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
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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