TIME ebola

The Psychology Behind Our Collective Ebola Freak-Out

Airlines and the CDC Oppose Ebola Flight Bans
A protester stands outside the White House asking President Barack Obama to ban flights in effort to stop Ebola on Oct. 17, 2014 in Washington, DC. Olivier Douliery—dpa/Corbis

The almost-zero probability of acquiring Ebola in the U.S. often doesn’t register at a time of mass fear. It’s human nature

In Hazlehurst, Miss., parents pulled their children out of middle school last week after learning that the principal had recently visited southern Africa.

At Syracuse University, a Pulitzer Prize–winning photojournalist who had planned to speak about public health crises was banned from campus after working in Liberia.

An office building in Brecksville, Ohio, closed where almost 1,000 people work over fears that an employee had been exposed to Ebola.

A high school in Oregon canceled a visit from nine students from Africa — even though none of them hailed from countries containing the deadly disease.

All over the U.S., fear of contracting Ebola has prompted a collective, nationwide freak-out. Schools have emptied; businesses have temporarily shuttered; Americans who have merely traveled to Africa are being blackballed.

As the federal government works to contain the deadly disease’s spread under a newly appointed “Ebola czar,” and as others remain quarantined, the actual number of confirmed cases in the U.S. can still be counted on one hand: three. And they’ve all centered on the case of Thomas Eric Duncan, who died Oct. 8 in a Dallas hospital after traveling to Liberia; two nurses who treated him are the only other CDC-confirmed cases in the U.S.

The almost-zero probability of acquiring something like Ebola, given the virus’s very real and terrifying symptoms, often doesn’t register at a time of mass paranoia. Rationality disappears; irrational inclinations take over. It’s human nature, and we’ve been acting this way basically since we found out there were mysterious things out there that could kill us.

“There are documented cases of people misunderstanding and fearing infectious diseases going back through history,” says Andrew Noymer, an associate professor of public health at the University of California at Irvine. “Stigmatization is an old game.”

While there was widespread stigma surrounding diseases like the Black Death in Europe in the 1300s (which killed tens of millions) and more recently tuberculosis in the U.S. (patients’ family members often couldn’t get life-insurance policies, for example), our current overreaction seems more akin to collective responses in the last half of the 20th century to two other diseases: polio and HIV/AIDS.

Concern over polio in the 1950s led to widespread bans on children swimming in lakes and pools after it was discovered that they could catch the virus in the water. Thirty years later, the scare over HIV and AIDS led to many refusing to even get near those believed to have the disease. (Think of the hostile reaction from fellow players over Magic Johnson deciding to play in the 1992 NBA All-Star Game.)

Like the first cases of polio and HIV/AIDS, Ebola is something novel in the U.S. It is uncommon, unknown, its foreign origins alone often leading to fearful reactions. The fatality rate for those who do contract it is incredibly high, and the often gruesome symptoms — including bleeding from the eyes and possible bleeding from the ears, nose and rectum — provoke incredibly strong and often instinctual responses in attempts to avoid it or contain it.

“It hits all the risk-perception hot buttons,” says University of Oregon psychology professor Paul Slovic.

Humans essentially respond to risk in two ways: either through gut feeling or longer gestating, more reflective decisionmaking based on information and analysis. Before the era of Big Data, or data at all, we had to use our gut. Does that look like it’s going to kill us? Then stay away. Is that person ill? Well, probably best to avoid them.

“We didn’t have science and analysis to guide us,” Slovic says. “We just went with our gut feelings, and we survived.”

But even though we know today that things like the flu will likely kill tens of thousands of people this year, or that heart disease is the leading cause of death in the U.S. every year, we’re more likely to spend time worrying about the infinitesimal chances that we’re going to contract a disease that has only affected a handful of people, thanks in part to its frightening outcomes.

“When the consequences are perceived as dreadful, probability goes out the window,” Slovic says. “Our feelings aren’t moderated by the fact that it’s unlikely.”

Slovic compares it to the threat from terrorism, something that is also unlikely to kill us yet its consequences lead to massive amounts of government resources and calls for continued vigilance from the American people.

“Statistics are human beings with the tears dried off,” he says. “We often tend to react much less to the big picture.”

