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On 19 October 2014, the President of Liberia apologized to the Mayor of Dallas for the Liberian national that brought the disease to the United States.<ref>{{cite web|url=http://www.cnbc.com/id/102100414#.|title=Liberian president: I'm sorry for US Ebola cases. Dallas: It's not your fault.|work=CNBC|accessdate=24 October 2014}}</ref>
On 19 October 2014, the President of Liberia apologized to the Mayor of Dallas for the Liberian national that brought the disease to the United States.<ref>{{cite web|url=http://www.cnbc.com/id/102100414#.|title=Liberian president: I'm sorry for US Ebola cases. Dallas: It's not your fault.|work=CNBC|accessdate=24 October 2014}}</ref>


By 19 October only one area in Liberia, [[Grand Gedeh]], has yet to report an EVD case. 14 out of the 15 districts have reported cases.<ref name="Ebola_WHO_22_oct">{{cite web |url=http://apps.who.int/iris/bitstream/10665/137091/1/roadmapsitrep22Oct2014_eng.pdf |accessdate=22 Oct 2014 |title=Ebola Response Roadmap Situation Report |date=22 Oct 2014 |author=WHO |work=who.int}}</ref> To date Liberia has 4,693 cases (with 2,709 confirmed / suspected cases).<ref name="Ebola_Outbreak_total_lr_19_Oct">{{cite web|url=http://www.mohsw.gov.lr/documents/SITRep%20157%20Oct%2019th,%202014.pdf|title=Liberia Ebola SitRep no. 157 |accessdate=22 October 2014| date= 22 October 2014}}</ref>
By 19 October only one area in Liberia, [[Grand Gedeh]], has yet to report an EVD case. 14 out of the 15 districts have reported cases.<ref name="Ebola_WHO_22_oct">{{cite web |url=http://apps.who.int/iris/bitstream/10665/137091/1/roadmapsitrep22Oct2014_eng.pdf |accessdate=22 Oct 2014 |title=Ebola Response Roadmap Situation Report |date=22 Oct 2014 |author=WHO |work=who.int}}</ref> To date Liberia has 4,693 cases (with 2,413 confirmed / suspected cases).<ref name="Ebola_Outbreak_total_lr_19_Oct">{{cite web|url=http://www.mohsw.gov.lr/documents/SITRep%20157%20Oct%2019th,%202014.pdf|title=Liberia Ebola SitRep no. 157 |accessdate=22 October 2014| date= 22 October 2014}}</ref>


The disease has been noted to be spreading in [[Monrovia]], the nation's capital.<ref>{{cite web |url=http://www.news24.com/Africa/News/Aid-workers-learning-to-fight-Ebola-as-they-go-20140929 |title=Aid workers fight as they go |work=News24 |accessdate=1 October 2014}}</ref> There are about 1 million people in the city.<ref>{{cite web |url=http://www.rappler.com/world/regions/africa/70583-ebola-hit-liberia-societal-breakdown |title=Ebola-hit Liberia on brink of societal collapse – experts |work=Rappler |accessdate=1 October 2014}}</ref> Monrovia is particularly affected with 305 new cases reported in the week ending 19 October.<ref name=Ebola_WHO_22_oct />
The disease has been noted to be spreading in [[Monrovia]], the nation's capital.<ref>{{cite web |url=http://www.news24.com/Africa/News/Aid-workers-learning-to-fight-Ebola-as-they-go-20140929 |title=Aid workers fight as they go |work=News24 |accessdate=1 October 2014}}</ref> There are about 1 million people in the city.<ref>{{cite web |url=http://www.rappler.com/world/regions/africa/70583-ebola-hit-liberia-societal-breakdown |title=Ebola-hit Liberia on brink of societal collapse – experts |work=Rappler |accessdate=1 October 2014}}</ref> Monrovia is particularly affected with 305 new cases reported in the week ending 19 October.<ref name=Ebola_WHO_22_oct />

Revision as of 00:23, 3 November 2014

Ebola virus epidemic in Liberia
A map of Liberia
Cases contracted in Liberia6,535 (as of 25 October 2014)
Deaths2,413

