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| In Liberia, a Good or Very Bad Sign: Empty Hospital Beds | In Liberia, a Good or Very Bad Sign: Empty Hospital Beds |
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| SUAKOKO, Liberia — For days this month, the ambulances from the Ebola treatment unit here went out in search of patients, only to return with just one or two suspected cases. And many times, those people ended up testing negative for the disease. | |
| “Where are the patients?” an aid worker wondered aloud as colleagues puzzled over the empty beds at the International Medical Corps treatment unit here in Bong County, Liberia, which opened in mid-September. | “Where are the patients?” an aid worker wondered aloud as colleagues puzzled over the empty beds at the International Medical Corps treatment unit here in Bong County, Liberia, which opened in mid-September. |
| Around the country, treatment centers, laboratory workers who test for Ebola, and international and national health officials trying to track the epidemic have noticed an unexpected pattern: There are far fewer people being treated for Ebola than anticipated. | Around the country, treatment centers, laboratory workers who test for Ebola, and international and national health officials trying to track the epidemic have noticed an unexpected pattern: There are far fewer people being treated for Ebola than anticipated. |
| As of Sunday, fewer than half of the 649 treatment beds across the country were occupied, a surprising change in a nation where patients had long been turned away from Ebola units for lack of space. | As of Sunday, fewer than half of the 649 treatment beds across the country were occupied, a surprising change in a nation where patients had long been turned away from Ebola units for lack of space. |
| Now, new admissions to treatment centers are dropping or flatlining, the number of samples being submitted to Ebola laboratories has fallen significantly, and the percentage of people testing positive for the disease has dropped as well. | Now, new admissions to treatment centers are dropping or flatlining, the number of samples being submitted to Ebola laboratories has fallen significantly, and the percentage of people testing positive for the disease has dropped as well. |
| “The numbers are decreasing, but we don’t know why,” said Malin Lager, a spokeswoman at a Doctors Without Borders treatment center just outside Monrovia, the capital. Its vast campus of white tents, which has a capacity for 253 patients, had only 90 on Sunday. | “The numbers are decreasing, but we don’t know why,” said Malin Lager, a spokeswoman at a Doctors Without Borders treatment center just outside Monrovia, the capital. Its vast campus of white tents, which has a capacity for 253 patients, had only 90 on Sunday. |
| “It’s too early to celebrate,” Ms. Lager said. | “It’s too early to celebrate,” Ms. Lager said. |
| Liberia has long been a focal point of the Ebola epidemic, the nation with the most cases and deaths from the disease, prompting a global call to action. Hundreds of new beds have been added in recent weeks, but now many are going unfilled even before any of the 18 treatment centers being built by the American military have opened, leaving many officials here confounded. | Liberia has long been a focal point of the Ebola epidemic, the nation with the most cases and deaths from the disease, prompting a global call to action. Hundreds of new beds have been added in recent weeks, but now many are going unfilled even before any of the 18 treatment centers being built by the American military have opened, leaving many officials here confounded. |
| Some are debating whether the World Health Organization’s dire warnings about the epidemic — that there could be as many as 10,000 new cases each week in West Africa by December, about 10 times the rate it recently reported — might be grossly inflated. | Some are debating whether the World Health Organization’s dire warnings about the epidemic — that there could be as many as 10,000 new cases each week in West Africa by December, about 10 times the rate it recently reported — might be grossly inflated. |
| “The projections were based on nothing happening” to curb the outbreak, said the United States ambassador to Liberia, Deborah R. Malac, during a visit to the International Medical Corps treatment center this month. “More things are happening every day.” | “The projections were based on nothing happening” to curb the outbreak, said the United States ambassador to Liberia, Deborah R. Malac, during a visit to the International Medical Corps treatment center this month. “More things are happening every day.” |
| For now, most officials are continuing to plan for the worst so as not to interfere with the mounting international response, which is seen as critical to preventing a resurgence. Even a single unsafe burial, in which mourners touch a highly infectious corpse, can result in dozens of new cases. | For now, most officials are continuing to plan for the worst so as not to interfere with the mounting international response, which is seen as critical to preventing a resurgence. Even a single unsafe burial, in which mourners touch a highly infectious corpse, can result in dozens of new cases. |
| The empty beds in Liberia come in the context of an intense public health campaign to educate the nation about the dangers of the disease and ways of combating it — from posters and billboards to messages broadcast when residents make phone calls. | The empty beds in Liberia come in the context of an intense public health campaign to educate the nation about the dangers of the disease and ways of combating it — from posters and billboards to messages broadcast when residents make phone calls. |