And that overreaction is often counterproductive. Gene Beresin, a Harvard Medical School psychiatry professor, says that fear is causing unnecessary reactions, oftentimes by parents and school officials, and a social rejection of those who in no way could have caught Ebola.

“It’s totally ridiculous to close these schools,” Beresin says. “It’s very difficult to catch. People need to step back, calm down and look at the actual facts, because we do have the capacity to use our rationality to prevent hysterical reactions.”

Read next: Nigeria Is Ebola-Free: Here’s What They Did Right

TIME health

How Lessons From the AIDS Crisis Can Help Us Beat Ebola

Health officials counsel guests on the p
Health officials counsel guests on the prevention of HIV/AIDS transmission at the Argungu fishing festival in Kebbi State, northwestern Nigeria on March 13, 2008. Hundreds of fishermen from different parts of Nigeria and neighbouring West African countries have started arriving in Argungu fishing Town to participate in the fishing festival. AFP PHOTO / PIUS UTOMI EKPEI (Photo credit should read PIUS UTOMI EKPEI/AFP/Getty Images) PIUS UTOMI EKPEI—AFP/Getty Images

Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, D.C.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster

Without urgent action, Ebola could become “the world’s next AIDS,” said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC). HIV/AIDS has killed some 36 million people since the epidemic began, and another 35 million are living with the virus. Is history really about to repeat itself?

It doesn’t have to, if we have the wisdom to learn from past experiences. The tools we need immediately are swift international action, strong leadership, respect for science and broad-based compassion. But once we contain Ebola – and we will – we need new resource commitments and global health strategies to bring the next deadly epidemic under control much more quickly.

We’ve already done some things right. President Obama traveled to CDC headquarters in Atlanta, a rare presidential action, to detail an aggressive offensive against Ebola that includes sending troops and supplies to build health care facilities in Africa. Contrast that with the response to AIDS under President Reagan, who did not mention the epidemic publicly until 1987, six years after people started dying from it. This time around, we’re seeing leadership at the top.

Health officials have also put out a unified message about how Ebola can be transmitted – only through direct contact with bodily fluids. That, too, stands in welcome contrast with HIV, where irresponsible rumors quickly took hold and people worried about sharing toilets seats and touching doorknobs. The importance of educating health care workers and keeping them safe represents a commonality between Ebola and HIV, and must be among our highest priorities. Following the science is the only way we’re going to stop this thing.

Another lesson from HIV is that adequate resources can transform disease outcomes. The President’s Emergency Plan for AIDS Relief (PEPFAR), a $15 billion, five-year commitment under President George W. Bush saved millions of lives around the world. But by contrast, even though the CDC is attacking Ebola with the largest global response in its history, the effort doesn’t come close to having the budget necessary to do all the field work needed to really beat back Ebola. Bipartisan funding support is crucial to enable public health officials to act aggressively.

One lesson that has not been well learned is that we stigmatize people at our own peril. During the AIDS epidemic, we saw an American teenager, Ryan White, expelled from school after he contracted HIV through a blood transfusion. In Dallas, where the first known Ebola victim in the U.S. has died, we hear reports that people of African origin have been turned away from restaurants and parents are pulling their children out of school. Cries to ban flights from Ebola-affected countries — an ineffective strategy reminiscent of the 22-year ban on the entry of HIV-positive people into the U.S. — are growing louder.

Experience tells us that when we are driven by fear, we tend to push infected people underground, further from the reach of the health-care system and perhaps closer to harming others. There was a time when many people assumed every gay man could spread AIDS; now some are suspicious that anyone from West Africa could harbor a deadly virus. Acting on ignorance is the best way to disrupt an optimal public health response.

We should look to other infectious diseases for lessons as well. After severe acute respiratory syndrome (SARS) surfaced in China in 2002 and spread to more than 30 countries in just a few months, an aggressive, well-coordinated global response averted a potential catastrophe. We saw how much could be done when political and cultural differences were set aside in favor of cooperation. SARS also spurred the World Health Organization (WHO) to update its International Health Regulations for the first time in 35 years, and prompted many countries to strengthen their surveillance and response infrastructure, including establishing new national public health agencies.