The West African nation of Liberia is currently afflicted by an epidemic of Ebola virus disease (EVD), along with the neighbouring countries of Guinea and Sierra Leone. The disease was discovered in late March 2014.[1] Ebola is a biosafety level four pathogen, an RNA virus first discovered in 1976.[2]

Before the Ebola epidemic, Liberia had 50 doctors for its population of 4.3 million, weakened from a civil war that ended in 2003.[3]

History of Ebola in Liberia

This is about the spread of Ebola virus disease in the West African country of Liberia. On March 31, 2014 Liberia confirmed its first two cases of Ebola virus disease.[4] By 23 April 2014 there were 34 cases and six deaths from Ebola in Liberia.[5] By June 17, 2014 sixteen people had died from Ebola in Liberia.[6] Doctors would get infected early on, because they would think the patient had malaria.[7] Malaria is extremely common in Liberia, for example in 2010 there were nearly 1.3 million cases of malaria in a country of about 4 million.[8][9]

The first deaths from Ebola in Monrovia occurred by 17 June 2014 when seven died from Ebola.[10] The dead included a nurse along with some from her household.[10] The nurse was treated at Redemption Hospital located west of Monrovia.[10] At the time there were about 16 cases reported in Liberia overall.[11] Redemption Hospital is a health care facility in New Kru Town somewhat west of Monrovia in Liberia.[12] It is a state-run institution that offers free health care in New Kru Town.[13]

By 2 July 2014 a doctor at the hospital, the head surgeon, died from Ebola.[14] At this time they then shut down Redemption Hospital and distributed its patients to other facilities in the area.[14] The Redemption Hospital doctor who died was being treated at the JFK Medical Center (also in Monrovia).[14]

On 21 July 2014, four nurses at Phebe Hospital in Bong Country contracted Ebola.[15] On July 27th Samuel Brisbane, one of Liberia's top doctors, died from Ebola. By this time a doctor from Uganda also died, and two U.S. doctors became infected.[16]

On July 30th Liberia shut down its schools as the Ebola outbreak spread.[17]

August

The reported weekly cases of Ebola in Liberia as listed on Wikipedia Ebola virus epidemic in West Africa; some values are interpolated.

On the weekend of 2-3 August 2014, locals fought a burial team trying to bury 22 bodies, and the police were called in to restore order.[18]

On 4 August, the Liberian government ordered corpses of those that died from Ebola virus disease to be cremated.[18] Ebola corpses are highly contagious immediately after death.[19] At this time there were 156 recorded deaths from the disease in Liberia.[20]

On 11 August, the Liberian government had announced the suspension of all flights coming from countries affected by Ebola. Ten days later, it decided to close its borders as well with Guinea and Liberia, the two countries most affected by Ebola, in view of the reactivation of old cases.[21]

On 27 August, there was a problem with dogs eating the corpses that had not been picked up, and packs of dogs were observed digging up bodies and eating them in Liberia. A doctor who works on viruses said that dogs do not get the symptoms of Ebola, but may carry the disease and are a risk factor by licking or nibbling people. One study pointed out pet dogs may eat up the vomit of humans sick with disease or eat at Ebola-infected carcasses.[22]

West Point quarantine (Aug 19-30)

A view of the West Point area of Monrovia

On 18 August, a mob of residents from West Point, an impoverished area of Monrovia, descended upon a local Ebola clinic to protest its presence. The protesters turned violent, threatening the caretakers, removing the infected patients, and looting the clinic of its supplies, including blood-stained bed sheets and mattresses. Police and aid workers expressed fear that this would lead to mass infections of Ebola in West Point.[23][24]

On 19 August, the Liberian government quarantined the entirety of West Point and issued a curfew state-wide.[25][26] Violence again broke out on 22 August after the military fired on protesting crowds.[27] The quarantine blockade of the West Point area was lifted on 30 August. The Information Minister, Lewis Brown, said that this step was taken to ease efforts to screen, test, and treat residents.[28]

