A Nigerian port health official speaks to a passenger at the arrivals hall of Murtala Muhammed International Airport in Lagos, Nigeria, Aug. 6, 2014.Sunday Alamba—AP
Nigeria’s most recent outbreak of Ebola is over, the nation’s government and World Health Organization (WHO) announced on Monday.
But — with fear of Ebola continuing to grip the world — what does that even mean? How does the WHO know that Nigeria is in the clear?
The answer, it turns out, is very specific: The WHO says a country can declare their outbreak to be over when it makes it through 42 days without a new case. That’s two incubation periods for the Ebola virus, so as long as 42 days have passed, during which the country had in place active surveillance and diagnostics but discovered no new cases, the WHO says it’s enough time to confidently say an outbreak is over. For health care workers to be considered “in the clear” they have to be monitored for 21 days after their last possible exposure to the virus, even if they were wearing full protective gear. Health care workers’ date of last contact is considered the day when the final patient with Ebola tests negative for the disease.
Inside the Ebola Crisis: The Images that Moved them Most
Pete Muller, Aug. 26, 2014. Sengema, Sierra Leone."The rain started shortly after a small team of Red Cross burial workers approached the body. The deceased man, reportedly in his mid-sixties, collapsed and died outside his remote home more than a day before the burial team arrived. Having received instructions from officials that bodies of Ebola victims are extremely contagious, his family members placed a sheet over his body, marked a cordon in the sand, and called the Red Cross. With approximately 20 burial workers serving all of Kailahun district, an area the size of Rhode Island and rife with Ebola, the team had a backlog of cases. His family endured the presence of his body, laying prone and exposed to the elements, for more than 24 hours. As the team removed the sheet, the stench of death filled the air. The white cloth around the man’s head was crimson with blood. As burial workers sprayed him with chlorine, family members erupted with emotion. I was moved imagining how I might respond if I were in the situation. To me, this picture represents the range of Ebola’s emotional impact. In the two women, we see the devastation and loss that the virus causes. In the faces of the men, we see a sense of despondence, disbelief and suspicion that also defines the response. It was a difficult but necessary picture to make."Pete Muller—Prime for the Washington PostKieran Kesner, Aug. 28, 2014. Monrovia, Liberia.
"This is a photograph of the first person I saw who had died from the Ebola virus in West Point, Monrovia. After the Liberian government mandated all schools be shut down in an attempt to stop the spread of the virus, the empty rooms of this school were converted into a temporary Ebola holding center. I entered the building alone and photographed the woman from a distance. I began to make my way closer to her, being careful to avoid the puddles of vomit and other pools of still liquid on the cement floor. Standing over her, I noticed the unbroken beads of sweat that remained on her face and realized the woman had only died a few hours before. I took a few steps back as a body removal team entered the room. Up until this point, to me, Ebola deaths seemed like statistics, but suddenly it had become real. I became enveloped in fear: fear of the invisible killer in the room, fear that I might have made a mistake, fear that I wouldn’t know for days whether or not I was sick, and fear that I would infect my family and loved ones. I desperately wanted to leave the room, to leave the country, to be home, but I couldn’t. I continued to photograph. I watched as the men burdened with the task of removing her body, clad all in angel white, lifted the woman from her mattress and placed her in a body bag on the floor. I photographed as they sprayed her one last time with disinfectant and zipped it shut."Kieran Kesner—The Wall Street JournalMohammed Elshamy, Aug. 25, 2014. Lango village, Kenema, Sierra Leone. "I arrived to Langtown village, Sierra Leone,with a team of volunteers from Kenema governmental hospital. They were there to bury Baindu-Koruma a female victim of the Ebola virus. Everyone was silent. She had been dead for two days, and everyone was terrified of going inside. As the volunteers left with the body, her husband, Idriss Koruma (who can be seen center) and relatives burst into tears. They had only realized then, it seemed, that she was gone.