But glaring gaps remain in the health care and public health systems of many nations, despite years of warnings from almost anyone who has taken a careful look at them. With a population of 4 million, Liberia has only 250 doctors left in the country. That’s more than just Liberia’s problem, because if we can’t contain the Ebola epidemic there, we’re at much higher risk here. And within our own borders, we have a public health system that the Institute of Medicine termed “neglected” back in 2002. That assessment was largely unchanged a decade later when the IOM said that “public health is not funded commensurate with its mission” in the U.S.

The international community dragged its feet far too long on Ebola, and as a result, the virus still has the upper hand, outpacing the steps finally being taken to defeat it. Sierra Leone has just 304 beds for Ebola patients and needs almost 1,500 right now; by next week, it will need more. When it comes to control and prevention, speed is paramount. With the epidemic doubling every three weeks, the actions we take today will have a much greater impact than if we take those actions a month from now.

When we finally subdue this epidemic, we also need to shed our complacency towards the infectious diseases that plague us still, and the new ones likely to arrive with little warning. In a globalized world, they remain an immense threat. Almost 50,000 new HIV infections occur in the United States every year, as do 2 million worldwide. Influenza kills thousands of people annually, and more virulent strains can be much more dire. Yet we shrug most of this off, rarely paying attention until blaring headlines announce an impending cataclysm.

To get ahead of the curve, we need a renewed commitment to research and action, and enough resources to put more public health boots on the ground, both at home and abroad. Greater support for the Global Health Security Agenda, designed to close gaps in the world’s ability to quell infectious disease, should be a priority. The agenda, launched earlier this year, is a partnership involving the U.S. government, WHO, other international agencies and some 30 partner countries.

For too long, the history of infectious diseases has been that of ignoring a threat until it nears disaster, and then stepping in to prevent it from getting even worse. We can’t afford to keep repeating that pattern, and squandering blood and treasure in the process.

Ebola is a humanitarian crisis, but it does not belong to West Africa alone. We are all in this together.

 

aspen journal logo

Ruth Katz is the director of the Health, Medicine and Society program at the Aspen Institute, a nonpartisan educational and policy studies institute based in Washington, DC. She served from 2009 to 2013 as Chief Public Health Counsel with the Committee on Energy and Commerce in the U.S. House of Representatives. Ms. Katz was the lead Democratic committee staff on the public health components of the health reform initiative passed by the House of Representatives in November 2009. Prior to her work with the Committee, Ms. Katz was the Walter G. Ross Professor of Health Policy of the School of Public Health and Health Services at The George Washington University. She served as the dean of the school from 2003 to 2008. This article also appears in the Aspen Journal of ideas.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

Blocked From Pope’s Synod By Ebola, Liberia’s Bishop Tells His Nation’s Story

Gbarnga ebola
Grave diggers prepare for new Ebola victim outside an Ebola treatment center in Gbarnga, Liberia on Oct. 7, 2014. John Moore—Getty Images

“As Bishop of my people I carry within my heart their wounds and pains every moment of life here,” says Bishop Anthony Borwah

One bishop is absent from Pope Francis’ Extraordinary Synod of the Bishops on the family. He was invited, he wanted to come, his name is on the participant list, but he is not in Rome. He is some 4,000 miles away. And few—if any—people outside the synod hall even know he is not there.

His name is Bishop Anthony Borwah, 48, and he leads the Catholic Diocese of GBarnga in central Liberia, where Ebola is wreaking havoc. Tony, as he is called, learned he could not travel to the Synod in late August, when the Ivory Coast closed its borders due to the Ebola outbreak and restricted the one airline that could have taken him to Abidjan, where he needed to apply in person for a Schengen visa to travel to the European Union.

(PHOTOS: See How A Photographer Is Covering Ebola’s Deadly Spread)

Borwah may not be at the Synod, nor is he able to participate remotely due to technological limits, but the gathering’s focus on the family is vital to his Liberian families. Ebola is their most urgent challenge, but it is not the only one, he explained to TIME in this exclusive interview. Borwah submitted an essay to the Synod—an “intervention” in Vatican-speak—about the situations facing Liberian families. Borwah’s essay is not being read aloud at the Synod but will be entered into the written record and considered in any final documents that the Synod produces.

