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Liberia to be declared Ebola free, but risk of disease's legacy goes on

West African nation will have reached the WHO benchmark of no new cases in 42 days on Saturday

Liberia is set to be declared free from Ebola on Saturday after 42 days without a new case. But while the country celebrates the official end of the outbreak, the virus's presence in the eye of a U.S. patient thought to have recovered underscores how it continues to dumbfound its victims and public health officials alike.

Completion of the World Health Organization’s benchmark for the end of the epidemic has been welcomed, but aid agencies used the occasion to warn against complacency.

“We can’t take our foot off the gas until all three countries record 42 days with no cases,” said Mariateresa Cacciapuoti, head of Medicins Sans Frontieres (MSF) mission in the country.

She urged Liberia to step up cross-border surveillance to prevent Ebola slipping back into the country.

Liberia will have to remain alert to two threats — the possibility that someone with Ebola might get into the country under the radar, and the risk of "small flare-ups" as seen in other outbreaks, according to David Nabarro, the United Nations' special envoy on Ebola. 

"My colleagues in Liberia told me that they expect to be keeping extensive surveillance and practicing precautions for probably as long as one year," Nabarro said.

At the height of the crisis in late September, the epidemic saw more than 400 cases a week, with uncollected and highly infectious bodies piling up in the streets of the capital, Monrovia. But shortly afterward, the gruesome tally fell to 100 cases per week and into single figures weekly by the start of 2015.

Some 4,700 people were killed in Liberia during the epidemic, according to WHO statistics, out of 10,564 probable, confirmed and suspected cases identified by the organization. In total, the virus has killed more than 11,000 people, mostly in the West African countries of Sierra Leone, Guinea and Liberia. 

The epidemic also devastated Liberia’s health care system, which was stretched even before the crisis. The hospitals and health clinics —some 50 doctors and 1,000 nurses provide care for 4.3 million people —lost 189 health workers to the virus.

Schools remained shut after the summer holidays, unemployment soared as the formal and black-market economies collapsed. And clinics closed as staff died and non-emergency healthcare ground to a halt.

And then the virus began to retreat. In large part, health care experts credit the massive emergency response effort by international NGOs for stemming Ebola — groups such as MSF, WHO, and the International Red Cross, which were initially criticized as slow to respond to the epidemic, as were Western industrialized countries.

But surviving the disease does not guarantee a healthy recovery. Survivors of the disease have reported chronic pain, headaches, and eye inflammations, according to a study by the Journal published on Thursday.

U.S. health officials drew attention to those complications on Thursday when doctors at Emory University Hospital in Atlanta announced that Ebola had been detected in the eyes of a patient, months after the virus had disappeared from his blood.

Ian Crozier, a physician who contracted the virus in September while handling Ebola patients Sierra Leone, was treated for ocular disease at the Emory several months after treating Ebola patients while working with the WHO. An analysis of his left eye, whose iris had turned green over the course of 10 days, revealed the presence of Ebola strains in the ocular fluid. It was not detected in his tears or the tissue around his eye.

Doctors believed Crozier did not pose a risk of infecting other people, but ophthalmologist Steven Yeh said the case shows that survivors of the virus should be monitored for possible eye infection. It is not known how long this condition can last. 

After undergoing treatment with a variety of medicines, Crozier began to recover his vision but it has still not retuned to normal.

Al Jazeera and wire services

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