TIME ebola

Liberia’s Children Go Back to School but Ebola Is Not Over Yet

Students stand in line before heading to their classrooms at Don Bosco High School in the Liberian capital Monrovia on Feb. 16, 2015.
Zoom Dosso—AFP/Getty Images Students stand in line before heading to their classrooms at Don Bosco High School in the Liberian capital, Monrovia, on Feb. 16, 2015

All across Liberia, streets are filled with the excited laughter of children returning to school after a six-month hiatus. The children, decked in the smart cotton uniforms of both public and private schools, line up in front of their classrooms to wash their hands in chlorine solution and wait to get their temperatures read by teachers wielding infrared thermometer guns.

Once inside they will pick up lessons abandoned in August, when an Ebola epidemic cut a swath through the country, infecting nearly 9,000 and killing at least 3,826. “The Ebola outbreak has had a devastating effect on our health and education systems and our way of life in Liberia,” Liberia’s Minister of Education Etmonia Tarpeh said in a statement. “We have managed to beat back the spread of the virus through collective efforts. Reopening and getting our children back to school is an important aspect of ensuring children’s education is not further interrupted.”

Ebola taught the nation to fear contact, to avoid unnecessary gatherings and to distrust a government and an international community that seemed both unwilling and unable to bring the crisis to an end. But with the start of school — deemed safe by the Ministry of Education, even though the virus has not been completely eradicated from the country — Liberians are regaining a sense of normalcy and can allow themselves to hope for a time when Ebola is little more than a bad memory. “It’s a good sign,” says school nurse Iris Martor. “We can’t let down our guard, but we can start thinking about the future again.”

Not all schools have opened. Some have yet to receive basic sanitation kits from the government and the U.N. Children’s Fund, and others are still being cleaned up and disinfected after having served as holding centers for the ill. Some, like Martor’s More Than Me Academy, which serves underprivileged girls from Monrovia’s West Point slum, won’t open their doors until March 2.

Schools have already reopened in neighboring Guinea, where the outbreak started in late 2013, and are expected to open in Sierra Leone, which has seen the highest number of infections, at the end of March. Of the three most affected countries, Liberia has recovered the quickest. It has seen just a handful of new cases every week since January, compared with an increase from 39 to 65 new cases in Guinea and 76 new cases in Sierra Leone in the week ending Feb. 8, according to the World Health Organization (WHO). Still, it’s a dramatic decline compared with the hundreds of new cases every week during the peak of the epidemic in September and October.

On Monday, officials in the three countries announced that they had set a target of reducing the number of new cases to zero within 60 days. It is an achievable goal, but similar targets have been set in the past, only to be undermined by a sudden flare-up in unexpected areas.

Ebola, which kills nearly half its victims, is spread through contact with infected bodily fluids. Practices like the washing of the dead are deeply ingrained in West African society; all it takes is one improperly conducted funeral for a new chain of transmission to start, undermining weeks of work. The WHO, in its most recent assessment, noted that Guinea reported a total of 34 unsafe burials last week.

Elsewhere in the country, village mobs attacked health workers from the Red Cross and Doctors Without Borders, accusing them of bringing the virus. Sierra Leone was forced to quarantine a fishing community in the capital, Freetown, after the discovery of a cluster of five new cases. “We are very, very far from the end of the outbreak,” Iza Ciglenecki from Doctors Without Borders told reporters at a science conference in California on Saturday. For most illnesses, it is enough to get the number of cases down to a low rate for doctors to be satisfied they have an infectious disease under control. Not so for Ebola. Until the number of new cases stays at zero for 42 days — twice the maximum incubation period — no one can afford to let their guard down, not even the students washing their hands in chlorine in the schoolyard.

TIME Liberia

Schools in Liberia Reopen After a Six-Month Closure Due to Ebola

Liberia Ebola West Africa
Abbas Dulleh—AP Liberian school children wash their hands before entering their classrooms as part of the Ebola prevention measures at Cathedral High School as students arrive in the morning to attend class in Monrovia, Liberia, Feb. 16, 2015.

Cases of the deadly virus have been in decline over the past few weeks

After a six-month closure due to the Ebola epidemic, many schools in Liberia reopened their classroom doors on Monday.

Before lessons began, pupils lined up to wash their hands in chlorinated water while teachers took their temperatures as part of new safety measures, reports the BBC.

Though students were excited to get back to school, some were worried that the virus had not been completely eradicated.

Liberia was one of the worst affected countries by Ebola with at least 3,800 people killed. However, there has been a general decline of the deadly disease in recent weeks.

According to the World Health Organization, only three new confirmed cases were reported in Liberia in the week leading to Feb. 8.