“Enormous are the pastoral challenges of the family in Liberia today,” his essay begins, before continuing to describe the challenges including Ebola, polygamy, migration, unemployment, the lack of a father-figures, domestic violence, child trafficking, and sexual tourism. “Existential questions from the poor, prevalently during the Civil war, are been asked again: Where is God? What wrong have we (Liberians) done again? How come we have once again become the abandoned and scum of the earth?”

(PHOTOS: Inside the Ebola Crisis: The Images That Moved Them Most)

The past few months since Ebola outbreak have been brutal for Liberia, where about 69% of the population is Christian, according to Pew Research Center. Borwah has lost dear friends to the virus, including his spiritual director, Father Miguel from Spain, his mentor and medical doctor Abraham Borbor, and his prayer partner Tidi Dogba. While the Catholic community as a whole has not had many deaths in Gbarnga, he says, those who are dying are relatives and friends. “As Bishop of my people I carry within my heart their wounds and pains every moment of life here,” he says.

The Liberian Catholic community is doing what it can to combat the virus. Borwah has called on all Catholics in his diocese to gather in prayer against Ebola from 5 to 6 p.m. every day from September 1 through November 30. The church uses the first ten minutes for education and updates about Ebola, and then for the last 50 minutes they pray with the Holy Rosary. They are observing strict medical rules about what kind of interaction they can have while together for prayer. No touching, no handshakes, and entrances of churches, homes, and offices have buckets of chlorinated water for hand washing.

The Catholic Church is also collaborating with the government on the national Ebola Task Force Team, Borwah says. The National Catholic Health Team is training nurses in three Catholic dioceses in Liberia, and Catholic clinics remain open. “Our Human Rights Department is also actively involved in violations issue[s] that may occur under such a crisis situation and the state of emergency when rights are restricted,” Borwah adds. “We hope to soon begin the distribution of food to mainly quarantined communities and other affected areas.”

The Ebola devastation extends beyond just a health crisis for Liberian families. The virus’ highly contagious nature means that family members are kept at a great distance from infected loved ones. Ignoring the restriction, on the other hand, can lead to death, but Liberian families are very affectionate especially in difficult times, Borwah explains, and the inability to show real human kindness is wounding morale.

Poverty is also increasing, he says. Already more than 80% of families in Liberia live below the poverty line, according to the Central Intelligence Agency. Now the price of rice and other essential commodities has spiked since the ebola outbreak due to port and border closures, according to the Food and Agriculture Organization of the United Nations (FAO). Labor shortages due to migration restrictions are also putting the fall’s rice and maize harvests at risk. Women, the FAO has noted, are particularly hard hit as many are the primary caregivers and can’t repay their small business loans. Schools are closed while the virus is present, and so students stay home and teachers do not get paid. “The Ebola situation has badly crippled the economy resulting in rife impoverishment and hunger,” Borwah says.

Increased poverty means increased desperation over the loss of family members to Ebola, he continues. That frustration is compounded when the government buries or cremates loved ones, often without family members present. “These new wounds are a tragic addition to festering wounds that families here experienced as a result of a more than 15 years of fratricidal civil war that officially ended a decade ago,” he says.

Borwah is grateful for global aid groups and donors like Catholic Relief Services and CAFOD, the official Catholic aid agency for England and Wales, but more support is needed, especially when it comes to supporting survivors. “Recently one of the survivors—my kinsman—committed suicide when people avoided him and he felt that he was unworthy of love anymore,” Borwah says. “We need more support to feed the thousand whom are hungry and angry and to care and counsel the Ebola survivors who carry the stigma.”

There is a dimension to the Ebola outbreak that also concerns him—the idea that Ebola’s spread could have a man-made and not just a natural source. “I believe that the causes of Ebola are not just physical but spiritual,” he says. “I like calling it the ‘Ebola phenomenon’ because it’s existence raises more questions than answers.”

Then there are Liberia’s non-Ebola-related challenges. Infidelity in marriages is common, with the causes ranging from poverty (mostly on the part of the women) and cultural permissiveness (on the part of the men), he says. “Generally the economy of the nation is in the pocket of few men, hence there is a lot of women prostitution,” he says. “I often say that these prostitutes are prophets and friends of Jesus as they signify the inequality, marginalization and injustice meted out against the poor and nobodies of our society especially women.”