City inhabitants have tried to spread knowledge about Ebola, especially the importance of not touching those that are sick or dead from Ebola.[29] (This is the first outbreak in Liberia.) Sanitation is a struggle in some parts of the city, with estimates that there are four public toilets in West Point, Monrovia.[30] The beach surrounding West Point is often used as a lavatory, but it is also a source for drinking water, and the fish from the water are taken for food.[30]

September

On 1 September, Ivory Coast announced the opening of humanitarian corridors with its two affected neighboring countries.[21]

The WHO reported on 26 September 2014 that Liberia had informed, as of 23 September 2014, there had been 3,458 total cases, 1,830 deaths, and 914 lab confirmed cases.[31] For comparison, Lassa fever is estimated to kill about 5000 people a year in West Africa,[32] and in Western countries, medical mistakes kill between 44,000 to 400,000 people a year.[33]

On 20 September, Liberia opened a new 150-bed treatment unit clinic in Monrovia. At the opening ceremony of the Old Island Clinic on Bushrod Island six ambulances were already waiting with potential patients. More patients were waiting by the clinic after making their way on foot with the help of relatives.[34] Two days later 112 beds were already filled with 46 patients testing positive for Ebola, while the rest were admitted for observation.[35] This expanded the number of beds in the city beyond 240.[36] 100 construction workers worked multiple shift for three weeks to get the clinic open, but its capacity was exceeded in 24 hours.[36] The term bed here is not just a bed, but implies the staff and logistics to take care of a patient with right precautions.[36] One source says it opened on 21 September 2014 with a 100-bed capacity.[37]

By late September there were three clinics in Monrovia, but it was an increasingly common occurrence to have patients waiting and even passing away outside because the clinics had run out of space.[38] If patients cannot get a bed in the clinic they sometimes wait in holding centers until a bed opens up.[39] There are additional cases in Monrovia where the bodies are dumped into the river.[40]

One woman used trash bags to protect herself as she cared for four other family members ill with Ebola.[41] Her father became ill in late July 2014, but they could not find a place of treatment for him and ended up doing home-care.[41]

On 25 September Liberia's chief medical official went on a self-enforced quarantine after her assistant died from the illness, having potentially exposed her to the Ebola virus.[42] By the 29th of September 2014, it was announced she tested negative for Ebola, but government officials praised her for following the self quarantine rules.[43]

On 28 September 2014, Ivory Coast resumed flights to Liberia which had been suspended since 11 August 2014, after WHO's critique for tending to economically strangle the affected nations.[21] From the beginning of the crisis, WHO has discouraged closing the borders with afflicted countries.

On 30 September 2014 a cameraman was diagnosed in a Texas hospital of having contracted Ebola before traveling back to the United States from Liberia, where he covered the Ebola outbreak for NBC News[44][45] (see 2014 Ebola virus cases in the United States). Also that day, Liberian's government also enacted restrictions on journalistic coverage aimed at protecting patients' privacy.[46]

October

The 25-bed Monrovia Medical Unit was constructed for health care workers supporting Operation United Assistance.

In early October, the president continued to ask for more aid to fight against Ebola.[47]

On 2 October 2014, a new 60-bed clinic was opened in Kenema.[48] However, the outbreak was described as being out of control and an exponential growth in cases was expected, with a focus on slowing the outbreak down.[49] One problem is that the health care establishments are overwhelmed, so even when those infected come to a hospital they are often turned away and go on to infect others.[50]

By 3 October 2014 at least 8 Liberian soldiers died after a woman infected with Ebola visited them.[51]

On 3 October 2014 medical supplies arrived from Germany, which cared for two evacuated Ebola cases in Germany by that date.[52] On that same day GERLIB opened up an Ebola isolation ward at its 48-bed facility in Paynesville (Monrovia).[53]

On 10 October 2014, journalists were banned from Ebola clinics.[54]

In October the WHO pushed for its 70-70-60 plan to control the outbreak.[55] By October 19, it was reported that 223 health care workers had cases of Ebola, and 103 of them had died in Liberia.[56][57]

