The spread of the Ebola virus into the Liberian capital of Monrovia has claimed another life, according to a statement from the country's Ministry of Health and Social Welfare (MOHSW) today. The news comes as public health officials ramp up efforts and struggle to maintain enough manpower to combat the outbreak that began in Guinea this spring.
Earlier this week, Liberia’s health minister said seven people had died from Ebola in Monrovia since June 8. Friday's MOHSW statement confirmed an eight death. Today's news brings Liberia’s total lab confirmed death count up to 17, with at least another seven suspected. The country had gone nearly two months without any new reported cases.
"The first phase of the epidemic was contained,'' Deputy Health Minister Tolbert Nyenswah, told the Associated Press on Tuesday. "But because of proximity to Guinea and Sierra Leone, we did not declare the outbreak over."
In March, the Ebola virus was discovered in individuals living in Guinea near the border of Sierra Leone and Liberia, a part of the country where border crossing and movement is common.
According to the MOHSW statement, health authorities from the affected countries of Liberia, Guinea, and Sierra Leone will meet in the Guinean capital of Conakry to “discuss and strengthen efforts to contain the Ebola outbreak.”
“The meeting will pave the way for a coordinated approach in dealing with critical issues of Ebola prevention and control including surveillance, contact tracing and follow-up, case management, and information-sharing in the region,” the MOHSW said.
Since the outbreak began, 24 people have died in Liberia, 49 in Sierra Leone, and 264 in Guinea, although not all of these have been lab verified. In total, there have been 530 cases of Ebola between the three West African nations, with nearly 400 occurring in Guinea alone.
“Ebola has become a regional health issue, therefore it's necessary that national authorities and international aid organizations scale up their response in order to raise awareness among the community and to mobilize more medical specialists in the region," the emergency manager for Doctors Without Borders (MSF) Marie-Christine Ferir said in a statement sent to VICE News.
MSF stated that on top of their heavy presence in Guinea, they have constructed an isolation unit in Northern Liberia in recent weeks, and another one in JFK hospital in Monrovia, while also carrying out training and making material donations. The organization has also set up transit isolation units in parts of Sierra Leone.
While experts had expected the outbreak to have simmered down by now, Armand Sprecher, a public health specialist with MSF who travelled to Guinea this Spring, told VICE News that this spread to the Liberian capital was not necessarily surprising.
“The starting point of the virus was in an area where Guinea, Sierra Leone, and Liberia come together,” he said. “Liberia seems to have the same problem we saw in Guinea... A lot of people have normal movement to and from the national capitals.”
After first springing up in the Guéckédou border region of Guinea in March, Ebola spread to Conakry by the end of the month. Sprecher said that the replication in Liberia was "completely expected.”
The movement between these three countries, and from rural to urban centers, is very specific, however, and Sprecher says it’s not likely the disease will start showing up in countries like Mali, Senegal, or Nigeria.
A major challenge has proven to be the regional stigma surrounding Ebola and the fear of workers trying to control the outbreak. “Communities aren’t especially thrilled about Ebola, they’re not happy to have external disease control officials running around,” Sprecher said. “They’re not actively engaged in disease control and that makes life difficult.”
According to Sprecher, despite the fact that MSF has had a lengthy presence in the region treating Malaria, in regards to Ebola, the communities have been distrustful of health officials. When the outbreak began in Guinea, rumors surfaced that officials were there to harvest organs and spread the virus, not cure it.
SMS messages spread warnings of a government Ebola vaccine program that people should avoid, despite the fact that there is no known vaccine for the virus. “Conspiracy theories are no less prevalent there than they are over here,” Sprecher said.
'You could compare it to catching jello in your hands. If it’s cold it’s going to slip through your hand, things are slipping through our fingers now and then, and it just means you need more hands.'
Back in April, Liberia's health ministry released a press release addressing concerns that individuals were purposely avoiding medical care.
“It has come to the attention of the Ministry of Health and Social Welfare that some persons who are required to be checked or isolated for being confirmed with the Ebola virus are evading the process, and have gone into hiding with the aid or either their relatives or other persons,” the MOHSW wrote.
The ministry said individuals knowingly harboring, hiding, or refusing to report cases would be dealt with under a law that allows individuals to be prosecuted for recklessly endangering lives of citizens.
Mobility has been another issue making it difficult for groups like MSF to get a handle on the outbreak. “The spread of Ebola is due to the mobility of the population, which attends funerals without adequate infection control, and to the fact that the disease still scares people who remain reluctant to be hospitalized,” Ferir said, highlighting the fact that the disease is passed through contact with corpses.
Public health officials need to be able to quarantine an infected individual and track people they have had contact with during the weeks-long incubation period. If someone has moved throughout rural areas or avoided medical care, officials must further expand contact tracing efforts, which can result in hours of driving and knocking on doors. They may also be required to set up more isolation units. This has all resulted in a force of officials that has been spread quite thin.
“You could compare it to catching jello in your hands. If it’s cold it’s going to slip through your hand, things are slipping through our fingers now and then, and it just means you need more hands,” Sprecher said.
Because Ebola is such a rare disease, he explained that there are relatively few people who have dealt with an outbreak more than once. During the current outbreak, organizers have had to spread experts throughout the region, while training others at the same time. At this point in the outbreak, officials who have already served in the region this spring are being recycled back into rotation.
“A fella is back now for a second time and he let us know he’s available for September, we hope that won’t be necessary,” Sprecher said. "This will end.”
Follow Kayla Ruble on Twitter: @RubleKB
Image via Flickr