The photo moved me because I felt helpless for the man – having a loved one laying on a bed but you can't say goodbye, as this is the least a human could do for one last time, but in a situation like this you can't because you'll probably get the virus and die as well."Mohammed Elshamy—Anadolu/Getty ImagesJohn Moore, Aug. 15, 2014. Monrovia, Liberia. "I arrived to Liberia the night before I entered the blue room. It was in a primary school, originally funded by USAID money, which had been closed due to the Ebola epidemic. The Liberian Ministry of Health had decided to open an Ebola observation ward there, and it was located in the West Point township of Liberia's capital of Monrovia. People were arriving to the school in ambulances and being brought in one by one. I photographed them as they made their way, weakly, into the dark building, which had neither electricity nor running water. The following day I returned to the school. I went back to the same blue room and, although the children had been moved to the classroom next door, new patients had arrived overnight. Two of them were now dead, lying on the floor, in pools of liquid. A third, a shirtless man named Ibrahim, sat near a column in the center of the room. Health workers asked him to try and move to another room, so they would be separated from the corpses lying nearby. I watched as Ibrahim struggled to rise. He got to his feet and began staggering towards the door. Just before he reached the threshold, he fell straight backwards, his head hitting hard on the concrete floor. His wife, Umu rushed into the room and stood over him, horrified, afraid to touch him, unsure what to do. A blank blackboard hung behind her on the wall."John Moore—Getty ImagesBenedicte Kurzen, September 2014."From early morning till late in the afternoon, we followed the Liberian Red Cross. They have a list of people who died and they go to their communities to collect the bodies. Every time the Red Cross workers do the same thing: they wear protective clothing, interview the family, spray the perimeter and the room, and the body. They carefully open the body bag, carry the body outside for pick up — sprayers and volunteers facing each other — and later remove their protective clothing as carefully as they can. Their work is measured, slow: any direct contact with the dead person's body can be dangerous. In this photo, it is all about the gesture. In this chlorinated, silent corridor, there is little else that can convey humanity besides this gesture. This is one human helping another."Benedicte Kurzen—NOORDominique Faget, Aug. 26, 2014. Bandor, near Monrovia, Liberia. "I went with a team from the Liberian Red Cross to Bandor from Monrovia to pick up five dead people who had been infected with the Ebola virus. After photographing the removal of three bodies, including a young pregnant woman, I followed the team to a small cottage house where we had heard the bodies of a dead couple were. Once there, one of the Red Cross team responsible for the removal of their bodies gestured to me, patting his heart — indicating that these people were still alive. I then approached and photographed this man lying silently in the doorway of his home. I wondered how many days this poor sick man, like hundreds of others, had been waiting alone?
Dominique Faget—AFPAhmed Jallanzo, Aug. 20, 2014. Monrovia, Liberia."Violence had broken out in the slum township of West Point as the government tried to quarantine tens of thousands of residents in order to stop the spread of the deadly Ebola virus. As I walked through the town to cover the reactions of residents towards security forces, I saw 15-year-old Shakie Kamara bleeding profusely, a pool of blood forming around him, with his right hand placed underneath his broken leg to keep it in balance. He was caught in clashes with police and had been shot. The ambulance service was somewhat slow to respond as he repeatedly cried for help. The tragic irony is that no one dared try to help for fear of contracting the Ebola virus from his blood and bodily fluids, as avoiding contact is one of the measures of preventing the disease from spreading.
Ahmed Jallanzo—EPATommy Trenchard, Aug. 20, 2014. Monrovia, Liberia.
"What's tragic about the case of 15-year-old Shackie Kamara is how needlessly he died. [He was shot in the legs during clashes with police]. Ebola didn't kill him, but the fear, panic and confusion it creates led to the circumstances in which he died. He is a symbol of what Ebola can do to a country or a community. The quarantine of West Point was heavily criticized and lifted shortly afterwards. It achieved little, and Ebola remains rife throughout the city. It is also telling that he died of a treatable wound. After health staff started getting ill and hospitals became seen as sites of infection, the whole health system collapsed. If you get sick or injured in Monrovia, there is simply nowhere to go."