The reopening of schools comes a day after leaders of the three worst affected West African states — Liberia, Guinea and Sierra Leone — vowed to achieve “zero Ebola infections within 60 days,” during a meeting in the latter on Sunday.

[BBC]

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After Ebola: See Life Returning to Normal in Liberia

After more than 3,600 deaths, Liberians are now looking at the future with optimism

With the number of new Ebola cases in decline in Liberia — in the last week of January, only five new infections were reported — the West African country is slowly returning to life as usual, as Getty Images photographer John Moore witnessed on his latest trip there.

It was August 2014 when Moore first visited Liberia. At that time, the country grappled with the deadly epidemic, as well as the terrorizing fear it engendered. The 47-year-old photographer spent a month documenting some of Liberia’s darkest hours – his harrowing images forever seared in readers’ minds.

This past month, as Moore returned to Liberia, he looked to bring the story full circle. “I tried to turn the focus from death to life,” he tells TIME. “I felt I owed that to the story, the people there — and to myself. The photos we make now live forever on the Internet — and also within ourselves. Those previous visits produced some very dark moments in pictures, and in my own memories. This time, I reached more toward the light.”

There’s no denying that the situation in Liberia was catastrophic last year. “There was so much fear during the height of the epidemic,” says Moore. “The only way to stop the spread of the virus was for people to stop touching each other, especially in times of sickness and death.”

As a result, Liberians had to demolish their own social fabric: raised in a very tactile culture, suddenly they had to be suspicious of any person displaying symptoms, and stop embracing each other altogether.

But on his most recent trip, Moore witnessed a marked change in behavior. “Seeing people interact again as physically affectionate human beings was most inspiring to me,” he says. “I photographed a wedding reception, where everyone openly embraced; beaches, where Monrovians relax on Sunday afternoons, enjoying the sun and playing soccer; groups posing together for photos; church services, students registering for schools due to open this month.”

Of course, Liberia is still not in the clear. “There is still the danger that the epidemic could resurge,” says Moore. “So all deaths, both of natural and unnatural causes, are being treated with extreme caution. The Liberian Red Cross burial teams continue to wear personal protective equipment to collect bodies. Only now, instead of sending them for cremation, they take the deceased to the new cemetery and families are permitted to watch the ‘safe’ burials.”

This has helped quash the epidemic in the capital, says Moore, “as many families were reluctant to give up their dead for cremation,” because it doesn’t conform with tradition.

Today, with many more Ebola treatment centers in place than at the height of the outbreak, there is no shortage of care for those infected. “The aid has greatly helped in treating those who come down with Ebola in recent months and in bringing the numbers of new infections down so much,” says Moore. “In addition to the Ebola centers, most Liberian clinics and hospitals that treat people for both routine and emergency health problems have reopened, although a critical shortage of doctors persists nationwide.”

On his last day in Liberia, Moore visited Redemption Hospital, a treatment center in the capital city of Monrovia that became one of the country’s most notorious Ebola holding centers. “This time, mothers were bringing in their infants for routine vaccinations and people were being cared for,” he says. “Also in Redemption, the National Institutes of Health launched its Ebola vaccination trials. Though too late to help the victims of this past outbreak, if the vaccine is successful, it could save thousands of lives next time — and with Ebola, there will be a next time.”

John Moore is a staff photographer with Getty Images.

Phil Bicker, who edited this photo essay, is a senior photo editor at TIME.

Olivier Laurent is the editor of TIME LightBox. Follow him onTwitter and Instagram @olivierclaurent

TIME portfolio

The Best Pictures of the Week: Jan. 30 – Feb. 6

From New York’s deadly train crash and night surfing in the Mediterranean sea to China’s traditional eagle hunters and a Fifty Shades of Grey inspired “Fifty Shades of Cake” exhibition in England, TIME presents the best pictures of the week.

TIME ebola

The First Ever Large-Scale Ebola Vaccine Trial Begins in Liberia

Health workers take temperature of boy who came in contact with woman who died of Ebola virus in Paynesville neighborhood of Monrovia
James Giahyue—Reuters Health workers take the temperature of a boy who came in contact with a woman who died of Ebola virus in the Paynesville neighborhood of Monrovia, Liberia, Jan. 21, 2015

Thousands are due to receive the experimental drug

Liberia has commenced the first large-scale trials of an experimental Ebola vaccine.

Scientists aim to immunize around 30,000 volunteers and health care workers in the country starting Monday, the BBC reports. The trial will involve injecting each of them with a tiny amount of chimpanzee cold virus that carries safe genetic material of Ebola, tricking the human body into producing an immune response.

The medicine has been hidden in a secret location in the country since it arrived one week ago.