Women, he adds, are generally subject to men culturally, and are often subjected to brutal domestic violence and impoverishment. The government of President Ellen Johnson Sirleaf has done a lot to raise the dignity of womanhood in beloved Liberia, he continues, but “the walk is still too long.”

Families are navigating questions of shifting identity. Western technological and cultural shifts mean that young people often have different value systems from their parents, and that is dividing families. “Parents can no longer control their children in the face of this new ethics, something, which brings a lot of pain and worries about the future of the family,” he says.

Borwah has a message for the world: “The friends of Jesus Christ—the nobodies, the poor, women and the innocents, the caretakers of others—need both the spiritual and material help. They are losing faith, hope and love. They are poorer, hungrier and very desperate. God has not and will not abandon us, so please do not abandon us to the onslaught of Ebola.”

And, in the midst of it all, Pope Francis, Borwah says, has not forgotten the Liberian people. “The Holy Father prays for Ebola stricken people everyday, even as the Synod goes on,” Borwah says. “He is very close to our suffering.”

His final words: “Please pray for us.”

TIME ebola

Ebola Health Care Workers in Liberia Defy Call to Strike

Liberia Races To Expand Ebola Treatment Facilities, As U.S. Troops Arrive
An Ebola burial team dresses in protective clothing before collecting the body of a woman from her home in the New Kru Town suburb of Monrovia, Liberia on Oct. 10, 2014 John Moore—Getty Images

Nurses and doctors continued to care for the sick

Updated 1:24 p.m. ET

Liberian health care workers largely ignored a call to strike Monday, despite claims that an estimated 80% of them are being forced to go without adequate supplies to fight the Ebola outbreak that has claimed more than 4,000 lives in west Africa.

The government had asked health care workers to be reasonable, arguing a strike would have negative consequences on the containment of the outbreak, BBC reports. Liberia’s National Health Workers Association had called the strike demanding an increase in hazard pay

Liberia is one of countries hit hardest by the Ebola outbreak, with 3,924 cases of the more than 8,000 total. Thousands of health care workers were due to stop treating patients as part of the strike, Reuters reports. But most medical staff continued continued caring for the sick Monday.

“There needs to be a proper coordination of what is being donated by the international community,” George Williams, the Liberia Health Workers Association secretary-general told Bloomberg. “We’re hearing about millions of dollars of taxpayers’ money being donated and we appreciate every cent. But we need to see it at the health facilities.”

Despite the fact that the most health care workers continued to treat patients, the workers association said they don’t have enough equipment to protect themselves and that the government is not meeting their needs. Ebola health care workers are dying faster than their patients.

[BBC]

TIME ebola

CDC Director Compares Ebola Outbreak to AIDS Epidemic

US-POLITICS-HEALTH-EBOLA-OBAMA
Dr. Tom Frieden, director of the Centers for Disease Control, listens while US President Barack Obama makes a statement to the press after a meeting in the Roosevelt Room of the White House October 6, 2014 in Washington, D.C. Brendan Smialowski—AFP/Getty Images

"In my 30 years in public health, the only thing that has been like this is AIDS."

The head of the Centers for Disease Control and Prevention warned Thursday that the world must act to prevent the current Ebola outbreak from becoming “the world’s next AIDs.”

CDC Director Tom Frieden made the remark while speaking at a conference at the World Bank in Washington, D.C. with representatives from around the world Thursday, including United Nations Secretary-General Ban Ki Moon and International Monetary Fund Managing Director Christine Lagarde, the Washington Post reports.

“In my 30 years in public health, the only thing that has been like this is AIDS,” Frieden said. “We have to work now so that this is not the world’s next AIDS.”

More than 8,000 people in Western Africa have been infected with the Ebola virus, according to the WHO, and 3,857 people have died. Thomas Eric Duncan, the first person to be diagnosed with Ebola inside the United States, died on Wednesday.

The CDC has projected that, without any intervention measures in West Africa, some 1.4 million people will be infected with Ebola by January. But the international community is stepping up efforts to contain the virus in the region, with the U.S. alone committing more than $500 million and approving the deployment of 4,000 troops to help fight the disease.

