The massive effort to get control of the Ebola outbreak in West Africa, the most devastating in history with more than 1,350 dead to date, has taken some bizarre turns in Liberia. The country's government on Tuesday quarantined a slum in Monrovia, the capital, provoking clashes there between angry residents and authorities.
The country's public health officials had already been reduced to rounding up patients that angry mobs "liberated" from an isolation facility last weekend, imposing a nationwide curfew of 9 p.m. to 6 a.m., and fighting the pernicious rumor that the hemorrhagic fever still raging through West Africa is a hoax. (Related: Q&A: American Virus Expert in Africa's Ebola Zone: 'This is Like War')
The situation in Liberia has been described by an experienced member of one response team as being in "free fall," while Doctors Without Borders said the situation in Monrovia is "catastrophic." Liberia now has more cases and more deaths than any other country, with 576 patients dead, compared to 396 in Guinea and 374 in Sierra Leone. Dozens of health care workers in the country have been infected with the virus. (Related: Successful Marburg Virus Treatment Offers Hope for Ebola Patients.)
Doctors Without Borders says there are reports that most of the country's hospitals are closed because fearful or ill health workers stopped reporting to work, and bodies are lying in the streets and in houses waiting to be collected.
In the countries affected by the outbreak, governments have established quarantine zones to contain the spread of the disease. In Liberia the zones are reinforced by the military. More than a million people are now living in quarantine zones in Liberia, Guinea, and Sierra Leone.
But concern is growing that food and supplies might not be reaching those inside the zones, and that the hardship might cause people to attempt to break out of quarantine. (Related: Q&A: Challenges of Containing Ebola's Spread in West Africa.)
Epicenter of Ebola
Controlling the outbreak in Liberia is considered key to controlling the outbreak across West Africa. "If we don't stabilize Liberia, we will never stabilize the region," Joanne Liu, international president of Doctors Without Borders, said Friday at a press conference in Geneva after a ten-day trip to the region.
"We believe we can overcome this fight," Lewis Brown, Liberia's Minister of Information, told National Geographic this week. "We are beginning to see evidence of that in some of the places that we had considered earlier to be the epicenters of this disease. The challenge now is in Monrovia."
But the challenge came to a head last weekend when a mob of Monrovians overran an isolation facility in the slum known as West Point, moved out at least 17 suspected patients and their relatives, and made off with contaminated beds and other materials. Brown said that all 17 have since been found and sent to the John F. Kennedy Medical Center in Monrovia. But West Point's 50,000 people are now under quarantine.
It was especially frightening to one observer who watched last weekend's mob touching and holding the people leaving the facility, since one of the main weapons in staunching the spread of Ebola is to avoid direct contact with people who have the disease.
"You cannot touch your loved ones when they are dead," wrote Mohammed Fobio, a 24-year-old university student in Monrovia, in a letter published in the World Post. "You cannot even go to them. I mean you cannot even touch your sick father."
Fobio said the situation in his city, which "cannot even provide medication for its citizens under normal circumstances," is "terrifying."
Winning Over the Public
Enlisting the public to fight the disease, which is essential for containment, is falling short. Many people still think the outbreak is a hoax, a common response in this region to many public health programs.
A response system that is overwhelmed has not helped quell the rumors or ease frustration. Simply retrieving and burying the dead, for example, is a complicated process, with workers donning protective gear, taking great care in removing the body and delivering it to a cremation site, and spraying themselves with a disinfectant afterward.
It is hot, tedious work in a dangerous setting, and it requires great concentration. At the moment, it appears that the number of dead is outracing the response.
"At this time we do not understand the full extent of the outbreak in Liberia," says Joel Montgomery, who leads the U.S. Centers for Disease Control and Prevention's response team in Liberia. "We need a more complete picture to draw conclusions about how and why the outbreak is progressing."
He said the only way to get control of the wave of new cases is with better case identification and contact tracking. "Once cases are identified, we need to have Ebola treatment centers with adequate staff and supplies to care for them," he said, including personal protective gear, which is now in short supply. "That is how we have stopped all previous Ebola outbreaks, and it is how we will stop this one."