5 Things I Learned In The World's Largest Ebola Outbreak
A long, long time ago (autumn of 2014), you may recall there was a worldwide panic over Ebola. While the threat of an outbreak in the USA was never more than an Internet meme, in West Africa, it looked like the fucking apocalypse.
Ebola, you see, thrives in bodily fluids -- ideally, human blood. It spreads by forcing the blood out of every orifice of its host's body, and then inducing violent tremors and spasms so that the victim sprays it on everyone around. In advanced stages, the hapless host lies in agonizing pain (described by victims as like being set on fire, inside and out) while the disease seeks to transmit itself through vomit, diarrhea, sneezes, or sweat. So now imagine what that's like to have everyone you know be doing that.
We spoke to Doug Woodhams, a Lieutenant Colonel in the Marine Corps reserves. He happened to be in Liberia when the outbreak occurred, and found himself at its epicenter. He told us ...
All It Takes Is One Infected Person To Unleash Chaos
The odd Ebola outbreak wiping out a small village is nothing new to Africa; the disease has flared up in the Congo almost every year since it was first discovered in 1976. What made the 2014 outbreak so devastating (and horrifying) was that, for the first time in history, it reached a major populated city. This was thanks to a terrified, sick young woman and Liberia's taxi system, which Doug described as "basically five people sitting on each other's laps in the back of a car."
"After the first few Liberian fatalities near the border," says Doug, "an exposed woman was put in quarantine and told to stay in the local hospital. So of course she snuck out in the middle of the night and caught a ride to the capital city, Monrovia. She was vomiting and had diarrhea in the back of the cab (with other passengers coming and going the whole time). Once in Monrovia, everyone went their separate ways."
Except for one notable passenger who decided to go all of those ways.
Doug, his fellow Marines, and the Liberian government were greeted the next day with the comforting knowledge that an unknown number of Ebola-exposed people were now loose and unchecked in a city packed with over a million people. And to finish off our Pandemic Movie Bingo sheet, the government immediately lied to try to cover up the danger of the situation. "Once word got out that there might be infected people in the city, the government -- like any government would have done -- simply announced, 'We've tracked them down. The situation is under control!'"
They hadn't, and it wasn't.
When the government says that they're handling an epidemic "by the book," the book in question shouldn't be The Stand.
"About a month later, Ebola cases started popping up everywhere. Remote villages were reporting numerous cases, but more alarming was that it was all over Monrovia. By April, it was getting our full attention." In mid-June, a little over two months after that fateful cab ride, more than 10,000 people were infected. Around that time, one of Liberia's top doctors (who was a former aide to the president) died -- the first Liberian doctor to succumb to the epidemic.
"There were now 50 to 60 new cases a day in Liberia -- not to mention cases were exploding in neighboring Sierra Leone and Guinea. The entire region couldn't ignore it at this point."
Controlling The Outbreak Falls To The Military -- Who Aren't Ready For It
Doug was in the country as an advisor to the local military, but immediately found that he and his fellow marines were tasked with controlling an apocalyptic situation. "Dealing with an uncontrolled outbreak of a deadly virus in a civilian population simply isn't something we train for. It was a case study in group fear. It felt like we were inside a movie. People's personalities emerged. Some were willing continue working alongside the AFL . Others nearly shut down. And of course some of our prankster Marines uploaded movies like Contagion and Outbreak to our shared folder."
Reminding us that we had to somehow maintain the calm without Morgan Freeman's voice at our disposal.
The plan handed down from their superiors was to stay in-country unless things started going completely to shit (like if the local population violently turned on the troops). They were told to maintain a three-foot buffer with all other humans at all times -- no handshaking, no high-fives, no congratulatory slaps on the butt, no handing money to the guy working the hot dog cart. No human contact, period.
"So ... you good?"
"If our guys were a bit nervous in our closed door settings, the AFL soldiers were downright near panic. Their family members were in the villages, walking around exposed corpses that were being eaten by dogs because health teams couldn't pick them up for days ... I was later told by an AFL Colonel, 'Had you guys pulled out, all our soldiers would have gone AWOL.' Since Liberian police were little more than unarmed volunteers, national security really fell to the AFL. The ultimate fear was that society would crumble into machete genocide while there was a biological terror running loose."
Then Ebola hit members of the Liberian military. These were the guys Doug and his men interacted with on a daily basis, and now some of them had a bloodborne murder pox. "There were 11 confirmed cases among the Liberians on the base where our team lived: eight soldiers and three of their dependents. The three dependents all died; seven of eight soldiers died. At this point, we had to watch what we said to our own families back home."
Then, Everything Falls Apart
Monrovia, like any city, has "good" and "bad" neighborhoods, and the distinction between the two is decided primarily by the inhabitants of the "good" ones. The neighborhood of West Point is the "bad part of town" in Monrovia. It is a slum, and it's also a peninsula "where 78,000 people live practically on top of each other, connected to the rest of the city by one road and two footpaths."