Tommy Trenchard—NPRGlenna Gordon, Sept. 29, 2014. Monrovia, Liberia."Ebola is a disease that divides husband and wife, mother and child, doctor and patient. Health care workers in protective gear that look like space suits attend to patients. Men with chlorine spray-cans take away bodies. Families aren't given the chance to say goodbye to their loved ones. Because the virus is transmitted through touch, it overrides the basic human need for contact and connection. In this picture, health care workers hold hands and pray before doing the risky work of entering an Ebola isolation ward. They find a way to connect despite the layers of latex. No one wants to be alone when facing Ebola. I'm not a religious person. At times like this though, there's little to do but hold hands and pray for each other."
Glenna Gordon—The Wall Street JournalSylvain Cherkaoui, April 19, 2014. Gueckedou, Guinea."Doctors Without Borders sent me to Guekedou Forest in Guinea to cover the current Ebola crisis. After receiving an alert a team of doctors went to look for a woman who was exhibiting symptoms of the Ebola virus. When one doctor took her temperature, it was confirmed: she was infected and had to be admitted to the care center. After donning protective gear, I followed her into the field hospital and took this picture when health care workers told Finda that she had Ebola. What I did not know was that she had an extremely high viral concentration. The next morning, members of her family came to visit. Not long after, maybe minutes later, a nurse told me that Finda had died during the night. It happened so fast, I was shocked and deeply moved."
Following a call, an MSF team goes to consult Finda Marie Kamano, 33 years, she feels great weakness with vomiting and dysentery. With fever, and nose bleeds, what the symptoms are caused by the Ebola virus.
After giving her a little water to drink, the woman doctor must tell her that her test is positive to Ebola, Finda remains impassive, several members of his family have died during the last weeks.Sylvain Cherkaoui—Cosmos/Redux for MSF
“Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval,” said WHO in a statement. “WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over.”
This is not the first time WHO has declared Ebola outbreaks over using this particular standard — Senegal was declared Ebola-free on Oct. 17, and the strategy has proven effective in prior, unrelated, outbreaks.
In 1995, there was an Ebola outbreak in the country then called Zaire (today’s Democratic Republic of the Congo); it was declared clear on Aug. 25 of that year. The New York Timesreported at the time:
The World Health Organization declared today that an outbreak in Zaire of the deadly Ebola virus was officially over after killing 244 of its 315 known victims.
The United Nations agency, which is based here, said that 42 days, the equivalent of two maximum incubation periods, had passed without any new cases reported. It said it was still not known where the Ebola virus existed between human epidemics, although samples from some 3,000 birds and mammals collected in the Kikwit area, the center of the outbreak, were now being analyzed.
It’s important to have definitive parameters for declaring outbreaks over because, as the current and former outbreaks have shown, oftentimes an outbreak will appear to be extinguished, only to reappear in full force a couple weeks later. This past April, Guinea’s health ministry thought the outbreak was slowing, which turned out to be false; in the 1995 outbreak, public health experts were also fooled. As TIME reported:
For a while last week it looked as though the outbreak might soon be brought under control. The plague police-medical teams dispatched by who in Geneva, the Centers for Disease Control and Prevention (CDC) in Atlanta and other public health groups-had set up an effective isolation ward at the main hospital in Kikwit, where the first case had been identified. Belgium’s Doctors Without Borders (Medecins Sans Frontieres, or MSF) rushed in loads of gloves, gowns, masks and other essential equipment to restore hygiene to filthy clinics. But when the strike forces, aided by local medical students, fanned out through the countryside around Kikwit, trying to follow the path of the fever, it became clear that the danger was far from past.
In an announcement made Monday morning, WHO called Nigeria a “spectacular success story,” citing proof that Ebola can be contained. “The story of how Nigeria ended what many believed to be potentially the most explosive Ebola outbreak imaginable is worth telling in detail,” WHO says in a statement.
To read more about how Nigeria contained their most recent outbreak of Ebola, check out our coverage, here.
