Ebola returns to Liberia with five recent cases of the disease. Sequencing data show the virus is genetically similar to the past Ebola outbreak. WHO conducts further tests to see if people unknowingly had the virus and explores other possibilities such as sexual transmission.
There are a considerable number of survivors. And we also know that it persists in certain bodily fluids, and that it can subsist for at least six months.
International donors pledge $3.4 billion for a total of $5.2 billion to help rebuild Liberia, Guinea and Sierra Leone following the Ebola epidemic. The U.N. will follow up to ensure the delivery of the money. New pledges include $745 million from the African Development Bank, $495 million from the European Union, $360 million from the Islamic Development Bank, $340 million from Britain, and $266 million from the United States. Liberian President Sirleaf says funds will revive the economies and societies of affected areas.
The world as a whole has a great stake in how we together respond to this global thread. Virus diseases, just like terrorism, know no national boundaries.
Liberian government dismantles a crematorium and removes drums containing the ashes of more than 3000 Ebola victims as outbreak of the disease is contained. Acting Information Minister Isaac Jackson:
These activities — these prayers services — are taking place in an effort to accord these people the utmost respect considering the circumstances under which they were cremated and they parted with their families. We think it is only but proper that we now accord them — the over 3,000 people cremated — respect in a more dignified way.
Beatrice Yardolo, 58, an English teacher is cured. It is the last confirmed case of Ebola in Liberia, Tolbert Nyenswah, the deputy health minister of Liberia:
There was a lot of excitement because we feel that this is a victory, But it’s not over yet. We are still cautioning people. We told them they must still protect their villages, their towns. They should report any suspicion of Ebola to the health teams. We still have a response that is tight.
The WHO says cases are declining in Liberia and this could be a real trend, although the epidemic is still continuing. There are empty beds in treatment centers and the number of burials has declined. There may be as much as a 25 percent week-on-week reduction in cases. WHO official:
The epidemic (in Liberia) may be slowing down
This is likely due to more safe burials, higher isolation rates, and public health campaigns.
AP reports that a Liberian analysis of bed space at Ebola treatment units concludes that of 742 spaces, 351 were occupied and 391 were vacant. It cites Assistant Health Minister Tolbert Nyenswah, who heads the government’s Ebola response. The main problem is the traditional practice of honoring the dead with burial ceremonies. Nyenswah:
For fear of cremation, do not stay home to die… We know cremation is not our culture in our country. But now we have disease, so we have to change the way we used to do business.
A study in Lancet Infectious Diseases warns of 171,000 cases of the virus in Montserrado county by Dec. 15, 12% of the country’s population, with over 90,000 fatalities. The study depends on the assumptions that every person with Ebola will infect 2.49 other people, and that health measures in Montserrado will remain unchanged. It says that if 4,800 beds are installed at treatment centres in November and health workers speed up fivefold the detection rate of Ebola cases, 77,312 cases could be averted. Health experts say the situation on the ground is changing. Doctor:
It’s too early to say whether the ongoing and intense control efforts in Monrovia have yet achieved control or merely slowed the epidemic, but what is being seen on the ground is clearly incompatible with the results in this paper.
The slum, which is Liberia’s biggest and is home to 50,000 people, introduces measures like avoiding contact with the sick and hand-washing using a bleach solution, and avoiding eating ‘bush meat,’ meat from monkeys and rodents. Aid worker Mechie Seih tells charcoal seller Mamie Kollie how to lower infection risk if a family member falls ill:
You put clean plastic bags on your hands. You wear a thick jacket with long trousers. You put shoes and socks on your feet.
Pharmacist Doris Nyenkan says she now tells customers complaining of fever to get tested for Ebola. She also sells hand sanitizer, and uses it herself:
People clean their homes every day now. Now they are washing their hands, buying this gel. Before Ebola you didn’t see people doing such things.
Forty-three Liberians in quarantine after four people died of Ebola in Jenewonda, a town in an impoverished corner of Grand Cape Mount County near the Sierra Leone border, threaten to break out of isolation as they have no food. The World Food Program has not previously been supplying the area but will begin doing so. The WFP’s logistics unit is delivering the food Thursday, but it must be driven in from Monrovia as there are no trucks in the area. WFP spokesman:
WFP in Liberia heard about this community being isolated only two days ago via the radio and staff immediately began organizing a mission to bring food to the quarantined people.
Friends and relatives of Ebola patients say many people have vanished after being admitted to Liberia’s hospital system. Some people passed through the health system without a paper trail, others were transferred between clinics without notice, and hundreds have been cremated before their families are informed that they have died. A hygienist who says he has reassured people that patients are okay, although he wasn’t sure himself:
I don’t want to be the one to tell them that bad news
An Oct. 10 Ministry of Health report shows that 2,425 people have died from the virus, including 95 health workers. It also shows a shortfall of 79,940 body bags and 989,985 suits over the next six months. (Full text here.)
Liberian families are reported to be paying for birth certificates stating that people who have died of Ebola did not have the virus, in order to allow traditional burial rites that include touching and kissing the dead. Prof. Columbia University epidemiology expert:
Unfortunately, the bodily fluid of recently passed victims continues to carry Ebola virus for up to three days following death. The body’s immune system stops fighting the disease, allowing virus to replicate unabated.
Liberia’s armed forces are leading anti-Ebola efforts including building 18 treatment centres across the country, and are working with U.S. Africa Command forces to rejuvenate their image after the country’s civil war. Joseph F. Johnson, a deputy minister at Liberia’s Defense Ministry:
We’re trying to rebrand the A.F.L. as a force for good. Piggyback on this.
Liberia bans journalists from Ebola treatment units due to concerns over privacy. Deputy information minister Isaac Jackson:
Journalists are no longer allowed to enter ETUs. These journalists enter the ETUs and cross red lines. They violate people’s privacy, take pictures that they will sell to international institutions. We are putting an end to that.
Liberian lawmakers are debating whether to grant Sirleaf wider powers to restrict movement and public gatherings. A proposal would give authorities to seize property ‘without payment of any kind or any further judicial process’ to combat Ebola and allow Sirleaf to ‘limit the right to assembly for any reason.’
Liberia requires journalists to obtain official permission to cover many aspects of the outbreak under new rules aimed at protecting patient privacy. Journalists can be arrested and prosecuted if they fail to get written permission from the health ministry before contacting Ebola patients, conducting interviews or filming or photographing healthcare facilities. Tolbert Nyenswah, assistant minister of health and head of Liberia’s Ebola Incident Management System:
We have noted with great concern that photographs have been taken in treatment centers while patients are going in to be attended by doctors. That is invasion of the dignity, privacy and respect of patients. Ebola patients are no different from any other patients. We should do that (report) under permission so that we don’t just take pictures or send out stories of naked people (in a way) that does not respect their privacy.
Liberia will prosecute Duncan for allegedly lying on an airport questionnaire about not having any contact with an infected person. He filled out a series of questions about his health and activities on Sept. 19, answering no to all of them. The form asked whether he had cared for an Ebola patient or touched the body of anyone who had died in an area affected by Ebola.Binyah Kesselly, chairman of the board of directors of the Liberia Airport Authority in Monrovia:
We expect people to do the honorable thing.
The agency obtained permission from the Ministry of Justice to pursue the matter.