[Washington Post]

 

TIME ebola

Liberia’s New Plan to Get Ebola Sufferers Into Isolation

Residents take home family and home disinfection kits distributed by Doctors Without Borders, on Oct. 4, 2014 in New Kru Town, Liberia.
Residents take home family and home disinfection kits distributed by Doctors Without Borders, on Oct. 4, 2014 in New Kru Town, Liberia. John Moore—Getty Images

The new Ebola Community Care Centers pioneered by Save the Children strike a compromise between home care and hospital-grade treatment. But will they work?

When U.S. President Barack Obama promised, on Sept. 16, to help Liberia set up 17 Ebola treatment centers to help stem the outbreak, the sense of relief was palpable in the west African country. That was the kind of robust international response it needed to stop Ebola in its tracks. Getting patients afflicted with the virus into isolation, where they could no longer infect friends and family, would go a long way towards cutting down Ebola’s exponential spread.

But nearly a month later those clinics aren’t up yet, and so far only one—a 25-bed unit designated solely for infected health workers—is even close to completion. Even though there are currently about 600 beds in Liberia, with another 300 expected to come on line in the next few weeks, it is nowhere near the 1,990 that the World Health Organization [WHO] estimates will be required for the current caseload.

The U.S.-built centers, which would make some 1700 treatment beds available, won’t be up and running for another two to three months, U.S. officials said this week. With 8011 infected and 3857 dead in west Africa as of Oct. 8, according to the WHO, and little hope of seeing the number of new cases each week go down any time soon, no one can afford to wait. Which is why both international and Liberian health officials are looking for alternatives. “One of the biggest challenges we are having is getting people out of their homes and into the treatment centers,” says Frank Mahoney, Liberia team leader for the Centers for Disease Control and Prevention’s Ebola response. “We have been working furiously trying to stand up treatment centers, but [new cases] have been outpacing our ability to stand them up.”

As a stopgap measure, USAID and some international NGOs are looking at ways to protect caregivers at home. But one organization, with support from both the Liberian government and U.S. officials, is proposing a radical compromise that gets suspected patients out of the home for care, without requiring beds in the yet-to-be-completed official Ebola Treatment Units [ETU]. They are called Ebola Community Care [ECC] centers, hyper-local clinics run by community volunteers and staffed not by trained health workers, but by the very people who would otherwise be taking care of patients in the home: family members.

To a certain extent, stopping Ebola is a question of simple math. If you can get the transmission rate to below one, meaning each infected person spreads the illness to less than one person, on average, the virus will die out. If the numbers are more than 2.5, that means the epidemic is “out of control,” according to Carolyn Miles, President of Save the Children, an international humanitarian aid agency working on Ebola in both Liberia and Sierra Leone. In Liberia, the transmission rate is somewhere between 1.75 and 2.5, dangerously close to becoming unstoppable. One of the greatest contributors to the high transmission rate is patients staying at home, where they can infect multiple family members. “From a transmission standpoint, it is essential to get people out of their homes,” says Miles. Ebola Community Care centers, she says, give people a place to go while waiting for the specialized treatment units to be set up.

One of the key factors delaying the ETUs is the necessity for a highly-trained staff of physicians, assistants, nurses, pharmacists and sanitation teams working 24/7. Finding, hiring and training that staff is at least as difficult, if not more so, as getting the physical beds in place. But Save the Children’s response cuts down the staff requirements by building temporary holding centers in every community affected by Ebola.

In these centers, patients suspected of having Ebola can wait for testing without fear of infecting others, while those with confirmed infections can wait in isolation wards until a bed in an official treatment center opens up. One caretaker, who will be trained by an on-site supervisor in basic care and self-protection measures, will accompany each patient. The caretakers will be provided with disposable gloves, aprons, gowns and masks, as well as disinfecting solutions for keeping themselves and their charges clean. “Only one family member per patient is allowed into the ECC,” says Miles. “That alone will get transmission to below one.”

The centers won’t have a medical staff on hand full time. Instead each center will be visited daily by rotating teams of doctors, nurses, sanitizers and personal protection gear suppliers, who will replenish stocks as necessary. The mobile teams will be able to visit up to four community care centers a day, reducing the need for staffing and training. One such center, with 20 beds for suspected cases and 10 in a separate isolation ward, will open later this week, in Magribi County, one of Liberia’s most afflicted areas. By the end of the month Save the Children expects to have 10 more up and running.

