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Abbas Dulleh / AP

West Africa takes extreme steps, but still Ebola spreads

Governments have ordered quarantines but dense geography and fear of health care workers has hampered efforts

Nearly 900 people have died in West Africa as the world’s worst-ever Ebola outbreak continues to spread beyond the control of some of the world’s poorest countries.  

With fears mounting that the virus has overwhelmed the underfunded health care systems of Sierra Leone, Liberia and Guinea, the three governments have instituted widespread quarantines and other measures including closing schools and tracking citizens’ movements.

But as new deaths and infections are reported each day, some say the governments are doing too little too late to stave off the spread. Experts say it might take more extreme measures, like closing off entire countries for travel, to stop the infection in its tracks. But given the governments’ checkered record in containing the virus so far, in addition to the dense geography of the region, and people’s lack of education about the disease, it’s unclear whether West Africa would be capable of effectively instituting those more serious measures.

“They should have started quarantining entire areas months ago,” said Dr. Robert Garry, an expert in viral pathogens at Tulane University who has worked extensively in West Africa. “But it’s spread all over, so you’re essentially talking about quarantining entire countries if you want to contain it.”

The Ebola outbreak was first reported to have infected people in remote sections of Guinea by the country's Department of Health in March. It slowly spread to Liberia and Sierra Leone and has most recently reached Nigeria.

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Click for the latest news and analysis on the epidemic in West Africa.

One of the main reasons behind the spread of the virus is that West African and world leaders were slow to issue alerts and take action to stem its advance. The U.S. Centers for Disease Control and Prevention only issued a travel warning for the affected countries last week, when the death toll was already at several hundred.

Some critics say that the slow response allowed Ebola to spread farther than it would have if governments had taken action months ago. 

“Once this thing started it would’ve been quite easy to isolate those small areas in the rainforest,” said Lansana Gberie, a West African historian who works with international organizations including the U.N. “There was a lack of preparedness, a lack of organization, an initial failure to quarantine. They should’ve done it sooner, but better late than never.”

The governments of the three countries worst hit by the outbreak are now taking extreme measures to try and stop Ebola in its tracks.

Sierra Leone ordered all citizens to stay home from work and school on Monday, as members of the military were dispatched throughout the country to assist in cordoning off remote villages that are hotspots of the virus. The government also banned large public gatherings.

The Liberian government has also urged its citizens to avoid large public gatherings.

Guinea, Liberia, and Sierra Leone have also taken other tough measures like empowering militaries to search the houses of those they believe to be infected, and ordering families of Ebola patients to stay in their houses and report to health care workers for daily assessments.

The scale of the effort is unprecedented, but officials can only wait and see if the toughest of restrictions will work.

But some of the challenges are beyond governmental control: The geography of the region, for example, complicates the ability to seal off villages. While it's easy for critics to point to past Ebola outbreaks as a model for how to contain the virus, Garry says that this is the first outbreak outside of Central Africa, which is much less densely populated than the west of the continent.

“Central Africa has less people. Roads in between villages are not really even roads. It’s easier to put a ring around a village in Central Africa and shut off the village and keep the virus from spreading,” Garry said. “In West Africa, the villages are closer together. And the mining companies have come in and built good roads.”

Beyond the spatial and political limitations of the response, many say the biggest challenge is convincing West Africans that the quarantine is necessary.

Health and relief workers say those being asked to stay home to be monitored often leave to go to work or to visit family and friends.

“When someone is notified to stay indoors, the health care workers come back the next day and they’re often gone,” said Michael Stulman, who works in West and Central Africa for Catholic Relief Services and recently returned from a trip to Sierra Leone. “I think it’s a pretty critical ask, and it’s really important for containing the outbreak, but it’s not going to be easy. Obviously these people have livelihoods.”

Suspicion of health care workers, and even suspicion among some West Africans that Ebola isn’t a real virus, has seriously hampered relief efforts. Some health facilities have been attacked, as villagers believe they are responsible for spreading Ebola.

Those incidents make some worry that even with strict quarantines and adequate international support, the outbreak will continue for many months.

“Fear has taken over rationality,” said Monia Sayah, a nurse with Doctors Without Borders (MSF) who returned to New York from West Africa about two weeks ago. “This is a very new disease for West Africans and it’s a scary disease. It’s a violent virus. I think it would scare just about anyone. People don’t trust the health care system. They hide their family’s sickness. But in the meantime it’s creating a domino effect.”

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