British pharmaceutical and healthcare company GlaxoSmithKline developed the vaccine alongside the U.S. National Institutes of Health; should the trial be successful, it would be the first preventative vaccine against the killer virus.

More than 8,500 people have died during the current Ebola outbreak, with 3,600 succumbing to the disease in Liberia alone. The number of new Ebola cases is in steady decline, however.

[BBC]

TIME ebola

The Ebola Virus Is Mutating, Say Scientists

Guinea West Africa Ebola
Youssouf Bah—AP A health care worker, right, takes the temperatures of school children for signs of the Ebola virus before they enter their school in the city of Conakry, Guinea, Monday, Jan. 19, 2015

The outbreak has so far claimed 8,795 lives across the affected West African region

Scientists at a French research institute say the Ebola virus has mutated and they are studying whether it may have become more contagious.

Researchers at the Institut Pasteur are analyzing hundreds of blood samples from Guinean Ebola patients in an effort to determine if the new variation poses a higher risk of transmission, according to the BBC.

“We’ve now seen several cases that don’t have any symptoms at all, asymptomatic cases,” said human geneticist Dr. Anavaj Sakuntabhai. “These people may be the people who can spread the virus better, but we still don’t know that yet. A virus can change itself to less deadly, but more contagious and that’s something we are afraid of.”

Although virus mutations are common, researchers are concerned that Ebola could eventually morph into an airborne disease if given enough time.

However, there is no evidence to suggest this has happened yet, and the virus is still spread only via direct contact with an infected person.

Institut Pasteur, which first pinpointed the current Ebola outbreak last March, is hoping that two vaccines they are developing will reach human trials by the end of the year.

Current figures indicate 8,795 of some 22,000 cases across Liberia, Guinea and Sierra Leone — around 40% — have been fatal.

[BBC]

TIME ebola

Doctors Without Borders Sees Fewer New Ebola Cases

SWITZERLAND-HEALTH-EBOLA-REDCROSS-AID-TRAINING
Fabrice Coffrini—AFP/Getty Images Health workers of the International Federation of Red Cross (IFRC) and medical charity Doctors Without Borders take part in a pre-deployment training for staff heading to Ebola areas on Oct. 29, 2014 in Geneva.

“We are on the right track," said Brice de la Vingne, the group's director of operations

The medical aid group Doctors Without Borders, or Médecins Sans Frontières (MSF), says it’s seeing declines in new cases of Ebola in its centers in Guinea, Liberia, and Sierra Leone.

There are just over 50 patients currently in MSF’s Ebola treatment centers across the three countries, the organization announced on Monday.

“This decline is an opportunity to focus efforts on addressing the serious weaknesses that remain in the response,” Brice de la Vingne, MSF director of operations said in a statement. “We are on the right track, but reaching zero cases will be difficult unless significant improvements are made in alerting new cases and tracing those who have been in contact with them.”

There is still work to do on that score; in Guinea and Liberia only half of the new cases are people who are known contacts of people with Ebola. Since just a single case can spur an outbreak, more contact tracing is needed.

MORE: TIME Person of the Year: Ebola Fighters

In Sierra Leone, incidences of Ebola have dropped to their lowest levels since August, though there are still hot zones like the country’s capital of Freetown. Guinea’s caseloads are also dropping, but more cases are coming from regions that were previously thought to be leveling out. Liberia has experienced some of the greatest drops out of all three countries. MSF says that on Jan. 17, there were no Ebola cases at the organization’s ELWA 3 Ebola management center in the capital city of Monrovia, and currently there are only two patients.

The latest case numbers from the World Health Organization (WHO) show cases have reached 21,724 with 8,641 deaths.

TIME ebola

Two Ebola Vaccines Are Heading to Trials in Liberia

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaks during a House Energy and Commerce Committee subcommittee hearing on the U.S. public health response to the Ebola outbreak in Washington, D.C., Oct. 2014.
Andrew Harrer—Bloomberg/Getty Images Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaks during a House Energy and Commerce Committee subcommittee hearing on the U.S. public health response to the Ebola outbreak in Washington, D.C., Oct. 2014.

Two vaccines will start trials in February

The long-awaited vaccine for Ebola is heading to clinical trials in Liberia.

Two vaccines, with the National Institutes of Health’s (NIH) support, will start efficacy testing in Liberia in the beginning of February.

The NIH is launching the trial in collaboration with the Liberian Ministry of Health. The trial will test two vaccines against a placebo. People in Liberia who agree to participate in the trial will be split evenly into three groups. Two groups will test separate vaccines and the third group will be given a placebo. The trial will take place in Montserrado County, which includes the capital Monrovia, one of the country’s hardest-hit regions.

