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Wednesday, July 30, 2014

Liberia Closes Most Borders, Bans Large Gatherings as Toll Mounts; CDC Issues Health Alert, but Calls Risk to U.S. Low


West Africa Strains to Contain Ebola Virus

 

Liberia Closes Most Borders, Bans Large Gatherings as Toll Mounts; CDC Issues Health Alert, but Calls Risk to U.S. Low

 

By Drew Hinshaw in Gombe, Nigeria, and ·  @drewfhinshaw


Betsy McKay in Atlanta  in the Wall Street Journal


The worst ebola outbreak in history has prompted Liberian officials to close their borders, as the governments in several West African countries raced to convince many of their citizens that ebola is a real disease. What is Ebola? How is it spread? http://blogs.wsj.com/briefly/2014/07/28/ebola-how-the-virus-could-spread-beyond-africa/

Liberia closed most of its borders on Monday as West African governments struggled to prevent the spread of the extremely deadly Ebola virus, which has infected more than 1,000 people in three countries this year.

Closing a country's borders for an infectious disease is uncommon, but illustrates the level of frustration government and health officials are experiencing as the deadly outbreak rages through its fifth month, having infected at least 1,201 people and killing 672. The moves follow the death of one of Liberia's top doctors over the weekend, as well as news that two U.S. health-care workers working in Liberia have been infected.

Those cases and the continuing outbreak prompted the Centers for Disease Control and Prevention in Atlanta on Monday to issue a health alert to U.S. health-care professionals to be on the lookout for patients who have traveled to West Africa recently and exhibit possible symptoms of Ebola—including fever, headache and diarrhea.

The agency also issued a "Level 2" travel notice warning visitors to avoid contact with the blood and bodily fluids of infected people—one level below a recommendation to avoid nonessential travel to the affected countries.

"It's a rapidly changing situation and we expect there will be more cases in the coming weeks and months," Stephan Monroe, deputy director of the CDC's National Center for Emerging and Zoonotic Infectious Diseases, said of the latest outbreak.

Liberian President Ellen Johnson Sirleaf ordered traffic to be channeled through a few entry points where people can be monitored and tested for Ebola. She said the airport would remain open, with passengers similarly screened. Arik Air Ltd., West Africa's largest carrier, canceled flights to Liberia on Sunday in response to the epidemic.

The president also banned large gatherings such as demonstrations. She is considering quarantining certain urban neighborhoods, said Tolbert Nyenswah, the assistant health minister.

Still, the CDC said there is little risk to the U.S.

"We do not anticipate this will spread in the U.S. if an infected person is hospitalized here, but we are taking action now by alerting health-care workers in the U.S. and reminding them how to isolate and test suspected patients while following strict infection-control procedures," CDC Director Tom Frieden said.

Ebola is spread through close contact with the blood or other bodily fluids of an infected person, or through indirect contact like a needle prick, the CDC said—meaning family members and health-care workers are most at risk. Infection as a fellow airplane passenger is unlikely. Moreover, the vast majority of flights to the U.S. from West Africa aren't direct, the CDC pointed out.

The two Americans, Kent Brantly and Nancy Writebol, are experiencing body aches, vomiting, diarrhea and fever after testing positive for Ebola, according to a spokeswoman for Samaritan's Purse, a Boone, N.C., charity with which both have been working. Both are in isolation in a hospital near Monrovia, where they are receiving intravenous fluids and pain management, said the spokeswoman, Rachael Mills.

Early, aggressive treatment can improve the outcome for an Ebola patient, medical experts say.

It isn't known how the two became infected. Dr. Brantly, 33 years old, of Fort Worth, Texas, has been in Liberia since October as part of a postresidency program and was treating Ebola patients, Ms. Mills said. Ms. Writebol is a volunteer who was helping to spray down medical personnel as part of the decontamination process after visiting Ebola patients, Ms. Mills said. Ms. Writebol and her husband came to Liberia from Charlotte, N.C., in 2013 as part of a missionary group.

Dr. Brantly's wife and two children had been visiting him in Liberia and left before he began showing symptoms. While people aren't contagious until they develop symptoms, the family is being monitored for fever for 21 days, the incubation period for Ebola, Dr. Monroe said.

As for remaining staff in Liberia, "we are closely monitoring everyone working," said Ms. Mills, adding that Samaritan's Purse workers already take extensive precautions, including wearing spacesuit-like protective gear and a half-hour decontamination in bleach baths after patient visits.

A viral disease that can kill as many as 90% of those it infects, Ebola took root in Guinea roughly five months ago and spread quickly across West Africa's porous borders to neighbors Liberia and Sierra Leone.

The outbreak has been raging off and on ever since, frustrating health officials on the ground and internationally who are up against sizable populations that move between countries and cities and harbor suspicions of Western medicine. Local belief systems encourage family members to care personally for the infected sick and engage in burial rites that bring them in contact with the still-contagious deceased.

While Ebola has caused more than 20 outbreaks in central Africa since it was first identified in 1976, it is new to West Africa and has proved to be a much greater challenge to control. President Sirleaf Johnson's moves will be difficult to enforce in a country where even many government workers haven't accepted the existence or epidemiology of the virus as scientific fact.

Local pastors and medicine makers have all claimed the power to cure the disease, facilitating its spread. Liberian officials on Monday were hoping that the rising death toll had begun to persuade Liberians otherwise.

"I'm not sure people are prepared to stay in a state of denial for much longer," said the president's spokesman Jerolinmek Piah. "There'll be a change in attitude."

Funerals in particular are a point of transmission: Custom among West Africa's Muslim population holds that bodies should be buried within 24 hours of death, with family members often handling the corpse.

Government attempts to alter funeral rites meet resistance from Liberians who refuse to let doctors in protective suits deal with the bodies of their loved ones. Quarantining sections of the capital, Monrovia, a densely packed city of 1.2 million people, would prove difficult as neighborhoods blend together, demarcated from one another by hard-to-police back alleys cutting between shacks.

And even convincing Liberians that Ebola exists remains a challenge in a country where rumors fill the void left by the lack of formal education. Large numbers there believe Ebola is an evil spirit. One Liberia senator recently called it a scam by his government.

"People love rumors," said Mr. Nyenswah, the assistant health minister. "We're trying to do what we can."

Liberian government workers have been screening videos showing the effects of the disease in local movie theaters. The government has been airing constant radio spots explaining the Ebola virus. It has helped to change minds, Mr. Nyenswah said.

 

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