People Standing In Line To Collect Food In Liberia.
Health officials who fought Ebola during the world’s deadliest outbreak of the disease in Liberia, Sierra Leone and Guinea have resurrected the tools they used during that crisis to stave off the coronavirus. Initially this led to a swift and coordinated response, and these nations have kept the number of infections low compared to many other countries around the world. But coronavirus is presenting additional challenges, and cases are on the rise.
When COVID-19 first appeared in the region in mid- to late March, health officials employed the strategies honed during the 2014–16 Ebola outbreak, including isolating people who test positive for the virus and quarantining those who may have been in contact with it. These actions probably slowed the spread of the virus. The incidence of COVID-19 reported in the three West African countries — between 2 and 5 cases per 10,000 people — is at least 12 times less than in South Africa, and 22 times lower than the rate in the United States. “We had the experience of Ebola, so the political will was there from the start,” explains Mosoka Fallah, the director of the National Public Health Institute of Liberia.
But infection rates are rising, and for complex reasons. Researchers in these West African nations say that infections are hard to spot, owing to asymptomatic cases among the overwhelmingly young population. Another challenge is that the three countries are among the world’s poorest, and their health systems lack resources to protect staff and care for people with the disease.
Fallah says that slowing the transmission of the virus has become especially hard as it reaches impoverished communities without running water and electricity. There, people share latrines and wells, and go to markets regularly to purchase food that cannot be stored at home. He says, “My fear is that the coronavirus is beginning to spread from the affluent to the poor, where social distancing is almost impossible.”
Following China’s lead
As the coronavirus spread in January, Fallah met with Liberian President George Weah to form a coronavirus task force that included many of the same doctors and public-health experts who led the Ebola response. The group resurrected the main pillars of outbreak response. This included acquiring coronavirus tests from the World Health Organization (WHO), coordinating teams of people to trace contacts and communicating health messages to the public. In operation centres in the capitals of the three countries, each COVID-19 task force began to meet regularly to adapt responses to the latest situations, just as they had done during the Ebola outbreak.
Tolbert Nyenswah, the former director of Liberia’s public-health institute, says the US Centers for Disease Control and Prevention (CDC) had helped to teach health officials these methods during the Ebola outbreak. Now based in Baltimore, Maryland, as a researcher at Johns Hopkins University, Nyenswah says he was stunned that the CDC downplayed these essential procedures in its own country. “I was shocked to see the US struggling to understand what contact tracing is, to organize a response, to put in place risk communication,” he says.
Health workers in Guinea sanitizing people about COVID-19
The situation in Guinea is slightly different from its neighbours. Cases are twice as high, but the fatality rate as of 20 July is lower — just 0.6%. One reason for the larger epidemic could be political unrest. The media has reported the violent suppression of opposition groups before and after Guinean President Alpha Condé altered the constitution to extend his rule to a third term. And deaths might seem artificially low if people are dying at home, and not being tested. However, Billy Sivahera, a physician and public-health expert with the non-profit organization ALIMA, based in the Guinean capital, Conakry, says another reason could be that hospitals in the city are successfully treating severe cases — and they have sufficient room to treat many more. However, he says, “If the outbreak goes deeper into the country outside of Conakry, people won’t have the same access to good hospital care.”
The spread of the epidemic to rural regions worries researchers in Sierra Leone and Liberia, too, because of the weakness of clinical care outside cities. Nkengasong is calling on communities in Africa’s poorest nations to do all they can to stop the spread of the virus through social distancing, adhering to quarantines and wearing masks. The number of confirmed cases in sub-Saharan Africa rose by 27% in the second week of July, according to the WHO. “If we get to the situation of the United States and South Africa,” he says, “it will be impossible to catch up with testing and contact tracing.”