Safe Practices Result in Quick Detection of New Confirmed Ebola Cases

ebola gloves
A burial team member tapes the gloves and sleeves together of another burial team member’s PPE so that skin is not exposed.

Safe Practices Result in Quick Detection of New Confirmed Ebola Cases

By: Katie Deierlein, Global Communities

On June 28th, an oral swab collected during the safe burial of a recently deceased 17-year old male’s body tested positive for Ebola. This was an immediate concern because it happened in Nedowein, Margibi County, Liberia. The country had been declared free of Ebola since May 9, and people had been enjoying Ebola-free status since then.

Global Communities has been involved in the Ebola response in Liberia for the last year, as part of the USAID/OFDA-funded Assisting Liberians with Education to Reduce Transmission (ALERT) program. In this case, as with thousands before it, Global Communities' burial team buried the body using safe and dignified protocols.

So despite there being an active, confirmed case, Liberians were assured that no one would be infected by participating in an unsafe burial. This is particularly important, since the body of an Ebola victim is most infectious after death.

In keeping with these safe practices, a Global Communities swab collector gathered a mouth-swab from the body before it had been buried, following safe protocol. This meant that the case could be confirmed as Ebola-positive in the first place, and that the person who collected the swab was not at risk of infection by simply conducting the collection. It also meant that, after being confirmed as a positive swab, the body could be retested.

This is yet another example of how Global Communities has helped contain the confirmed cases, thus ensuring that all safe practices, which were developed with the Ministry of Health, have been maintained throughout the entire period that Liberia was labeled free of Ebola.

On May 9, the day the World Health Organization declared Liberia to be free of Ebola, the whole country rejoiced. And, understandably, people relaxed. According to Sinéad Clear, Global Communities Logistics Manager:  “The first thing everyone did that day was to shake hands!”

ebola temperature
A traveler passing between Guinea and Liberia has his temperature checked and his name, age, destination, and temperature recorded at an official crossing point.

Liberians began to return to life as normal: washing their hands less frequently, and not hand-washing before entering all public buildings; less frequent temperature checks; and resuming consumption of bushmeat such as monkeys or bats.

But now, there are five confirmed cases of Ebola in Liberia.

Fortunately, the lessons learned while reaching zero the first time allowed the response systems to engage quickly. The current outbreak is contained and health officials are confident that onward transmission from these cases will be low.

Global Communities is just one part of that response; it immediately mobilized to support the Government of Liberia to prevent a potentially catastrophic 3rd phase of the epidemic. It relocated burial teams to be closer to the outbreak’s epicenter; is coordinating and providing supplies to screen travelers at checkpoints along domestic and international borders; is providing logistical support to deliver supplies to the homes of contacts and health facilities at risk; and continues to be responsible for safe burial teams. Each of these activities is critical to ensuring that high-risk contacts do not catch the disease.

Global Communities has been the largest partner of the Ministry of Health for dead body management throughout the crises, supporting a total of 72 teams in all 15 counties during the height of transmission. CDC has attributed many new infections from the unsafe handling of dead bodies or traditional burial practices that involve touching and washing the body prior to internment.

food purchased
Global Communities staff at the Red Light Market to buy food items and other supplies for the self-quarantined healthcare workers who cared for the patients that tested positive for Ebola.

By providing safe and dignified burial services, offered at hospitals, funeral homes, cemeteries and within communities, Global Communities is effectively cutting Ebola off at one of its sources. And by collecting oral swabs of nearly all dead bodies, Global Communities is identifying Ebola-positive patients before they can infect everyone in their households.

The four remaining patients are alive and being cared for in an Ebola Treatment Unit, where trained professionals are following strict hygiene protocols. All contacts of the confirmed cases, over 100 of them, are being monitored and many are voluntarily under “precautionary observation.” Global Communities and other entities provided food and supplies to 24 healthcare workers at two clinics. They are maintaining voluntary isolation, since they had contact with the confirmed Ebola cases, and they will need provisions while they complete their wait. Some acts, such as providing food and cooking supplies, are small but important to the overall response because it means that everyone is safer, starting with the most high-risk contacts.

Since the outbreak in Guinea and Sierra Leone is still active, with 20 new cases confirmed in the week ending June 28, Global Communities is continuing its border surveillance. Working closely with the County Health Teams and the Bureau of Immigration and Naturalization, Global Communities has stationed people at all international checkpoints and many internal checkpoints to take and record travelers’ temperatures and other information.

It is also working closely with communities that live near informal crossing points, which are used daily despite being unofficial, to do the same activities. This type of vigilance is identifying travelers that are exhibiting Ebola-like symptoms so that they can be tested and treated before infecting more people.

ebola checkpoint
Travelers pass through an international checkpoint between Bong County, Liberia and Guinea.

So far, this latest outbreak has been contained. This is due in large part to the quick and efficient response coordinated by the Incident Management System, presided over by the Ministry of Health and including partners like Global Communities. The widespread outbreak in 2014 was proof that Liberia needed to improve disease surveillance, and many of those systems were put in place during the past year.

Moving forward, Global Communities will continue to do the same activities – safe and dignified burials, swab collections and border surveillance – while learning from and adapting to the current outbreak. With these safety measures, and the relevant systems in place, Ebola can be contained. Montserrado County Burial and Disinfection Coordinator, Lorenzo Beyan, stated, “I am most proud of… our own response as Global Communities because if it hadn’t been for our team’s rapid response, we wouldn’t have even known that we had a confirmed case in Liberia. It is because of our swab collection that we know that there is a case. I am very proud that we can now detect and immediately respond to Ebola in this country.”