On 19 October 2014, the President of Liberia apologized to the Mayor of Dallas for the Liberian national that brought the disease to the United States.[58]

By 19 October only one area in Liberia, Grand Gedeh, has yet to report an EVD case. 14 out of the 15 districts have reported cases.[57] To date Liberia has 4,693 cases (with 2,413 confirmed / suspected cases).[56]

The disease has been noted to be spreading in Monrovia, the nation's capital.[59] There are about 1 million people in the city.[60] Monrovia is particularly affected with 305 new cases reported in the week ending 19 October.[57]

Healthcare capacity

Doctors from Médecins Sans Frontières and the American CDC put on protective gear before entering an Ebola treatment ward in Liberia, August 2014.

Clinics

One of the other clinics in Monrovia is a 160-bed facility by Doctors Without Borders.[61]

JFK is another treatment center, and could hold 35 beds but expanded to 75 because of the demand.[62]

Confounding factors

A CDC official consulting with a Liberian District representative about Ebola.

Corruption

In Liberia, some body-collection teams dispatched to collect the Ebola dead have collected bribes to issue falsified death certificates to family members, stating that their dead relative did not die from Ebola. The body of the Ebola victim would also be left with relatives. Ebola carries a stigma in Liberia, and some families do not want to admit that their relative died of Ebola. Another factor is that families wish to give their relative a traditional burial.[63]

During the 10-day Liberian government quarantine of the West Point slum in Monrovia, residents were able to leave the blockaded area by paying bribes to soldiers and police officers.[64] A journalist inside West Point told a local radio station that Liberian soldiers and police were seen "daily soliciting monies from those being quarantined in the area to escape". The journalist reported that "many of those even suspected of having the disease were given free passage to leave West Point for Monrovia city center."[65]

Public hiding of Ebola infected and dead

In October it was noted that many of the Ebola dead and dying are not being reported to health authorities in Liberia. While the epidemic has been accelerating, the number of bodies being collected is falling. “Very, very few of those dying in the community are being brought forward,” said Cokie van der Velde, who organises body collections with Médecins Sans Frontières.[66]

Van der Velde said that in late September the main crematorium in Monrovia was running at full capacity - burning 80 bodies at a time on its mass pyre. In early October, the number of bodies has dropped to 30 or 40 a day. Van der Velde said “That means they’re being kept hidden and buried in secret”. Traditional funerals have been a risk factor in the spread of Ebola.[66]

In late October it was reported that many beds in Liberian Ebola treatment centres were empty due to people no longer self-reporting suspected Ebola symptoms to health authorities. The assistant Liberian health minister said at the time that an assessment of Ebola treatment units found that out of 742 spaces, 351 were occupied by patients.[67]

The non-reporting by the public is believed to be due to an August policy decision to cremate all bodies of suspected Ebola victims in Monrovia, with cremation being against local sensibilities and preference for a traditional burial. The cremation order came after people in Monrovia's neighbourhoods resisted the burial of hundreds of Ebola victims near their homes.[67]

Flight of government leaders

On August 6, Liberian President Ellen Johnson Sirleaf told absent government ministers and civil service leaders to return to Liberia as part of an emergency announcement.[68] In late August, Sirleaf dismissed 10 government officials, including deputy ministers in the central government who refused to return to Liberia, and froze the benefits and pay for nearly twenty other high-ranking officials who would not return.[69]

Transfusions of blood from Ebola survivors

A black market in the blood of Ebola survivors for has been reported in Liberia. Buyers of the blood hope to gain immunity or recovery via a blood transfusion.[70] These transfusions have been noted as posing a risk for the transmission of HIV/AIDS, malaria and other blood-borne diseases, which "has the potential to divert time and resources originally allocated to control Ebola", stated a US military report.[71]

