Story highlights
Liberia has gone without a new case for 42 days, twice the maximum incubation period
"The road to zero has been long and hard," says Dr. Thomas Frieden, director of the CDC
Guinea and Sierra Leone each had nine new cases last week
(CNN) —
After losing more than 4,000 people to Ebola, Liberia has now been declared free of the disease by the World Health Organization (WHO).
I wish I were there to hug the wonderful people I met when I visited at the height of the epidemic in September, when any contact, even shaking hands, was forbidden.
It was a horrible time. Ebola patients stood in line to get into hospitals that didn’t have a bed to spare. Thousands of children in West Africa were orphaned. Burial teams roamed the streets carrying victims to crematoriums.
“We went through just a horrific epidemic,” said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, who visited the country in August. “It’s a searing memory that many of us will carry with us for the rest of our lives.”
Something else is seared in my mind, too: the realization that smart people failed to stop this epidemic before it got so terribly out of hand. The outbreak started in March, and when I arrived six months later, the response was still clumsy.
Officials in Monrovia, including ones from the WHO, held an elaborate opening ceremony for an Ebola hospital, but then a few hours later when patients arrived, no one came out to help them. Weakened by the virus, the patients fell out of ambulances onto the ground.
A doctor in a rural county begged authorities for an Ebola hospital, but no help arrived. He was forced to build one himself, where he managed to save many patients.
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John Bonifield/CNN
Dr. Gobee Logan worked around the clock to help fight Ebola in Bomi County, Liberia.
In another part of Liberia, a woman couldn’t find space in the hospital for her four Ebola-stricken relatives and was forced to take care of them at home by herself. She had no protective gear, and so suited up in trash bags to keep herself safe. Why was gear unavailable? It was just one of many unanswered questions during my time there.
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John Bonifield/CNN
Fatu cared for four of her family members with Ebola, keeping three alive without infecting herself. Her trash bag method was taught to others in West Africa who couldn't get personal protective equipment.
Larry Gostin, faculty director of the O’Neill Institute for National & Global Health Law at Georgetown University, gives the world an “F” for the initial response to Ebola.
“If the world had mobilized rapidly and decisively, we could have saved 10,000 lives, great human hardship, and enormous health and social costs in three of the poorest countries in the world,” he wrote CNN.
Three reasons are often given for this poor initial response: Ebola hit big cities, where people live in close quarters; the West African countries have a dangerous lack of doctors, nurses, laboratories and supplies; and it was difficult to convince people to put a halt to the tradition of washing their dead relatives before burial, which spread the virus.
While all of those are true, there was something else going on.
Frieden describes how back in March of last year, he tried to get his teams into Guinea, where the outbreak started, but he says WHO leaders there wouldn’t let them in.
“We got all these crazy questions, like ‘We’re not sure your team is qualified, send us more CVs,’ and ‘We’re not sure when would be a convenient time for you to come,’” he said.
Frieden Intervened, calling WHO officials in headquarters in Geneva. “That’s really unusual, for me, at my level, to have to call and say, ‘Let my staff in,’” he said. “There’s been maybe one other instance where I had to do that in my six years as director of the CDC.”
In July, the CDC was allowed to ramp up the response, sending 50 staffers in just 10 days and 100 total by the end of the month.
“But our team was not particularly welcome there,” he said. “It was not a very comfortable situation.”
The problem, he says, was that WHO leaders in Africa failed to appreciate the severity of the outbreak and were overconfident they could handle it on their own. “We were surging into the area and the WHO said, ‘We don’t need you,’” he said.
As those issues resolved in the late summer and fall, the CDC and others could move in and do their jobs. Gostin gives this “late, belated response” an “A.”
It eventually worked. Liberia has gone without a new case for 42 days, twice the maximum incubation period, which is why it’s now deemed free of Ebola.
“The road to zero has been long and hard,” Frieden said.
Guinea and Sierra Leone each had nine new cases last week, a dramatic decline from last fall when each week saw hundreds of new cases.
There’s currently an internal and external review of the WHO Ebola response. “What WHO did or did not do will be examined by this commission and the results will be made publicly available for all to see,” said WHO spokesman Tarik Jasarevic. “In parallel, we are currently undergoing an independent evaluation of our response chaired by Dame Barbara Stocking.”
And the organization is already making reforms to respond more rapidly and effectively to public health emergencies. “We have an extensive program of work to implement these changes and will be reporting to the World Health Assembly later this month,” Jasarevic wrote CNN.
