By Rufus N. Darkortey
The current strategy to contain and eradicate Ebola from Liberia does not seem to be effective as the virus continues to spread exponentially in the country and beyond its borders. According to an analysis of the Center for Disease Control and Prevention (CDC), the total cases of Ebola in Liberia at the moment are 4,249, which accounts for about 47% of the total 8,993 cases within the world.
Liberia accounts for about 2,458 deaths of the total 4,992 deaths within the world, which constitutes about 55% of total deaths. The virus has spread too deep within the communities and the country has lost the ability to identify infected individuals and trace contacts. The primary strategy that is historically used to eradicate Ebola is to quickly identify infected individuals, isolate them for treatment, and effectively trace their contacts for effective monitoring. Liberia did not initially implement such strategy, leading to the virus spiraling out of control and thus spreading exponentially. The only approach that can turn the curve to eradicate the disease is a systematic house-to-house search community-based strategy. The objective of this strategy is to quickly identify, isolate, contain, treat, report, and monitor all incidence of Ebola at the community level to ensure the eradication of the disease from the country within about four (4) months or less.
Because the national crisis facing the country must urgently be resolved, I would like to state here that this article only seeks to use available Ebola data to assess whether the current approaches being used by Liberia are effective or not. The article does not seek to criticize nor seek to discount the level of hard work that is being performed by everyone to defeat this disease. This point is necessary because ideas and inputs are often quickly politicized by different groups within the country and/or trashed by policymakers of the country suggesting that their performance and credibility are being questioned. We are all in this fight together, so this is the time for every Liberians and stakeholders to unite around a common effective strategy that defeats this virus rather than sticking with one that is not working for personal aggrandizement.
Evidencing the Ineffectiveness of the Current Strategy
In spite of the enormous domestic and international aid Liberia continues to receive, Ebola still seems to be increasing at an increasing rate within the country. The death rate of the virus has astronomically increased by 1,705% for the past 80 days from about 129 deaths by July 31, 2014 to about 2,458 deaths by October 19, 2014. According to the CDC, the number of deaths within the country rose from 129 in July to 2,339 by October 12, 2014, for a total of 2,458 deaths since the virus emerged in the country on March 22, 2014. Although some spikes of successes are inconsistently observed within the country, this data suggests that the current Ebola eradication strategy is ineffective. Prior to the imposition of the state of emergency, there were about 129 deaths in the country over a 131 days span; from March 22, 2014 to July 31, 2014. This resulted to an average of about 1 death per day. Since the imposition of the state of emergency and other related measures aimed at eradicating the disease, the number of deaths and death rate increased astronomically by 1,705% over the 80 days period from July 31, 2014 to October 19, 2014. The country has incurred about 2,329 deaths over that period for an average of about 30 deaths per day.
The enormous amount of Ebola-related aid the country has received during this state of emergency period does not match the gains it has made in terms of eradicating the disease during the period. Prior to the imposition of the state of emergency, the country spent approximately less than US$1 million dollars to eradicate the disease and managed to incurred about 129 deaths. One key explanation for the low expenditure on the Ebola eradication efforts during this period is that the country still doubted the existence and intensity of the disease. Like many around the world, some policymakers were never inclined to believing the emergence of the virus in West Africa. Ordinary citizens too were in denial as well. As a result, the standard strategy for Ebola eradication was not implemented, thus prompting the country to spend no more than US$1 million dollars on the disease eradication process.
During the current state of emergency period, which has only lasted for about 80 days (July 31, 2014 to October 19, 2014), the country has received approximately US$300 million worth of cash donations and about US$100 million worth of in-kind (medical supplies) donations. However, the country has incurred about 2,329 deaths during this period alone. This puts the net gain of the country’s Ebola death reduction strategy at a very negligible and immaterial amount, evidently suggesting that the current Ebola eradication strategy is ineffective and must be changed to a systematic house-to-house search strategy.