That "500 ft" measurement is not a typo. More than the entire population of Scranton, Pennsylvania lives here.
Now, the authorities didn't trust the people of West Point, because it was a high-crime area. And the people of West Point didn't trust the government, because they were the government. Simmering tensions came to a boil when the government set up an Ebola clinic in West Point.
"Given the distrust the West Pointers have of the government, the outcome was inevitable: A riot started up. One half of the mob was saying, 'There is no Ebola, it's malaria.' The other half said, 'We didn't have Ebola before -- now you set up this clinic and it's suddenly here.' The mob stormed the clinic where 17 confirmed cases were housed, replete with bloody mattresses and all the biohazards that come with an Ebola case. They grab these people and loot the clinic ... so now you've got bloody mattresses, blankets, and cases of Ebola loose all over West Point."
You get a good idea of where West Point was at for "bloody plague mattress" to have
been considered a viable looting target.
In response, the Liberian government told the military to come up with a plan of action for West Point, since the whole area was now filled with criminals and Ebola. Their immediate plan of action was as simple as it was evil: wall the whole neighborhood off and let them Ebola it out. "This is where I got with their operations officer and said, 'Shutting off West Point and doing a quarantine is a bad idea. You're just creating a situation where people are going to riot. You have Ebola all across Monrovia anyway, so you're not 'locking in' anything. What is gained by sealing off the whole peninsula?"
If your plan resembles a cliched movie government bad guy's plan, you need a new plan.
But despite the fact that Ebola was already rampant everywhere else, the Liberian government was really bullish on this quarantine idea. And from a military execution perspective, they pulled it off well ("By 4 a.m., they had a total lockdown in place for 78,000 people"). As Doug predicted, though, things quickly got out of hand. Somewhere around a dozen people drowned trying to swim out of the peninsula, and for weeks afterward, their corpses washed up on the city shoreline.
"Next morning, you have a mob forming at the barricade. By noon, they turned their anger inwards towards the mayor's house and started pelting it with rocks. The mayor, naturally, feared for the lives of herself and her family, so she called the police, who formed a geared-up react team that entered West Point and extracted them towards the barricade. Now you have thousands of people yelling: 'We're not going to stay locked down.'
Shockingly, this is not a sight that inspires a lot of calm in an angry and confused mob.
"They storm the gates with bottles, sticks, chairs ... The AFL soldiers fire warning shots. There are casualties among the soldiers, casualties among the civilians, and a 15-year-old kid ends up dying. The 'bad idea' prediction comes true: You're looking at this slum at the boiling point, and 30 scared soldiers with AKs holding the line. If the mob gets through, Monrovia's burning to the ground ... and no one's touching this country ever again."
But just as it looked like the Liberian government was determined to play the role of the bad guy in this disaster movie, along comes President Ellen Johnson Sirleaf. "The president of the country, to her credit, did something very atypical for African leaders: She showed up in person and walked the slums of West Point ... She calmed them down. The AFL started bringing in food and water. That settled things down a bit, and a couple weeks later, the government finally ate some crow and ended the quarantine altogether."
But this deep-rooted mistrust of authority wasn't finished claiming lives of infected victims ...
Paranoia Runs Rampant -- And Death Follows
This is how doctors look in an Ebola outbreak zone:
"Reassuring" might not be the right word.
Admit it, you'd probably freak a bit if you saw your primary care physician looking like that. These are clearly not "take two Aspirin and you'll be fine" outfits. Now imagine you're a rural African villager and these freaking guys say "trust me" and abduct your sick mom from your home. Mom never returns, and you can never see her body, and now aunt and uncle are getting sick ...
Looking like alien invaders has never been a good PR move.
"Westerners coming in spacesuits creep these people out, and they think, 'It's a Western plot to bring Ebola and wipe us all out.' So if you have a sick or dying family member, especially in remote areas, they don't have , they can't just walk into the ER. The local witch doctor will grind up some herbs and try to deal with it. In their tradition, a lot of their medicine is practiced through laying-on of hands."
Then the witch doctor gets sick, because although Ebola spreads only through direct physical contact, it's extremely efficient at doing that one job. And then another Westerner in a space suit comes to take him away. The locals quickly realize that when a spacesuit-person takes someone away, that person never comes back. "The villagers took umbrage. We had Western doctors coming under attack. Getting stones thrown at them. Machetes. Posturing and threats of violence. The point came when the Red Cross said, 'We're done. It's not worth it to risk our own personnel.' Then Samaritan's Purse folded their tents and left Liberia."
When killer plagues are the second most dangerous thing in your day job, you start updating your LinkedIn profile.
And while the situation was bad in Monrovia, it was damn near apocalyptic in the countryside. "In the briefings, we'd hear 'Such-and-such village in Lofa County facing extinction' because everyone in that village was potentially going to die." And that's the thing: Here in the U.S., news of the growing epidemic was met with countless memes and news articles drawing comparisons to the zombie apocalypse. For a few weeks, we were all addicted to the story because it was scary, but distant enough to be fascinating. But while the "threat" of Ebola was something that American talk show hosts could joke about, for Doug and his men, the human toll of the outbreak was all too real.