But Gostin is concerned WHO won’t do enough.
“I believe firmly that the world remains unprepared for the next epidemic,” he wrote to CNN. “The next epidemic, moreover, could be far worse than Ebola, and we are not well prepared.”
Photos: The Ebola epidemic
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An Ebola survivor participates in a study in Monrovia, Liberia, on June 17, 2015. The country launched a five-year study to unravel the mystery of the long-term health effects that plague survivors of the viral disease. Since the epidemic started more than a year ago in a remote village in Guinea, more than 11,000 people have died, the vast majority in three West African nations, according to the latest numbers from the World Health Organization. And that number is believed to be low, since there was widespread under-reporting of cases, according to WHO.
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Women in Monrovia celebrate after the World Health Organization declared Liberia Ebola-free on May 9, 2015. Other cases have recurred since, however. Two people in Liberia have died of the disease since the end of June, just weeks after the WHO declared the nation free of the disease.
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A man walks past an Ebola awareness painting in Monrovia on March 22, 2015.
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Soldiers from the U.S. Army's 101st Airborne Division walk across the tarmac at Campbell Army Airfield before reuniting with their families at a homecoming ceremony March 21, 2015 in Fort Campbell, Kentucky. The 162 soldiers were deployed in Liberia, where they helped fight the spread of Ebola.
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Relatives weep for a loved one who it was believed died from Ebola, at a graveyard on the outskirts of Monrovia on March 11, 2015.
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Doctors Without Borders staffer Alex Eilert Paulsen watches as mattresses and bed frames burn at the Ebola Treatment Unit in Paynesville, Liberia, on January 31, 2015. The organization reduced its number of beds from 250 to 30 as gains were made in battling the virus.
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Pauline Cafferkey, a Scottish woman diagnosed with Ebola, is put on a plane in Glasgow, Scotland, on December 30, 2014. Cafferkey, a 39-year-old nurse who volunteered in Sierra Leone, was being transported to London for treatment.
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A child who survived the Ebola virus is fed by another survivor at a treatment center on the outskirts of Freetown, Sierra Leone, on November 11, 2014.
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Abbas Dulleh/AP
Health workers in Monrovia cover the body of a man suspected of dying from the Ebola virus on October 31, 2014.
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Robert F. Bukaty/AP
Kaci Hickox leaves her home in Fort Kent, Maine, to take a bike ride with her boyfriend on October 30, 2014. Hickox, a nurse, recently returned to the United States from West Africa, where she treated Ebola victims. State authorities wanted her to avoid public places for 21 days -- the virus' incubation period. But Hickox, who twice tested negative for Ebola, said she would defy efforts to keep her quarantined at home.
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Health officials in Nairobi, Kenya, prepare to screen passengers arriving at the Jomo Kenyatta International Airport on October 28, 2014.
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U.S. President Barack Obama hugs Ebola survivor Nina Pham in the Oval Office of the White House on October 24, 2014. Pham, one of two Dallas nurses diagnosed with the virus, was declared Ebola-free after being treated at a hospital in Bethesda, Maryland. The other nurse, Amber Vinson (not pictured), was treated in Atlanta and also declared Ebola-free.
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Health workers in Port Loko, Sierra Leone, transport the body of a person who is suspected to have died of Ebola on October 21, 2014.
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Health workers bury a body on the outskirts of Monrovia on October 20, 2014.
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Garteh Korkoryah, center, is comforted during a memorial service for her son, Thomas Eric Duncan, on October 18, 2014, in Salisbury, North Carolina. Duncan, a 42-year-old Liberian citizen, died October 8 in a Dallas hospital. He was in the country to visit his son and his son's mother, and he was the first person in the United States to be diagnosed with Ebola.
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Boys run from blowing dust as a U.S. military aircraft leaves the construction site of an Ebola treatment center in Tubmanburg, Liberia, on October 15, 2014.
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Aid workers from the Liberian Medical Renaissance League stage an Ebola awareness event October 15, 2014, in Monrovia. The group performs street dramas throughout Monrovia to educate the public on Ebola symptoms and how to handle people who are infected with the virus.
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Ebola survivors prepare to leave a Doctors Without Borders treatment center after recovering from the virus in Paynesville, Liberia, on October 12, 2014.
