August 21, 2014
Liberia set to overtake Sierra Leone in Ebola cases

Looking at the latest WHO Ebola figures it appears that Liberia will soon surpass Sierra Leone in Ebola cases. Reports from Monrovia indicate a desperate situation, considerably more so than in Sierra Leone. President Ellen Johnson Sirleaf Liberian President Ellen Johnson-Sirleafannounced a 9pm-6am curfew on Tuesday August 19 among the latest efforts to halt the spread of the disease. Over recent weeks reports from Monrovia indicate a near-breakdown in the health system. Most hospitals have been reported closed, following the infection of health workers and the abandonment of wards by patients. Dead bodies have been reported in the streets of Monrovia; burial teams appear not to have been well organized and accounts speak of bodies rotting in houses as frantic relatives call authorities for assistance.  This after having been warned not to touch the bodies of dead Ebola victims as they are highly infectious. At some point the task of burying bodies was handed over to the Ministry of Internal Affairs, who presumably had little experience in such tasks. As bodies piled up, authorities have hastily buried Ebola victims in a mass grave on the banks of a river close to areas where well water is widely used ( ) causing justifiable alarm among residents. The Liberian health minister himself went over the BBC to confess that his country is unable to cope with the situation. Liberian soldiers

Over the weekend in the Monrovia slum of West Point, rioters attacked a newly installed Ebola treatment center and looted items including potentially infectious mattresses and bed sheets.Following this, in her curfew announcement Johnson-Sirleaf also announced the quarantining of West Point, to be enforced by police and armed forces personnel. In subsequent rioting soldiers were forced to fire into the air to quell the protests.

Liberia appears to have now become the focal point of the outbreak. It was not so initially. For a time Liberia had the smallest number of cases of the three principally affected countries, and it looked as though the country would escape the outbreak relatively lightly. Whilst Guinea reported cases early Liberia after a handful of initial cases went many weeks without recording new cases. The table and chart below continue from the earlier versions published in  Chronology of the Ebola outbreak in West Africa.

Ebola Table wk 20
Compiled from WHO updates of laboratory confirmed cases.
Liberia Total records all cases including lab confirmed, probable and suspect while other rows record confirmed only.
* After review and consolidation on May 12

Why has Liberia's position deteriorated so? On review of various sources it does not appear that the country took the threat lightly initially, especially after its first handful of cases were discovered in Week 1. There are numerous reports of alerts and investigations within the country from this period on. However, after the first few cases were confirmed by the Guinean and European labs the US company Metabiota took over lab testing for Liberia ( )

Ebola Chart wk 20

For many weeks after this Liberia recorded no new cases of Ebola and upon review of existing cases even revised its numbers downwards. It was only in June, some three weeks after Sierra Leone had begun reporting cases that Ebola began to be rediscovered in Liberia. Then and up till now, whilst there were a large number of probable and suspected cases, the number of cases confirmed by laboratory testing was relatively small compared to the other two countries. This perhaps reflects the breakdown of the health care system in Liberia, as patients and medical staff abandoned hospitals and clinics. Because of the large number of probable and suspected cases in Liberia the chart and table above include data for total Liberian cases.

Sierra Leone’s situation appears a little better, although only time will tell The emergency measures were announced in Sierra Leone on August 7. With an incubation period of 2 to 21 days, one would expect to see a decrease in the number of new cases after this period IF  the measures are working. So far, approximately two weeks after the measures were introduced, there is no sign of this in the figures.