When serology contradicts the experience of the disease: Ethics, research, and announcements about Ebola in Guinea

Abstract

In Guinea, serological tests have shown the absence of antibodies in people declared cured of Ebola Virus Disease (EVD), thus refuting their previous diagnosis; and the presence of antibodies in contact cases who had not been diagnosed. These findings have led to reflections on the implications of telling those affected. The objectives of this study are to identify the stakes of announcing these results in the Guinean health context. 24 people, cured of Ebola or with expertise in ethics or health, were interviewed between November 2019 and February 2020 in Conakry. They presented their experiences in terms of medical announcements in Guinea, and their opinions on the relevance of announcing these discordant serological results. Although it is an important step in the care relationship, the medical announcement sometimes seems neglected in Guinea. In addition, the opinions of the interviewees are rather homogeneous and favorable to the announcement to people seropositive to the Ebola virus who had not been diagnosed. However, their views are varied regarding the announcement of a negative serology to people declared cured of the EVD. They follow two trends, between Ebola survivors who say the announcement is undesirable, and ethicists and healthcare professionals for whom it is preferable. This survey shows that certain biological results deserve critical reflection before being announced, especially when they indicate a new diagnosis. In order to decide on a course of action for the situations exposed, a second expertise would be useful, taking into account our results and new knowledge about the virus.