| “Lonestar Cell cares about your health. Ebola is real,” one company’s recording says. | “Lonestar Cell cares about your health. Ebola is real,” one company’s recording says. |
| Some consider the latest developments an indication that the efforts to combat the virus, including the opening of new treatment units, are beginning to succeed. | Some consider the latest developments an indication that the efforts to combat the virus, including the opening of new treatment units, are beginning to succeed. |
| “We can see it subsiding bit by bit,” the Rev. Omalley M. Segbee told his congregation at Sunday services at Grace Baptist Church in the town of Gbarnga. “This means you are on our side, oh Lord.” | “We can see it subsiding bit by bit,” the Rev. Omalley M. Segbee told his congregation at Sunday services at Grace Baptist Church in the town of Gbarnga. “This means you are on our side, oh Lord.” |
| But because Liberians celebrated early once before — believing the virus had been eradicated in the spring, only to see it rage back with greater force in the summer — there is a near universal hesitance to call the outbreak under control. Liberia’s neighbors, Sierra Leone and Guinea, have been experiencing a troubling surge of cases in recent weeks. | But because Liberians celebrated early once before — believing the virus had been eradicated in the spring, only to see it rage back with greater force in the summer — there is a near universal hesitance to call the outbreak under control. Liberia’s neighbors, Sierra Leone and Guinea, have been experiencing a troubling surge of cases in recent weeks. |
| There is also the likelihood that many people dying of Ebola in Liberia are hidden from the authorities, as has been true throughout the epidemic. | There is also the likelihood that many people dying of Ebola in Liberia are hidden from the authorities, as has been true throughout the epidemic. |
| Many parts of the country are not well monitored, many contacts of Ebola patients are not traced, and officials have long acknowledged that the statistics on the numbers of Ebola cases across West Africa are rough estimates, at best. | Many parts of the country are not well monitored, many contacts of Ebola patients are not traced, and officials have long acknowledged that the statistics on the numbers of Ebola cases across West Africa are rough estimates, at best. |
| Treatment beds and laboratories in Liberia are also concentrated in the capital. Large swaths of the country are hours away from these centers on bad roads, in areas that lack cellphone services, which is why the new treatment centers being built far from other Ebola facilities are considered so important. | Treatment beds and laboratories in Liberia are also concentrated in the capital. Large swaths of the country are hours away from these centers on bad roads, in areas that lack cellphone services, which is why the new treatment centers being built far from other Ebola facilities are considered so important. |
| Many of the monitoring experts, too, are based in the capital. Months into the crisis, officials still remind themselves of the need to get out into the wider country to test their assumptions about the epidemic. But even in the capital, many Ebola patients are suspected to have died at home, leaving big gaps in data on the scope of the disease. | Many of the monitoring experts, too, are based in the capital. Months into the crisis, officials still remind themselves of the need to get out into the wider country to test their assumptions about the epidemic. But even in the capital, many Ebola patients are suspected to have died at home, leaving big gaps in data on the scope of the disease. |
| Anna Halford, a field coordinator for Doctors Without Borders, said the charity had a broad network of community members who promoted Ebola awareness in and around the capital. | Anna Halford, a field coordinator for Doctors Without Borders, said the charity had a broad network of community members who promoted Ebola awareness in and around the capital. |
| “Not a single one of the supervisors believes there is a significant drop in cases,” she said. | “Not a single one of the supervisors believes there is a significant drop in cases,” she said. |
| Families may keep sick relatives at home for many reasons, including rumors of mistreatment inside Ebola units and fears of quarantine and stigma, Ms. Halford said. Beyond that, “It is a disease that comes in waves because of the variability of the incubation period and because of the mobility of people.” | Families may keep sick relatives at home for many reasons, including rumors of mistreatment inside Ebola units and fears of quarantine and stigma, Ms. Halford said. Beyond that, “It is a disease that comes in waves because of the variability of the incubation period and because of the mobility of people.” |
| And then there are the known hot spots, where the virus continues to spread through families. | And then there are the known hot spots, where the virus continues to spread through families. |
| Last weekend, eight people from one community were admitted to the International Medical Corps treatment center. In another cluster, the mother and sister of a woman who died on her way here later became patients; the mother died last week. | Last weekend, eight people from one community were admitted to the International Medical Corps treatment center. In another cluster, the mother and sister of a woman who died on her way here later became patients; the mother died last week. |
| In the capital, teams in protective gear are supposed to pick up the dead and ensure they are cremated. But some families continue to conduct private burials, distrustful of the government’s handling of bodies. | In the capital, teams in protective gear are supposed to pick up the dead and ensure they are cremated. But some families continue to conduct private burials, distrustful of the government’s handling of bodies. |
