According to the World Health Organization, deaths from the year-plus outbreak of Ebola now exceed 10,000. But as of Friday, March 13 it has been three weeks since a new transmission was confirmed in Liberia.
A team of Reuters reporters — or their headline editor — summarize Liberia’s key lessons-learned as watch carefully and explain frequently. Both depending on (and potentially contributing to) trust-building community engagement.
Liberia was hit hard and, the nation’s President admits, slow to react. But what seems to now differentiate Liberia’s — tentative — eradication from continuing (if much slowed) transmission in neighboring Sierra Leone and Guinea has been the accuracy of “contact-tracing” — essentially a mapping of personal relationships and movement related to any confirmed transmission.
This is classic public health practice. But to actually do it depends on a shared sense of solidarity… community… common cause… and community-oriented organization that cannot be taken for granted.
The recent measles outbreak in the United States demonstrates the epidemiological challenges that can emerge from a break-down of trust in communities. I am intrigued (tempted?) with analogies to public safety and counter-terrorism challenges. Many historians of community policing trace its origins to public health models. But I will not go there today.
Overall, this second wave of H7N9 influenza viruses represents “a major increase in genetic diversity” compared with the viruses in the first wave, the study authors wrote. Unless live poultry markets are permanently closed, merchants stop transporting chickens from region to region, and other control measures are put in place, the virus will “persist and cause a substantial number of severe human infections.” So far, most people were sickened by handling infected chickens; cases of the virus spreading directly from person to person have been limited. That might change if the virus mutates, as happened with the H1N1 swine flu pandemic that began 2009.
In any case, Ebola is not the only potential epidemic (upon, on, among the people) to present a risk.
This may only be a projection of preconceived bias, but in trying to discern what is different in the experience of Liberia and Sierra Leone, I perceive a bottom-up strategy in Liberia and a top-down strategy in Sierra Leone. Trust-building has been a challenge in both countries. But the bottom-up strategy (or emergence?) in Liberia has been much more effective. As a hypothesis to be tested, I would suggest the top-down strategy in Sierra Leone has potentially been as “effective” in suppressing a more sustainable bottom-up approach.
And I surmise this could have implications far-beyond Ebola.