The risk for family caretakers is still high, given that well-trained health care practitioners working for some of the most rigorously protective treatment centers are still getting sick. But the alternative is more dangerous, says Miles. “ECCs are not as safe as an ETU, but they are safer than having an ill person at home, being cared for by multiple family members in an environment where real isolation may not be possible.”

As much as communities are warming to the idea, the new care centers still face the fear and stigma that plagues anything to do with Ebola. “A lot of people do want to care for their loved ones in a safe environment, and they know there are not enough ETUs,” says Miles. The problem, she notes, is that no one wants a center next door. But until U.S. officials can keep President Obama’s promise, these kinds of stopgap solutions might be the only chance to slow the spread of Ebola.

TIME ebola

This Is How Ebola Patients Are Equipping Their Homes

A Doctors Without Borders, worker displays a family and home disinfection kit which MSF distributed on Oct. 4, 2014 in New Kru Town, Liberia.
A Doctors Without Borders, worker displays a family and home disinfection kit which MSF distributed on Oct. 4, 2014 in New Kru Town, Liberia. John Moore—Getty Images

"It’s dangerous, but there are not many other options”

When his wife grew sick with Ebola, Alex T. Kamanda didn’t have the option of sending her to one of Monrovia’s Ebola Treatment Centers. They were all full. But he knew how contagious the disease could be, and how risky it was to come in contact with her bodily fluids. So he did the best he could to protect himself while caring for her, wrapping his hands in plastic garbage bags until members of his church were able to bring him supplies. He mixed chlorine powder with water to make a disinfecting solution for his skin and a stronger version to clean up her vomit and diarrhea. It was a solution that almost certainly saved his life.

Caring for Ebola patients at home is a practice that is becoming more common in a region with not enough Ebola Treatment Units (ETUs), supplies or personnel to treat the sick—a stop-gap solution that is now being standardized in Liberia. But it’s not without controversy.

The United States has pledged to send up to 400,000 so-called “home treatment kits” to Ebola-stricken households in Liberia; some 9,000 have already been distributed, according to USAID. Each kit contains gloves, masks, disposable gowns and plastic aprons, along with chlorine powder, buckets, spray bottles and plastic bags to safely dispose of infected items.

This is not the gold standard infection control, but overcrowding in Liberia’s Ebola treatment centers leaves little choice. Government health officials and NGOs have already started door-to-door training so that affected families know how to use the equipment properly.

“’Perfect’ cannot be the enemy of ‘good’ in this case,” says Stephan Monroe, the deputy director of the Centers for Disease Control and Prevention’s (CDC) National Center for Emerging Zoonotic and Infectious Diseases. “Perfect is having patients in isolation centers with health care workers treating them, but we cannot build them fast enough.”

Treatment at home carries risks. Even fully trained and equipped health-care workers in isolation wards are getting sick. And there are concerns that providing the protection kits may encourage families to keep their loved ones at home, under the assumption that it is safe.

According to Amanda McClelland, the senior officer coordinating the Ebola response for the International Red Cross, the organization is starting to attempt safe home-based care training in Monrovia, and other groups are trying a variation of it in other locations. “We are really in this gray phase. We have to do extraordinary measures to do the best we can until the isolation centers have met the demand in the next few weeks,” says McClelland. “There’s a lot of pressure on us and other organizations to undertake things like home-based care. Which is shifting the risk from health workers to families. It’s dangerous, but there are not many other options.”

The Red Cross will have volunteers in every affected community, and if they get a suspected case they will try to transfer the patient to a treatment center, but if they can’t, they will help the family isolate the patient in the home, even if it is just a mattress tucked behind a makeshift drape. They will also train a family member to care for the patient as safely as they can until admission into a treatment center can be arranged. “It is quite a reasonably controversial idea. It’s really the measures of last resort that we are in at the moment,” says McClelland.

The missionary group Samaritan’s Purse announced on October 7 that it has also launched home-based intervention training in the most remote areas of Liberia by instructing caregivers in infection control and giving families home care kits. The Samaritan Purse kits, in addition to the basic protective gear, also include medicine to treat Ebola’s side effects, like pain, dehydration and diarrhea. So far they’ve been equipping families in an area along the River Gee in southern Liberia where cases have been on the rise, but there are no Ebola treatment centers nearby.