Inside the Ebola Crisis: The Images that Moved them Most
Pete Muller, Aug. 26, 2014. Sengema, Sierra Leone."The rain started shortly after a small team of Red Cross burial workers approached the body. The deceased man, reportedly in his mid-sixties, collapsed and died outside his remote home more than a day before the burial team arrived. Having received instructions from officials that bodies of Ebola victims are extremely contagious, his family members placed a sheet over his body, marked a cordon in the sand, and called the Red Cross. With approximately 20 burial workers serving all of Kailahun district, an area the size of Rhode Island and rife with Ebola, the team had a backlog of cases. His family endured the presence of his body, laying prone and exposed to the elements, for more than 24 hours. As the team removed the sheet, the stench of death filled the air. The white cloth around the man’s head was crimson with blood. As burial workers sprayed him with chlorine, family members erupted with emotion. I was moved imagining how I might respond if I were in the situation. To me, this picture represents the range of Ebola’s emotional impact. In the two women, we see the devastation and loss that the virus causes. In the faces of the men, we see a sense of despondence, disbelief and suspicion that also defines the response. It was a difficult but necessary picture to make."Pete Muller—Prime for the Washington PostKieran Kesner, Aug. 28, 2014. Monrovia, Liberia.
"This is a photograph of the first person I saw who had died from the Ebola virus in West Point, Monrovia. After the Liberian government mandated all schools be shut down in an attempt to stop the spread of the virus, the empty rooms of this school were converted into a temporary Ebola holding center. I entered the building alone and photographed the woman from a distance. I began to make my way closer to her, being careful to avoid the puddles of vomit and other pools of still liquid on the cement floor. Standing over her, I noticed the unbroken beads of sweat that remained on her face and realized the woman had only died a few hours before. I took a few steps back as a body removal team entered the room. Up until this point, to me, Ebola deaths seemed like statistics, but suddenly it had become real. I became enveloped in fear: fear of the invisible killer in the room, fear that I might have made a mistake, fear that I wouldn’t know for days whether or not I was sick, and fear that I would infect my family and loved ones. I desperately wanted to leave the room, to leave the country, to be home, but I couldn’t. I continued to photograph. I watched as the men burdened with the task of removing her body, clad all in angel white, lifted the woman from her mattress and placed her in a body bag on the floor. I photographed as they sprayed her one last time with disinfectant and zipped it shut."Kieran Kesner—The Wall Street JournalMohammed Elshamy, Aug. 25, 2014. Lango village, Kenema, Sierra Leone. "I arrived to Langtown village, Sierra Leone,with a team of volunteers from Kenema governmental hospital. They were there to bury Baindu-Koruma a female victim of the Ebola virus. Everyone was silent. She had been dead for two days, and everyone was terrified of going inside. As the volunteers left with the body, her husband, Idriss Koruma (who can be seen center) and relatives burst into tears. They had only realized then, it seemed, that she was gone.
The photo moved me because I felt helpless for the man – having a loved one laying on a bed but you can't say goodbye, as this is the least a human could do for one last time, but in a situation like this you can't because you'll probably get the virus and die as well."Mohammed Elshamy—Anadolu/Getty ImagesJohn Moore, Aug. 15, 2014. Monrovia, Liberia. "I arrived to Liberia the night before I entered the blue room. It was in a primary school, originally funded by USAID money, which had been closed due to the Ebola epidemic. The Liberian Ministry of Health had decided to open an Ebola observation ward there, and it was located in the West Point township of Liberia's capital of Monrovia. People were arriving to the school in ambulances and being brought in one by one. I photographed them as they made their way, weakly, into the dark building, which had neither electricity nor running water. The following day I returned to the school. I went back to the same blue room and, although the children had been moved to the classroom next door, new patients had arrived overnight. Two of them were now dead, lying on the floor, in pools of liquid. A third, a shirtless man named Ibrahim, sat near a column in the center of the room. Health workers asked him to try and move to another room, so they would be separated from the corpses lying nearby. I watched as Ibrahim struggled to rise. He got to his feet and began staggering towards the door. Just before he reached the threshold, he fell straight backwards, his head hitting hard on the concrete floor. His wife, Umu rushed into the room and stood over him, horrified, afraid to touch him, unsure what to do. A blank blackboard hung behind her on the wall."John Moore—Getty ImagesBenedicte Kurzen, September 2014."From early morning till late in the afternoon, we followed the Liberian Red Cross. They have a list of people who died and they go to their communities to collect the bodies. Every time the Red Cross workers do the same thing: they wear protective clothing, interview the family, spray the perimeter and the room, and the body. They carefully open the body bag, carry the body outside for pick up — sprayers and volunteers facing each other — and later remove their protective clothing as carefully as they can. Their work is measured, slow: any direct contact with the dead person's body can be dangerous. In this photo, it is all about the gesture. In this chlorinated, silent corridor, there is little else that can convey humanity besides this gesture. This is one human helping another."Benedicte Kurzen—NOORDominique Faget, Aug. 26, 2014. Bandor, near Monrovia, Liberia. "I went with a team from the Liberian Red Cross to Bandor from Monrovia to pick up five dead people who had been infected with the Ebola virus. After photographing the removal of three bodies, including a young pregnant woman, I followed the team to a small cottage house where we had heard the bodies of a dead couple were. Once there, one of the Red Cross team responsible for the removal of their bodies gestured to me, patting his heart — indicating that these people were still alive. I then approached and photographed this man lying silently in the doorway of his home. I wondered how many days this poor sick man, like hundreds of others, had been waiting alone?
