An epidemic of Ebola virus disease occurred in Liberia from 2014 to 2016, along with the neighbouring countries of Guinea and Sierra Leone. The first cases of virus were reported by late March 2014. The Ebola virus, a biosafety level four pathogen, is an RNA virus discovered in 1976.
Before the outbreak of the Ebola epidemic the country had 50 doctors for its population of 4.3 million. The country's health system was seriously weakened by a civil war that ended in 2003.
History
West African outbreak
Researchers generally believe that a two-year-old boy, later identified as Emile Ouamouno, who died in December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea, was the index case of the current Ebola virus disease epidemic. His mother, sister, and grandmother then became ill with similar symptoms and also died. People infected by those initial cases spread the disease to other villages. Although Ebola represents a major public health issue in sub-Saharan Africa, no cases had ever been reported in West Africa and the early cases were diagnosed as other diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.
Start of outbreak: 2014
On 30 March 2014, Liberia confirmed its first two cases of Ebola virus disease in Foya, Lofa County.
Early events
By 23 April, thirty-four cases and six deaths from Ebola in Liberia were recorded. By 17 June, sixteen people had died from the disease in the country. The initial cases were thought to be malaria, an extremely common disease in Liberia, and thus leading to doctors being infected with the Ebola virus.
By 17 June, the first deaths occurred in Monrovia from Ebola when seven patients died from the disease. Among them was a nurse, along with other members of her household. At the time, there were about 16 cases reported in Liberia in total. The nurse was treated at Redemption Hospital, a free state-run health care facility in New Kru Town, west of Monrovia.
On 2 July, the head surgeon of Redemption Hospital died from the disease. He was treated at the JFK Medical Center in Monrovia. Following his death Redemption Hospital was shut down, and patients were either transferred or referred to other facilities in the area. By 21 July, four nurses at Phebe Hospital in Bong County contracted the disease. On 27 July, Samuel Brisbane, one of Liberia's top doctors, died from Ebola. A doctor from Uganda also died from the disease. Two U.S. health care workers, one a doctor (Kent Brantly) and the other a nurse were also infected with the disease. Both of them missionaries, they were medically evacuated from Liberia to the US for treatment where they made a full recovery.
By 28 July, most border crossings had been closed, with medical checkpoints set up at the remaining ports and quarantines in some areas. Arik Air suspended all flights between Nigeria and Liberia. On 30 July, Liberia shut down its schools in an attempt to prevent the outbreak from spreading.
August
On the first weekend of August, locals quarreled with a burial team trying to bury 22 bodies. The police were summoned and order was restored. On 4 August, the Liberian government ordered all corpses of those who died to be cremated. The body of a patient who died from Ebola is highly contagious in the days following the death. At the time, there were 156 recorded deaths from the disease in Liberia.
On 11 August, the Ivorian government announced the suspension of all flights to and from countries affected by Ebola. Ten days later, it decided to close its borders as well with Guinea and Liberia, the two countries most affected by Ebola. On 27 August, wild dogs were seen eating the corpses that had not been collected for burial. A pack of dogs were observed digging up bodies and eating them in Liberia. One study indicated that dogs may eat at Ebola-infected carcasses and may become carriers of the disease.
West Point quarantine (19–30 Aug)
On 18 August, a mob of residents from West Point, an impoverished area of Monrovia, descended upon a local Ebola clinic to protest its presence. The protesters turned violent, threatening the caretakers, removing the infected patients, and looting the clinic of its supplies, including blood-stained bed sheets and mattresses. Police and aid workers expressed fear that this would lead to mass infections of Ebola in West Point.
On 19 August, the Liberian government quarantined the entirety of West Point and issued a curfew statewide. Violence again broke out on 22 August, after the military fired on protesting crowds. An inquiry into the incident found the security forces at fault, stating they "fired with complete disregard for human life". The quarantine blockade of the West Point area was lifted on 30 August. The Information Minister, Lewis Brown, said that this step was taken to ease efforts to screen, test, and treat residents.
September
By 1 September, Ivory Coast announced the opening of humanitarian corridors with its two affected neighboring countries.
On 20 September, Liberia opened a new 150-bed treatment unit clinic in Monrovia. At the opening ceremony of the Old Island Clinic on Bushrod Island six ambulances were already waiting with suspected Ebola patients. More patients were waiting by the clinic after making their way on foot with the help of relatives. Two days later 112 beds were already filled with 46 patients testing positive for Ebola, while the rest were admitted for observation. This expanded the number of beds in the city beyond 240. Its capacity was exceeded within 24 hours with a shortage of staff and logistics to take care of a patient with correct precautions in place. One source says it opened on 21 September 2014, with a 100-bed capacity. As of 23 September, there had been 3,458 total cases, 1,830 deaths, and 914 lab confirmed cases according to the World Health Organization.
