Ebola cases plummet in Liberian hot spot as aid groups gain trust

By LENA H. SUN

Washington Post

Last modified: 11/16/2014 12:35:12 AM

The number of new Ebola patients has fallen to practically zero in one of Liberia’s hardest-hit areas because aid workers gained the trust of the community so the sick were treated quickly and the dead were buried safely, according to a report released yesterday by the Centers for Disease Control and Prevention.



In a separate development, a Maryland surgeon working in Sierra Leone has been diagnosed with Ebola. The plan is to fly him to the United States for treatment at the Nebraska Medical Center in Omaha, Neb., today, according to an administration official.



The surgeon, Martin Salia, 44, is a Sierra Leone citizen and a legal permanent U.S. resident who lives in Maryland. He will be the third Ebola patient at the Omaha hospital, which has a special isolation unit, and the 10th person with Ebola to be treated in the United States. On Tuesday, Craig Spencer was released from a New York hospital.



The CDC report said that the strategy put in place in Lofa County by Doctors Without Borders has been so effective that it could serve “as a model to implement in other affected areas to accelerate control of Ebola.” Liberia’s epidemic began in Lofa County, which borders Guinea and Sierra Leone.



The measures are aimed at reducing fear of everything associated with the disease, from the health care workers, who looked like astronauts in their protective gear, to the way treatment facilities are designed.



At the Ebola treatment unit in the town of Foya, for example, the facility’s high walls were replaced with transparent fences so people could see what was happening at the center. Family members also were allowed to talk with loved ones across the fence or visit with them inside the ward while wearing full personal protective equipment.



The dead were buried in designated sites in the presence of family members and in graves with clear identification. Family members were invited to hold grieving ceremonies according to local customs.



As a result, the number of people admitted to the 135-bed treatment unit plummeted from 133 at its peak, in the week ending Aug. 16, to one person in the week ending Nov. 1, according to the CDC report.



The report about the decrease in disease transmission in Lofa County comes as the rate of Ebola infections has fallen sharply in Liberia in recent weeks, leaving once-overwhelmed treatment centers half-empty and some corners of the country with few new cases. Half of Liberia’s cases have been in Montserrado County, home to the capital city of Monrovia. Since mid-September, admissions to Ebola treatment units there declined 73 percent. At the same time, despite the recent positive turn in Liberia, infections are up in Sierra Leone and in parts of Guinea. Sierra Leone added 218 cases in two days, according to a report released yesterday by the World Health Organization.



Liberia’s president lifted the state of emergency Thursday that was imposed to control the outbreak that has ravaged the country.



Meanwhile, in neighboring Mali, authorities are trying to trace more than 250 contacts linked to confirmed and probable Ebola victims in an effort to control its second outbreak, the WHO said yesterday. Mali has four reported cases, including three deaths.



In Liberia, Doctors Without Borders took over the running of the treatment center in Foya in August from another nonprofit organization and the Liberian health ministry.



“We redesigned the center to maximize transparency in a safe way, to address rumors about what may be happening inside and demystify our work,” Serge St-Louis, field coordinator for Doctors Without Borders in Foya, said in an email. Taking down the high walls was key.



“Prior to this there had been an air of suspicion about what was going on behind the walls,” he said. “People were known to go in but were often not seen again.”



The Lofa County report was one of six reports on Ebola the CDC released yesterday. Four describe the epidemic in Liberia, and two describe the cases in Dallas. Thomas Eric Duncan died Oct. 8; the two Dallas nurses who treated him became infected but recovered. None of the 147 who cared for Duncan or the nurses developed Ebola.



In Liberia, Sierra Leone and Guinea, the number of Ebola cases has reached 14,383, including 5,165 deaths. Despite progress in some parts of Liberia, the efforts are tenuous, the CDC reports note. The United States and other partners are responding to new outbreaks in hard-to-reach locations instead of larger outbreaks occurring in more accessible areas. Many CDC teams are hiking hours through heavily forested regions or traveling by canoe to reach villages and towns.



In recent weeks, there has been one new outbreak or cluster every day, according to CDC. By comparison, during the past four decades, CDC has responded to one Ebola outbreak every one to two years.



Also yesterday, the Pentagon announced that Defense Secretary Chuck Hagel signed an order authorizing the mobilization of about 2,100 Army Reserve and Army National Guard troops to replace service members rotating out of Senegal and Liberia. About 2,300 U.S. soldiers are in West Africa.