Dominique Faget—AFPAhmed Jallanzo, Aug. 20, 2014. Monrovia, Liberia."Violence had broken out in the slum township of West Point as the government tried to quarantine tens of thousands of residents in order to stop the spread of the deadly Ebola virus. As I walked through the town to cover the reactions of residents towards security forces, I saw 15-year-old Shakie Kamara bleeding profusely, a pool of blood forming around him, with his right hand placed underneath his broken leg to keep it in balance. He was caught in clashes with police and had been shot. The ambulance service was somewhat slow to respond as he repeatedly cried for help. The tragic irony is that no one dared try to help for fear of contracting the Ebola virus from his blood and bodily fluids, as avoiding contact is one of the measures of preventing the disease from spreading.
Ahmed Jallanzo—EPATommy Trenchard, Aug. 20, 2014. Monrovia, Liberia.
"What's tragic about the case of 15-year-old Shackie Kamara is how needlessly he died. [He was shot in the legs during clashes with police]. Ebola didn't kill him, but the fear, panic and confusion it creates led to the circumstances in which he died. He is a symbol of what Ebola can do to a country or a community. The quarantine of West Point was heavily criticized and lifted shortly afterwards. It achieved little, and Ebola remains rife throughout the city. It is also telling that he died of a treatable wound. After health staff started getting ill and hospitals became seen as sites of infection, the whole health system collapsed. If you get sick or injured in Monrovia, there is simply nowhere to go."
Tommy Trenchard—NPRGlenna Gordon, Sept. 29, 2014. Monrovia, Liberia."Ebola is a disease that divides husband and wife, mother and child, doctor and patient. Health care workers in protective gear that look like space suits attend to patients. Men with chlorine spray-cans take away bodies. Families aren't given the chance to say goodbye to their loved ones. Because the virus is transmitted through touch, it overrides the basic human need for contact and connection. In this picture, health care workers hold hands and pray before doing the risky work of entering an Ebola isolation ward. They find a way to connect despite the layers of latex. No one wants to be alone when facing Ebola. I'm not a religious person. At times like this though, there's little to do but hold hands and pray for each other."
Glenna Gordon—The Wall Street JournalSylvain Cherkaoui, April 19, 2014. Gueckedou, Guinea."Doctors Without Borders sent me to Guekedou Forest in Guinea to cover the current Ebola crisis. After receiving an alert a team of doctors went to look for a woman who was exhibiting symptoms of the Ebola virus. When one doctor took her temperature, it was confirmed: she was infected and had to be admitted to the care center. After donning protective gear, I followed her into the field hospital and took this picture when health care workers told Finda that she had Ebola. What I did not know was that she had an extremely high viral concentration. The next morning, members of her family came to visit. Not long after, maybe minutes later, a nurse told me that Finda had died during the night. It happened so fast, I was shocked and deeply moved."
Following a call, an MSF team goes to consult Finda Marie Kamano, 33 years, she feels great weakness with vomiting and dysentery. With fever, and nose bleeds, what the symptoms are caused by the Ebola virus.
After giving her a little water to drink, the woman doctor must tell her that her test is positive to Ebola, Finda remains impassive, several members of his family have died during the last weeks.Sylvain Cherkaoui—Cosmos/Redux for MSF