| Matthew Siakor said he wore two pairs of gloves and a raincoat when he helped bury his mother, whose body had been spirited out of Monrovia by his younger brother. He said the choice to do so came after another family member died. | Matthew Siakor said he wore two pairs of gloves and a raincoat when he helped bury his mother, whose body had been spirited out of Monrovia by his younger brother. He said the choice to do so came after another family member died. |
| “After they took the body away and they did the testing, there were no results back to the family whether the body that was carried was an Ebola body,” he said, adding that he and his brother were voluntarily quarantining themselves now. “It is difficult for people to lose their loved ones, and they take them away and they can’t get the body.” | “After they took the body away and they did the testing, there were no results back to the family whether the body that was carried was an Ebola body,” he said, adding that he and his brother were voluntarily quarantining themselves now. “It is difficult for people to lose their loved ones, and they take them away and they can’t get the body.” |
| Community resistance to public outreach efforts also persists in some pockets. | Community resistance to public outreach efforts also persists in some pockets. |
| “People ran away,” the Rev. G. Victor Padmore, a member of an Ebola task force here, reported after visiting a community where there had been a case. Days later, in another district, he visited a family that had recently lost a 3-year-old child. | “People ran away,” the Rev. G. Victor Padmore, a member of an Ebola task force here, reported after visiting a community where there had been a case. Days later, in another district, he visited a family that had recently lost a 3-year-old child. |
| “They don’t want to accept the child died of Ebola,” he said. “I made them understand.” | “They don’t want to accept the child died of Ebola,” he said. “I made them understand.” |
| Some rural health workers say the outreach efforts have made residents more willing to report cases and seek treatment. | Some rural health workers say the outreach efforts have made residents more willing to report cases and seek treatment. |
| “It’s not as it was in August or September,” said Kollie Singbeh, an Ebola case investigator for Margibi County. | “It’s not as it was in August or September,” said Kollie Singbeh, an Ebola case investigator for Margibi County. |
| But Elvis Ogweno, a Kenyan nurse who heads the International Medical Corps ambulance team, said that several Ebola-affected communities he had visited still reacted with fear. | But Elvis Ogweno, a Kenyan nurse who heads the International Medical Corps ambulance team, said that several Ebola-affected communities he had visited still reacted with fear. |
| “They just took off to the forest,” he said. “You keep on shouting, ‘Is someone there? Is someone there?’ ” | |
| He sometimes drives five hours to reach communities, returning again and again until the resistance dissipates, often once someone is very ill. “After three days you go back and the patient is critical,” he said. “Now they want to come immediately.” | He sometimes drives five hours to reach communities, returning again and again until the resistance dissipates, often once someone is very ill. “After three days you go back and the patient is critical,” he said. “Now they want to come immediately.” |
| He warned the doctors here not to trust the perceived drop in cases. “I told them Ebola, from my five to six weeks of experience here, you find for three days there are no patients, and then it erupts again.” | He warned the doctors here not to trust the perceived drop in cases. “I told them Ebola, from my five to six weeks of experience here, you find for three days there are no patients, and then it erupts again.” |
| In part, that is because of the difficulty some of the sick have in finding help. “Some patients say, ‘Since two days ago I’ve been looking for assistance,’ ” he said. | |
| Last week, to better understand whether gaps in detecting and tracing cases might explain why treatment numbers are low, the W.H.O. sent experts to the country’s far-flung districts. | Last week, to better understand whether gaps in detecting and tracing cases might explain why treatment numbers are low, the W.H.O. sent experts to the country’s far-flung districts. |
| Employees of the United States’ Centers for Disease Control and Prevention also went out into communities to try to get a better understanding of the situation. Their conclusions are expected in the coming days. | Employees of the United States’ Centers for Disease Control and Prevention also went out into communities to try to get a better understanding of the situation. Their conclusions are expected in the coming days. |
| As Dr. Samson Arzoaquoi, who heads the Ebola task force in Bong County, bumped along a dirt road over the weekend, he said the area had been quieter. | As Dr. Samson Arzoaquoi, who heads the Ebola task force in Bong County, bumped along a dirt road over the weekend, he said the area had been quieter. |
| “This time is not yet a time for us to rejoice,” he warned a crowd gathered to begin an Ebola outreach program. “If we begin to laugh and celebrate, what will happen? We will go right back where we are coming from.” | “This time is not yet a time for us to rejoice,” he warned a crowd gathered to begin an Ebola outreach program. “If we begin to laugh and celebrate, what will happen? We will go right back where we are coming from.” |