"I traveled with the AFL Colonel to hard-hit Bomi county to see how bad things were. We saw a family of about eight Liberians confined to an old government building. The villagers all avoided them, while some of the locally-stationed AFL soldiers had been leaving some of their own rations at the edge of the road for them to pick up. Naturally, we asked what happened. The one-year-old child had been discovered trying to nurse at the breast of her dead mother, who had just succumbed to Ebola. So now the family was faced with the dilemma of watching the child die of dehydration or die of Ebola -- whichever was less slow. The villagers decided to quarantine the entire family to the old government building, since no Ebola Treatment Unit (ETU) had yet been built in the area."
At this, Doug paused a moment. "I think of that family from time to time. I imagine they are all dead by now." This is a picture of that family:
At this point, the outbreak started hitting the one group that's most vulnerable, even though you'd never think of them that way: the doctors. Precautions only go so far when you're exposed to dozens of plague victims, day after day. Hundreds of doctors died in countries that weren't exactly overflowing with trained physicians to begin with.
So now you have additional deaths -- not only from Ebola, but also of people going untreated for flu, malaria, car crashes -- due to a lack of staff. "... doctors and nurses were getting Ebola so often that the rest weren't willing to come into work. One of the major hospitals had only a few janitors in it at one point." Remember the kid who died in that riot? He would've lived if there'd been any doctors to meet him at the hospital. "He had a badly fractured leg with loss of blood. There were no doctors to treat him. Those hospitals were ghost towns."
It Will Happen Again
In a country like the United States, which has easily available healthcare and rapid communication about outbreaks, it would be next to impossible for Ebola to get a foothold. In a third-world African nation, it's almost impossible to stop it. That's because both the treatment and the prevention are hard as hell.
For example, one of the most useful treatments for Ebola sufferers involves transfusions from people who have survived their own brushes with the disease. "A survivor's blood will have antibodies. It is pretty much the only viable transfusion for someone who will otherwise bleed to death. You can only get so much plasma, but what they really need is blood. People who survive Ebola are the only ones who can donate." And as you can imagine, that stuff doesn't exactly exist in abundance.
"We've got 16 donors and need 45,000 quarts of blood, so 'I'm scared of needles' isn't going to fly."
"Two Samaritan's Purse doctors caught it when it was spiking in Monrovia. They were the first two Americans to get it. The male is the one they put on the airplane -- some guy loaned his private jet to fly them to that Atlanta hospital. He arrived in a fully air-sealed moon suit, barely walking. But by then, he was already through the worst of it, because he had to be stable enough to make the flight."
And how did he get stabilized? Well, this doctor had earned some love from the locals after risking his life to save theirs for months at a time. He'd shown up and given fluids to the sick when no other foreign doctors would dare. One of his patients -- a young boy -- survived, and donated his antibody-rich blood to the doctor. "That's a big part of why he recovered -- by the time he got on the plane to Atlanta, the worst of it was past."
The surviving doctor went on to meet the president and speak before Congress.
The child donor, we assume, returned to his fortress of solitude to be recharged by Earth's yellow sun.
That all happened in 2014. Liberia got it under control. A death rate of 70 percent is certainly "under control" compared to past Ebola outbreak death rates of 90 percent or more, right? The good guys won! The Marines saved the day! Yay, us! But then this happened last month:
Doug is confident that it won't be like last time. "You can tell they're taking it seriously off the bat. Two casualties and it's big news. I think the public consciousness has been seared so badly. Everyone in the country has lost a relative. This time, they won't spend precious months trying to figure out if it is real or not."
Right now, they are also testing a vaccine that's showing promise -- enough that they've been cleared to start giving it to the most at-risk members of the population (those closest to existing victims), in hopes of keeping the disease from spreading. But until a vaccine can be developed and distributed freely to a bunch of poor people across the continent (at tremendous expense to somebody), the disease is never going to die out completely.
And that not even factoring whether Africa's Jenny McCarthy fan club chapter will start getting in people's heads.
"It will never go away -- it will always come back. That's why it comes in and out of the Congo with disturbing regularity. Once it's in a highly populated area, it'll never go away. It's in the DNA of the countryside now."
Robert Evans has a Twitter. Calix Lewis Reneau is working with Doug writing the feature film OUTPOST ECHO, the amazing true story of the USMC mission in Afghanistan. You can read his secrets to surviving depression in his book Dancing With The Black Dog and his secrets to surviving religion in his book Why I Hate Being A Christian.
Doctors working overseas have seen some shit, man. Find out what life is like in Caracas in 5 Harsh Truths You Learn As A Doctor In The Third World. Or find out what life is like when death is always looming in 6 Surprising Ways Life Looks Different With Terminal Disease.
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