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A man dressed in protective clothing treats the front porch of a Dallas apartment on October 12, 2014. The apartment is home to one of the two nurses who were diagnosed with Ebola after treating Thomas Eric Duncan, a Liberian national who traveled to Dallas and later died from the virus.
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A woman crawls toward the body of her sister as a burial team takes her away for cremation October 10, 2014, in Monrovia. The sister had died from Ebola earlier in the morning while trying to walk to a treatment center, according to her relatives.
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A man digs a grave on October 7, 2014, outside an Ebola treatment center near Gbarnga, Liberia.
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A person peeks out from the Dallas apartment where Thomas Eric Duncan, the first person diagnosed with the Ebola virus in the United States, was staying on October 3, 2014.
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A girl cries as community activists approach her outside her Monrovia home on October 2, 2014, a day after her mother was taken to an Ebola ward.
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A health official uses a thermometer September 29, 2014, to screen a Ukrainian crew member on the deck of a cargo ship at the Apapa port in Lagos, Nigeria.
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Workers move a building into place as part of a new Ebola treatment center in Monrovia on September 28, 2014.
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Medics load an Ebola patient onto a plane at Sierra Leone's Freetown-Lungi International Airport on September 22, 2014.
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A few people are seen in Freetown during a three-day nationwide lockdown on September 21, 2014. In an attempt to curb the spread of the Ebola virus, people in Sierra Leone were told to stay in their homes.
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Supplies wait to be loaded onto an aircraft at New York's John F. Kennedy International Airport on September 20, 2014. It was the largest single shipment of aid to the Ebola zone to date, and it was coordinated by the Clinton Global Initiative and other U.S. aid organizations.
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A child stops on a Monrovia street September 12, 2014, to look at a man who is suspected of suffering from Ebola.
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After an Ebola case was confirmed in Senegal, people load cars with household items as they prepare to cross into Guinea from the border town of Diaobe, Senegal, on September 3, 2014.
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A health worker wearing a protective suit conducts an Ebola prevention drill at the port in Monrovia on August 29, 2014.
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A burial team from the Liberian Ministry of Health unloads bodies of Ebola victims onto a funeral pyre at a crematorium in Marshall, Liberia, on August 22, 2014.
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Dr. Kent Brantly leaves Emory University Hospital on August 21, 2014, after being declared no longer infectious from the Ebola virus. Brantly was one of two American missionaries brought to Emory for treatment of the deadly virus.
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An Ebola Task Force soldier beats a local resident while enforcing a quarantine on the West Point slum on August 20, 2014.
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Local residents gather around a very sick Saah Exco, 10, in a back alley of the West Point slum on August 19, 2014. The boy was one of the patients that was pulled out of a holding center for suspected Ebola patients after the facility was overrun and closed by a mob on August 16. A local clinic then refused to treat Saah, according to residents, because of the danger of infection. Although he was never tested for Ebola, Saah's mother and brother died in the holding center.
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Workers prepare the new Ebola treatment center on August 17, 2014.
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Liberian police depart after firing shots in the air while trying to protect an Ebola burial team in the West Point slum of Monrovia on August 16, 2014. A crowd of several hundred local residents reportedly drove away the burial team and their police escort. The mob then forced open an Ebola isolation ward and took patients out, saying the Ebola epidemic is a hoax.
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A health worker disinfects a corpse after a man died in a classroom being used as an Ebola isolation ward August 15, 2014, in Monrovia.
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Aid worker Nancy Writebol, wearing a protective suit, gets wheeled on a gurney into Emory University Hospital in Atlanta on August 5, 2014. A medical plane flew Writebol from Liberia to the United States after she and her colleague Dr. Kent Brantly were infected with the Ebola virus in the West African country.
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Members of Doctors Without Borders adjust tents in the isolation area in Kailahun on July 20, 2014.
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Boots dry in the Ebola treatment center in Kailahun on July 20, 2014.
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Dr. Jose Rovira of the World Health Organization takes a swab from a suspected Ebola victim in Pendembu, Sierra Leone, on July 18, 2014.
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Red Cross volunteers disinfect each other with chlorine after removing the body of an Ebola victim from a house in Pendembu on July 18, 2014.
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A scientist separates blood cells from plasma cells to isolate any Ebola RNA and test for the virus April 3, 2014, at the European Mobile Laboratory in Gueckedou, Guinea.
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Health specialists work March 31, 2014, at an isolation ward for patients at the facility in southern Guinea.