The Current Ebola Eradication Strategy and Key Components
It is not clear what strategy Liberia is currently using to eradicate the virus. However, with the exponential and sporadic manner in which the disease continues to spread across the country, it can confidently be suggested that the country’s current strategy clearly deviates from the historical norms, standards, and strategies for Ebola eradication that have been successfully used by many countries affected by the disease. A very simple strategy that has always effectively stopped the outbreak of the disease is the approach of quickly identifying Ebola patients, isolating them, tracing and monitoring their contacts, and treating them for recovery. Nigeria and Senegal are prime examples of countries that have effectively stopped the outbreak of the disease by utilizing the standard strategy of Ebola eradication. Ebola entered Nigeria from Liberia in mid July 2014 and by September 5, 2014 the country had contained the virus within just 46 days, thus tallying only 8 deaths during that period.
A large number of new Ebola cases and deaths are still being reported on a daily basis in Liberia. The country incurred a total of 1,227 new cases over a 24 days span from September 19, 2014 to October 12, 2014 for an average of 52 cases per day. Also, the country averaged about 37 deaths per day for a total of 880 deaths during that period. The data also suggest that the country observed very large sporadic spikes in the number of new cases and deaths during that period. About 258 new cases were reported by September 21, 2014. That number fell to 178 by September 23 and later jumped to 376 by September 30. During the same period, the number of deaths also peaked, fell, and peaked again. This indicates that the current strategy being utilized is ineffective. At this point, the total number of cases and deaths should be increasing at a decreasing rate, suggesting that the numbers of new cases and death should be significantly decreasing at this moment.
Contrary to a Front Page Africa report on October 20 suggesting that Ebola is declining in the country with fewer cases, the World Health Organization (WHO) also reported on October 15 that the Ebola situation is getting worst within the country. This excerpt from the WHO report states that “Data acquisition continues to be a challenge in Liberia. Evidence obtained from responders and laboratory staff in the country suggests that the situation in Liberia is getting worse, and that transmission remains intense in the capital, Monrovia. As has been the case over the past four weeks, very few confirmed cases were reported from Monrovia between 6 and 11 October reflecting ongoing delays in matching laboratory results with clinical surveillance data.” The growth rate for new cases has fluctuated over that 24 days period. Similar trend is observed with the growth rate of the number of deaths during that time period.
And also show a downward trending of the average new cases and deaths per day during that 24 days period. This seems to suggest that the incidence of the virus is indeed declining. However, the WHO report seems to suggest the opposite. The WHO also recently predicted on October 14, 2014 that there could be about 10,000 new cases per week by December 2014 if much is not done to stop the virus. During that same time period, the Liberian president also wrote the entire world on October 19, 2014 indicating that the virus has brought her country to a standstill killing more than 2,000 persons and crippling its economy, thus needing help to defeat the virus.
Based on the CDC and other pertinent reports of the WHO and the Liberian president, the current Ebola eradication strategy in the country does not seem to be working. According to sources and other observations, the Ebola effort in the country is completely disorganized, lacks coordination, direction, and leadership. The fight is a voluntary one in most cases where community members, individuals, and other organizations are taking upon themselves to provide service and directions in areas that the policymakers have not provided leadership.
The country is yet to subsidize the distribution of hand sanitizers, disposable gloves, food, and medical supplies to affected areas, impoverished individuals, and pertinent medical facilities. Other reports suggest that some communities have organized themselves using house-to-house approach to identify infected persons, trace contacts, and provide food to infected people. According to a Front Page Africa report on October 21, 2014, the UNDP is supporting community identification and contact tracing efforts in certain communities. While such efforts are commendable, they are not sufficient to end this disease. This virus cannot be defeated with the act of voluntarism on the part of people or organizations that are willing and able to act or not. The battle can only be won if the country lead in every way, developing and implementing winnable strategies in a broader manner. The Ebola virus is widespread within the country. Therefore, the country must implement the same strategy within every infected area of the country. Otherwise, the disease will continue to spread with the current hit-or-miss or disorganized approach that is being taken.
A Systematic House-to-House Search Strategy
Liberia must adopt a house-to-house search strategy as a new approach to aggressively end this disease within the next four months or less. This strategy will quickly identify, isolate, contain, treat, report, and monitor all incidence of Ebola at the community level to ensure the eradication of the disease from the country within a timely manner. As indicated, the country has lost the ability to identify infected individuals as well as tracing contacts, which are the essential elements of traditional approaches to curb any Ebola outbreak. Since the country cannot identify who currently has Ebola or not, it must immediately implement a house-to-house search across the entire country for areas that are affected by the disease.
