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Fear spreads as Ebola moves from remote areas into cities

Todd C. Frankel

The Washington Post

Published: Saturday, Aug. 30 2014 10:40 p.m. MDT

Liberian health workers outside a home of a man that they believed died from the Ebola virus in Monrovia, Liberia, Friday, Aug. 29, 2014. The Ebola outbreak in West Africa eventually could exceed 20,000 cases, more than six times as many as are now known, the World Health Organization said Thursday. A new plan released by the U.N. health agency to stop Ebola also assumes that the actual number of cases in many hard-hit areas may be two to four times higher than currently reported.

Abbas Dulleh, AP

Enlarge photo»

FREETOWN, Sierra Leone — The dreaded Ebola virus came to the children's hospital in the form of a 4-year-old boy.

His diagnosis became clear three days after he was admitted. The Ola During hospital — the nation's only pediatric center — was forced to close its steel gates. Fear swelled. The boy died. The 30 doctors and nurses who had contact with him were placed in quarantine, forced to nervously wait out the 21 days it can take for the virus to emerge. And remaining staff so far have refused to return to work. They, along with millions of others, are facing the worst Ebola outbreak in history. Already, the hardest-hit West African nations of Guinea, Liberia and Sierra Leone have reported more than 3,000 cases, including the infections of 240 health-care workers.

Ebola is now spreading from the remote provinces and into the teeming cities such as Freetown, where 1.2 million people jostle for space. Previous outbreaks had been limited to remote villages, where containment was aided by geography. The thought of Ebola taking hold in a major city such as Freetown or Monrovia, Liberia's capital, is a virological nightmare. Last week, the World Health Organization warned that the number of cases could hit 20,000 in West Africa.

"We have never had this kind of experience with Ebola before," David Nabarro, coordinator of the new U.N. Ebola effort, said as he toured Freetown last week. "When it gets into the cities, then it takes on another dimension."

The hemorrhagic fever has no cure. Odds of survival stand at about 50-50. Detection is difficult because early symptoms are hard to distinguish from those of malaria or typhoid, common ailments during the rainy season. While Ebola is not transmitted through the air like the flu, it does spread by close contact with bodily fluids such as blood, saliva and sweat — even something as innocent as a tainted tear.

Now it is headed to Freetown, where the streets hum with low-level panic. People long ago stopped shaking hands. Hugs are unheard of. Plastic buckets filled with a diluted chlorine solution are posted outside many businesses to encourage hand-washing. Some of these homemade solutions tingle and burn; others smell like aromatic cleansers. For a while, street peddlers, who normally sell peanuts or umbrellas from stacks balanced on their hands, sold surgical gloves, $1 each.

But the roads are still crammed with autos and people, stray dogs and wild chickens. Trucks with loudspeakers rumble down rutted roads."Wash your hands!" they announce in Krio. "Ebola is real!" shout banners strung throughout the city. Radio ads detail the virus' symptoms: headache, fever, nausea and vomiting. The government of Sierra Leone has been running these messages in the capital for months, just in case.

Sierra Leone's first case appeared in late May, in the distant Kailahun district. A month later, the country had 158 total cases. In late July, it was up to 533 cases. A national state of emergency was declared. Soldiers erected roadblocks to cordon off the rural epicenter, raising memories of the country's brutal civil war, which ended in 2002. Residents were ordered to stay at home for one day of prayer and reflection. An evangelist texted tens of thousands of people before dawn one morning, telling them to douse themselves in saltwater for protection from Ebola. People rushed into the streets, singing and washing.

"It looked like panic," said Killian Doherty, an Irish architect living in Freetown. "It's the kind of thing that makes you lose your bearings."

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