Responder discusses effort to control Ebola outbreak in Liberia

Thomas Kirsch, M.D., M.P.H.
Thomas Kirsch, M.D., M.P.H.

An expert in disaster management and science who responded to the Ebola outbreak in Liberia said the disease had essentially been eradicated there.

Thomas Kirsch, M.D., M.P.H., director of the Center for Refugee and Disaster Response and an associate professor of emergency medicine at Johns Hopkins University, traveled to Monrovia, the Liberian capital, to work in an emergency operations center during the crisis late last year. He presented the W. Kendall McNabney, M.D., Lecture at the School of Medicine on April 30.

The largest Ebola outbreak ever recorded primarily affected the West African countries of Liberia, Sierra Leone and Guinea. More than 10,000 people died, according to the World Health Organization. “We went from a small, isolated outbreak of a very scary disease, that is a horrible way to die, that has a mortality rate of up to 90 percent, to this massive outbreak, which clearly caught the attention of the world,” Kirsch explained.

When he arrived in Liberia, Kirsch said he expected to find himself in a “zombie apocalypse.” Instead, he found that life in Monrovia was relatively normal. Shops were open, and people were going about their daily lives.

But there were washing stations with bleach solution in front of every building. Also, hand shakes and other forms of touching were forbidden, which Kirsch found disorienting. “Try to go through life like that,” he said. “It’s very odd, it’s very disturbing. But that’s the way people lived there.”

Kirsch was modest and stressed that the focus of his efforts in Liberia was on public health and that he did not provide clinical care. “I was a bureaucrat,” he said.

The United States spent hundreds millions of dollars and deployed troops to Liberia, a historical ally, when estimates suggested failure to act would result in 1 million people in West Africa becoming infected. But the disease was on the wane before the military opened its first treatment center. “Clearly, it was not the Ebola treatment beds that turned this epidemic,” Kirsch said.

What had changed was people’s behavior, Kirsch said. In addition to hand washing stations, isolating the sick and safer burial practices helped to bring the disease under control. “When a first spike occurs in your community, and you watch your neighbors vomiting on the street and dying, you change your behavior,” Kirsch said.

Kirsch said the competence of the political leaders and public health officials in Liberia was key to the social mobilization and education efforts. While there have been no known community transmissions in 80 days, a Liberian woman’s infection was confirmed in March. It is believed she contracted Ebola from unprotected sex with a man who survived the virus. The virus has been found in the semen of some men who have recovered from the infection. “This disease is now endemic in West Africa,” Kirsch said.

Kirsch, however, sounded optimistic that an Ebola vaccine would be developed eventually. “Ebola is a stupid little virus,” he said. “It’s not HIV.”