Local conspiracy theories

  • In late October it was reported that harassment of gay Liberians in Monrovia was occurring after some church leaders said that "God was angry with Liberians over corruption and immoral acts such as homosexuality, and that Ebola was a punishment". The harassment included car windows being smashed and some gay people were forced from their homes and had to go into hiding.[75]
  • “The Ebola outbreak was sparked by a bewitched aircraft that crashed in a remote part of Sierra Leone, casting a spell over three West African countries -- but a heavily alcoholic drink called bitter Kola can cure the virus.”[76]
  • “Some members of the community thought it was a bad spirit, a devil or poisoning.”[77]
  • At the beginning of the outbreak, many did not believe that the disease existed. “I thought it was a lie (invented) to collect money because at that moment I hadn't seen people affected in my community.”[77]

Effects

A sign in a Monrovia radio station advising people not to shake hands, as Ebola can be spread through physical contact via body fluids.

Evacuations

On 5 August 2014, the Brothers Hospitallers of St. John of God confirmed that Brother Miguel Pajares had been infected after volunteering in Liberia. The Spanish military helped with his transfer on 6 August 2014.[78] Authorities stated he would be treated in the 'Carlos III' hospital in Madrid. This attracted controversy, amid questions as to the authorities' ability to guarantee no risk of transmission.[79] Brother Pajares died from the virus on 12 August.[80]

Kent Brantly, a physician and medical director in Liberia for the aid group Samaritan’s Purse, and co-worker Nancy Writebol were infected while working in Monrovia.[81][82][83] Both were flown to the United States at the beginning of August for further treatment.[84] On 21 August, Brantly and Writebol recovered and were discharged.[85]

A French volunteer health worker working for MSF in Liberia contracted EVD and was flown to France on 18 September 2014. French Health Minister Marisol Touraine stated the nurse would receive the experimental drug favipiravir.[86] By 4 October 2014 she had recovered and was released from the hospital.[87]

After a news-network's cameraman came down with Ebola, he was evacuated to the U.S. and the rest of the crew also returned and went into quarantine.[88]

Local works derived from the Ebola crisis

  • "White Ebola", a political song by Mr. Monrovia, AG Da Profit and Daddy Cool, centered on the general mistrust of foreigners.[89]
  • "Ebola in Town", a dance tune by a group of West African rappers, D-12, Shadow and Kuzzy Of 2 Kings warns people of the dangers of the Ebola virus and explaining how to react, became popular in Guinea and Liberia during the first quarter of 2014.[90][91] A dance was developed in which no body contact was required, a rare occurrence in African dance.[92] Some health care workers from the IFRC had concerns that the Ebola In Town song's warning "don't touch your friend" may worsen the stigma.[92][93]
  • Senegalese rapper Xuman parodied Rihanna's "Umbrella" in "Ebola est là" (Ebola Is Here). The song's lyrics warns locals that, "The disease is among our neighbours, Liberians and Guineans." The track was a hit.[91][94]
  • "Ebola is Real", A hip hop tune done in collaboration with Liberian artists F.A., Soul Fresh, DenG, Adolphus Scott (a Liberian communication specialist for UNICEF) and Liberia’s Ministry of Health & Social Welfare became the most played song on Hott FM.[95][91]
  • A 5 minute public service advert was carefully crafted by Adolphus Scott and others, to increase general Ebola awareness. The clip runs an estimated 5 times a day on local TV stations.[95]
  • “State of Emergency”, a hip hop tune by Tan Tan B and Quincy B, produced without government involvement also has high play time on air.[95][96]
  • In August 2014, George Weah and Ghanaian musician Sidney produced a song to raise awareness about Ebola.[94] All proceeds from the track been donated to the Liberian Health Ministry.[97]
  • Charles Yegba, leader of the AFROCO music group, plans to record a song and video to raise awareness about Ebola across Liberia.[77]
  • There are a number of Ebola-themed jokes circulating in West Africa.[98]
  • Liberian Radio programme directors have increased vernacular Ebola prevention programs' air time on 44 community radio stations to include most of the 30 minority languages used in the rural areas. Programmes of 30 minutes, 3 times a day, include commercials, phone-ins and news, broadcast in the local language. Only about 20% of Liberians understand English. [99]

See also

References

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External links