By late September, there were three clinics in Monrovia. Despite this patients waiting to be treated died outside as the clinics had run out of space to treat the increasing number of patients. If patients could not get a bed in the clinic they sometimes waited in holding centers until a bed opened up. There were additional cases in Monrovia where the bodies were dumped into the river. One woman used trash bags to protect herself as she cared for four other family members ill with Ebola. Her father became ill in late July, but they could not find a place of treatment for him and ended up doing home-care.
On 25 September, Liberia's chief medical official went on a self-enforced quarantine after her assistant died from the disease, fearing she might have been accidentally exposed to the virus. By 29 September it was announced she tested negative for Ebola and government officials praised her for following the self quarantine protocol.
A few days later, on 28 September Ivory Coast resumed flights to Liberia which had been suspended since 11 August 2014, after WHO's critique for tending to economically strangle the affected nations. From the beginning of the crisis, WHO has discouraged closing the borders with affected countries.
On 30 September, a cameraman was tested positive for Ebola in a Texas hospital after contracting the disease before traveling back to the United States from Liberia. He covered the Ebola outbreak for NBC News (see 2014 Ebola virus cases in the United States). Following this the Liberian government enacted strict restrictions on journalistic coverage aimed at protecting patients' privacy.
October
In early October, Ellen Johnson Sirleaf, the President of Liberia, continued requesting more aid to fight the disease. On 2 October, a new 60-bed clinic was opened in Kenema. By then, the outbreak was described as being out of control and an exponential growth in cases was seen. The focus shifted to slowing the outbreak down. A key element was that the health care establishments were overwhelmed thus leading to those infected being turned away from treatment centers. This eventually led to the infection of others taking care of sick or dying patients at home.
By 3 October, at least eight Liberian soldiers died after contracting the disease from a female visitor. On 3 October more medical supplies arrived from Germany. On that same day Gerlib opened up an Ebola isolation ward at its 48-bed facility in Paynesville (Monrovia).
On 10 October all journalists were banned from entering Ebola clinics.
On 14 October, a hundred U.S. troops arrived in Liberia, bringing the total to 565 to aid in the fight against the deadly disease. On 16 October, U.S. President Obama authorized, via executive order, the use of National Guard and reservists in Liberia. A report on 15 October indicates that Liberia may need 80,000 more body bags and about 1 million protective suits for the next six months. In October, WHO pushed for its 70-70-60 plan to control the outbreak. By 19 October, it was reported that 223 health care workers had been infected with Ebola, and 103 of them had died in Liberia.
On 19 October, the President of Liberia apologized to the Mayor of Dallas, for the Liberian national that brought the disease to the United States. By 19 October, only one area in Liberia, Grand Gedeh County, had yet to report an Ebola case. 14 out of the 15 districts have reported cases. The disease had been noted to be spreading in Monrovia, the nation's capital with over one million inhabitants. Monrovia was particularly affected with 305 new cases reported in the week ending 19 October.
November
By 5 November, Liberia had 6,525 cases (including 1,627 probable, 2,447 suspected cases) and 2,697 deaths.
The 5 November WHO situation report noted that, "There appears to be some evidence of a decline at the national level in Liberia, although new case numbers remain high in parts of the country." A report by CDC released on 14 November, based on data collected from Lofa county, indicates that there has been a genuine reduction in new infections. This is credited to an integrated strategy combining isolation and treatment with community behaviour change including safe burial practices, case finding and contract tracing – this strategy might serve as a model to implement in other affected areas to accelerate control of Ebola. Roselyn Nugba-Ballah led the Safe & Dignified Burial Practices Team for the Liberian Red Cross and was awarded the Florence Nightingale Medal for her work during the crisis in 2017.
On 13 November, the Liberian President announced the lifting of the state of emergency in the country following the decrease in the number of new cases in the country. The decline in Liberia cases was contradicted in reports from WHO with 439 new cases reported between 23 and 28 November.
December
On 4 December, it was reported that President Sirleaf banned all rallies and gatherings in Monrovia before the senatorial election, fearing that the risk of the Ebola virus spreading may be increased.
Outbreak continues: 2015
On 13 January 2015, the Liberian government announced that new cases of Ebola in Liberia were now restricted to only two of its counties: Grand Cape Mount County and Montserrado County. On 28 January, the ELWA-3 Ebola treatment centre in Monrovia was partially dismantled. When the centre opened in August it had been swamped with patients, even needing to turn some away, but according to staff it was now down to only two patients. The MSF field coordinator said that as of that date Liberia was down to only five confirmed cases in all of Liberia. On 30 January, Liberia extended school reopenings by two weeks. On 10 February, the U.S. military indicated it would end its relief mission. On 20 February, Liberia opened its land borders.
In the first week of March, the World Health Organization announced that Liberia had released its last Ebola patient after going a week without any new cases of the virus being reported. If the country had reported no new cases for 42 days, it would be declared Ebola-free according to the WHO.