anthropologist. Her previous ethnographic work focused on maternal health and local medicines in Benin and Sierra Leone. Thomas Kratz, MD, undertook medical studies in Marburg/Germany and Strasburg (France) in order to obtain his medical degree in 2003. He worked as an assistant doctor in Strasburg and several hospitals in Germany with obtaining the specialization of a GP in 2014. Since 2007, He worked as a medical doctor in missions with Médecins sans Frontières (MSF). He commenced postgraduate Studies in International Health in Berlin in 2010, as by the beginning of 2015 finalization of Master's Thesis upon Bundibugyo Ebolavirus disease. Since the end of 2014, he is working with a focus on special pathogens for the Robert Koch Institute in Berlin (Germany), a Federal institute within the portfolio of the Federal Ministry of Health.

The severe Ebola virus disease epidemic occurring in West Africa stems from a single zoonotic transmission event to a 2-year-old boy in Meliandou, Guinea. We investigated the zoonotic origins of the epidemic using wildlife surveys, interviews, and molecular analyses of bat and environmental samples. We found no evidence for a concurrent outbreak in larger wildlife. Exposure to fruit bats is common in the region, but the index case may have been infected by playing in a hollow tree housing a colony of insectivorous free-tailed bats (Mops condylurus). Bats in this family have previously been discussed as potential sources for Ebola virus outbreaks, and experimental data have shown that this species can survive experimental infection. These analyses expand the range of possible Ebola virus sources to include insectivorous bats and reiterate the importance of broader sampling efforts for understanding Ebola virus ecology.

Lassa fever is a zoonotic hemorrhagic illness predominant in areas across Nigeria, Sierra Leone, Guinea, Liberia, and southern Mali. The reservoir of Lassa virus is the multimammate mouse (Mastomys natalensis), a highly commensal species in West Africa. Primary transmission to humans occurs through direct or indirect contact with rodent body fluids such as urine, feces, saliva, or blood. Our research draws together qualitative and quantitative methods to provide a fuller and more nuanced perspective on these varied points of human–animal contact. In this article, we focus on the hunting, preparation, and consumption of rodents as possible routes of exposure in Bo, Sierra Leone. We found that the consumption of rodents, including the reservoir species, is widespread and does not neatly tally against generational or gender lines. Further, we found that the reasons for rodent consumption are multifactorial, including taste preferences, food security, and opportunistic behavior. We argue that on certain topics, such as rodent consumption, establishing trust with communities, and using qualitative research methods, is key to investigate sensitive issues and situate them in their wider context. To conclude, we recommend ways to refine sensitization campaigns to account for these socio-cultural contexts.

1 AnthropologyDepartment,DurhamUniversity,Durham,UnitedKingdom,2 DepartmentofSociology,PhilosophyandAnthropology,ExeterUniversity,Exeter,UnitedKingdom,3 DepartmentofGlobalHealthandDevelopment,LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom,4 InstituteofTropicalMedicineandInternationalHealth,Charite—UniversitatsmedizinBerlin,Berlin,Germany,5 DepartmentofVirology,BernhardNochtInstituteforTropicalMedicine, Hamburg,Germany,6 MercyHospitalResearchLaboratory,Bo,SierraLeone,7 InfectiousandTropicalDiseasesDepartment,NationalHospitalDonka,Conakry,Guinea,8 DepartmentofMicrobiology,CollegeofMedicineandAlliedHealthSciences,UniversityofSierraLeone,Freetown,SierraLeone,9 DepartmentofInfectiousDiseaseEpidemiology,LondonSchoolofHygieneandTropicalMedicine,London,UnitedKingdom* hannah.brown@durham.ac.uk