I wrote a full proposal on September 16, 2014 on how the house-to-house search strategy could be implemented. The proposal was submitted to the Liberian government and other partners, including the US government.
The current approach of waiting to see who shows up at a hospital or the street corner before we know that they have Ebola is not efficient and effective, and will only lead to the exponential spreading of the disease. This wait and see approach is responsible for the uncontrollable spreading of the disease within this country because before an infected individual reaches a hospital, it is more than likely that that person has infected others along the way that could be difficult to trace. Liberia can defeat Ebola like Nigeria, Senegal, and other countries within a shorter period of time, but the country must be willing to act now and swiftly too.
Ebola is spreading in Liberia as if the virus hates the country with a vengeance. No, this virus does not hate Liberians, nor are Liberians attractive to contracting the disease. Over 50% of the current Ebola cases within the world are found in Liberia. Also, over another 60% of the all Ebola-related deaths are found in Liberia. It is very difficult to understand why the incidence of this virus is so profound within the country than others. Ebola is a very deadly disease, but it can very, very, very, very easily be contained with simple identification and isolation of infected individuals. The cost of defeating the disease at the early stages is very small. However, Liberia has turned a very inexpensive problem into a complex crisis now requiring millions of dollars to solve.
A Call to Action
Fellow Liberians, humanitarian friends, and stakeholders, Liberia and Liberians everywhere are under attack by this virus. Our fellow impoverished Liberians are dying and suffering from this disease. Our already underdeveloped country is losing every gain made. Liberians outside the country are facing difficult times being stigmatized and subjected to justifiable, and at times unnecessary scrutiny. Our friends in other countries are facing clear risks of the virus spreading from Liberia into their countries. We can no longer let this virus linger around as if there is no viable alternative to stopping it right now. As our friends are supplying the logistical, medical, and financial support to help us stop this disease, we must also do our part to say no to this virus by matching the resources to a workable strategy. We are all in this fight together, so we must fight it for each other.
For those of you who are still in denial or harboring any theory about the existence of this virus, I am calling on you to see and feel how this virus is devastating the lives of your fellow men, country, and others and do all you can to help defeat this virus.
To my fellow Liberians, you must patriotically unite around a common cause to defeat this common enemy. You must call on your leaders and nonviolently pressure them to begin a house-to-house search approach to quickly identify and treat infected individuals as a mean to end this virus. You must commit your resources to this fight.
To our leaders, with your constitutional and democratic mandate to lead, we cannot and do not want to seek any other leadership outside of you. Therefore, we are asking you to lead and lead now. Leadership is the key to the spread of this disease, and leadership must be the key to end it. You must devise a clear strategy; and clearly provide the direction and ensure complianc. You must not allow the voluntarism of some incredibly kind-hearted individuals and organizations to be seen as the best approach to ending this disease. We cannot win this battle based on voluntarism. Victory must be crafted and deployed with the utmost precision. Voluntarism is extremely applauded at this time, but could undermine the fight due to the limited resources and capacities of the volunteers. You must immediately implement a nationwide systematic house-to-house search strategy as the only best available approach to ending this virus. You must commit and exhaust all necessary resources on defeating this virus before it defeats us.
To friendly countries and our friends around the world, we applaud your humanitarian support for us during this difficult time. We are incredibly indebted to you. As you continue to support Liberia during this critical time, we are also calling on you to pressure our government to immediately begin a nationwide house-to-house search for infected individuals. As we also understand that your fear of contracting the virus from Liberians is justified, we are also encouraging you to not let your fear to let you subject Liberians residing within your country to unnecessary scrutiny and stigmatization.
Liberians are very decent and caring people that would do anything to make the lives of others better even at their own detriment. It is already a tough time for us and we are calling on our friends to stand with us at all levels during this fight. I am also calling on Liberians and others that are traveling from West Africa to take all necessary precautions to not spread the virus into other countries, thus earning the respect of our host countries that we will do all that we can to not let them get infected by the disease on their soil.
Rufus N. Darkortey is economist/president, Liberia Economic Development Initiative (LEDI) www.ledinow.org | firstname.lastname@example.org | 216-577-3177 | 216-202-LEDI (5334).