MORE: TIME Person of the Year: Ebola Fighters

The vaccines have already undergone early safety trials at various sites in the U.S., Europe, and in parts of Africa. “There were no significant safety concerns and [the vaccine] induced the type of response that was quite comparable to the animal response of the monkeys,” says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID). Prior trials in monkeys had shown the vaccine made the animals immune to the virus.

Initially the target date for the vaccine trial in West Africa had been end of January, but some logistics still need to be worked out. Fauci told TIME that he can say with almost certainty that the trials will indeed launch in early February. “There are a couple of minor issues that we are just ironing out with regard to the protocol with the FDA,” says Fauci. “Nothing that’s a show stopper.”

One of the two vaccines being tested is a vaccine developed and tested by the NIH and pharmaceutical company GlaxoSmithKline (GSK), and the other vaccine is coming from biotech company NewLink Genetics and the pharmaceutical company Merck.

When the trial starts, the vaccines will initially be given to 600 people to collect additional data on the vaccine’s safety. If all goes well, the second part of the trial will launch with 27,000 people.

TIME ebola

Ebola Epidemic May End by June 2015 In Liberia

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SCOTT CAMAZINE—Getty Images/Photo Researchers RM At one time in 2014, Liberia experienced the fastest growing number of Ebola cases

That’s only if current hospitalization rates continue, say researchers

Understanding the ebb and flow of the Ebola outbreak that erupted in West Africa last year—and continues to percolate in the three hardest hit countries—is critical to stopping it. That means knowing who’s getting infected, where the highest rates of transmission are occurring and which strategies work best to control its spread.

Scientists initially thought that even if almost every infected person could be hospitalized, it wouldn’t stop the rapid spread of the Ebola virus for months to come. But researchers in the U.S. are now predicting in the journal PLOS Biology that the epidemic in Liberia, which at one point had the biggest explosion in Ebola cases, could peter out by June 2015.

MORE: TIME Person of the Year: The Ebola Fighters

In coming up with their predictive models, the researchers, led by John Drake University of Georgia, took into account data from previous outbreaks of Ebola, as well as probabilities about infection rates among healthcare workers, family members of the infected and those who are exposed to the virus during burials.

In order for Liberia’s Ebola outbreak to end, new hospital beds would have to be added at the same current rate (300 were provided between July and September 2014), the study authors concluded. That would allow 85% of infected patients to be treated with the nutritional and hydration therapy that is critical to overcome the infection. If new beds aren’t continually added, then hospitalization rates could drop back down to 70%, and cases may start to outpace public health workers’ ability to contain the disease.

MORE: U.N. Official Says Ebola Can Be Beat in 2015

Burial practices need to change as well. Cultural norms include touching the bodies of the deceased, which spreads the Ebola virus in a community. Safer burial practices, in which infected patients are isolated from healthy people, are keeping transmission levels under control, the authors say.

MORE: Ebola Vaccine Is Safe and Effective, According to First Study

The key to reducing the number of Liberia’s Ebola cases by summer is ensuring that anyone who is sick is hospitalized. “These modeling exercises suggested that in the absence of rapid hospitalization of most cases, none of the proposed scenarios for increasing hospital capacity would have been likely to achieve containment,” the authors write. “Continuing on the path to elimination will require sustained watchfulness and individual willingness to be treated.”

TIME Photojournalism Links

Photojournalism Daily: Jan. 9, 2015

A compilation of the most interesting photojournalism found on the web, curated by Mikko Takkunen

Today’s daily Photojournalism Links collection highlights Alex Maclean‘s aerial photographs of Detroit. The work captures the contrasting fortunes and economic inequality between the depopulated areas (defined by vacant lots and boarded-up homes) and the wealth of some surrounding areas (mansions and manicured lawns). It can appear bleak, but there’s cause for optimism as Detroit’s worst decline appears to be slowing, evident by new green spaces and corporate investment. Maclean’s pictures offer an excellent and insightful bird’s-eye view on the struggles of Motor City and its fight to survive.

Alex S. MacLean: Detroit by Air (The New York Times)

In Memoriam: Remembering the Photographers We Lost in 2014 (TIME LightBox)

An Intern Learns to Swim in the Deep End (National Geographic PROOF) Sara Lewkowicz won a three-month internship at National Geographic when she came out on top at last year’s College Photographer of the Year competition. She talks about her experience and shares photographs she made during her internship project in Mexico.

John Moore (BBC Radio 4 World at One) The Getty photographer is interviewed about his Ebola coverage in Liberia. See TIME LightBox interview as well.

David Burnett (Photo Brigade) The legendary photographer talks about his career at length.

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