On Oct. 3, USAID administrator Dr. Raj Shah said in a press conference that USAID is offering support in the distribution of hygiene and protective equipment kits “so families can protect their patients in their families.” USAID, along with UNICEF and the World Health Organization, has already distributed 9,000 of those kits. According to Shah, another 10,000 are on their way, and are being distributed throughout Liberia.

According to U.S. ambassador to Liberia, Deborah Malac, home care is a short-term solution. “Until you have some place to take someone to receive further treatment, you need to protect yourself and family members as much as possible,” she says. “So [the kits are for use] in the home, but not for long term care, [and only] if there is no other alternative.” That kind of temporary solution to a vexing public health problem is also likely to be well received on the ground. The ETUs are simply taking too long, says Kenneth Martu, a community organizer in Westpoint, one of the hardest hit areas of Monrovia. “You call for an ambulance, and they say there are no beds available [in the treatment centers]. So home care is one of the best approaches in the fight against Ebola. It’s what we can do in the absence of beds. We need to prevent Ebola’s spread.”

With reporting by Aryn Baker / Monrovia

TIME ebola

Halting Flights to Ebola Regions Could Threaten Relief Efforts, Experts Warn

Cuban doctors and health workers unload boxes of medicines and medical material from a plane upon their arrival at Freetown's airport to help the fight against Ebola in Sierra Leone, on Oct. 2, 2014.
Cuban doctors and health workers unload boxes of medicines and medical material from a plane upon their arrival at Freetown's airport to help the fight against Ebola in Sierra Leone, on Oct. 2, 2014. Florian Plaucheur—AFP/Getty Images

Officials and aid agencies say the fight against Ebola is being hampered by the shortage of transportation to the epicenter of the disease in West Africa

You can book to travel on British Airways (BA) from London Heathrow to Roberts International airport in Monrovia, but the direct flight will take nine hours—and at least 25 weeks—to arrive in the Liberian capital.

In August BA suspended flights to Liberia and Sierra Leone, citing public health concerns amid the spread of ebola in the region. Now, the U.K. carrier has announced its decision to maintain that suspension through the end of March 2015. BA isn’t alone; there are now so few airlines flying into the area that key workers are being forced onto wait lists and lengthy journeys with multiple stopovers. Right now, European travelers hoping to get to Monrovia or Sierra Leone’s capital Freetown must squeeze on to services operated by Brussels Airlines and Royal Air Maroc, or thumb a ride on a military jet.

Nobody would dispute the wisdom of taking the threat of Ebola very, very seriously, but aid agencies warn that a shortage of transportation to and from west Africa, far from containing Ebola, instead risks undermining efforts to quell the epidemic.

At an Oct. 8 Washington press conference with U.K. Foreign Secretary Philip Hammond, U.S. Secretary of State John Kerry called for the international community to “step up” efforts against Ebola and stressed the importance of keeping air routes open. It is a point Justin Forsyth, CEO of the U.K.-based charity Save the Children, also emphasizes.

“The main way to defeat the spread of Ebola not just in the region but globally is to get it under control in Sierra Leone and Liberia and Guinea and the best way of getting it under control is to make sure that we can get health workers into the region because they’re not going to have enough capability in these countries themselves,” says Forsyth, whose charity is working with the British military to establish a treatment center in Sierra Leone, as well as setting up care centers in Liberia and training thousands of health workers. “They’re going to need a lot of people coming in, and not all of it by military [flights].”

There have been fresh calls to isolate the disease by further isolating west Africa, after Liberian Thomas Eric Duncan died on Oct. 8 in Dallas, and Spain awaits news of Teresa Romero Ramos, the first person to contract Ebola outside west Africa in this outbreak. Louisiana Gov. Bobby Jindal had already advocated banning all flights from the region. “We need to protect our people,” he said last week.

On the surface it makes sense. Ebola may not be airborne, but authorities’ assurances that sitting on a plane with an infected person shouldn’t pose a big risk ring increasingly hollow, as Spanish health authorities try to figure out how Ramos caught the disease. She wore protective clothing and followed hospital protocols, though she has said she may have touched her face with a contaminated glove.

Yet in the view of many experts, following the impulse to isolationism is already making countries beyond Africa more vulnerable, not less. Christopher Stokes, director of Médecins Sans Frontières (Doctors Without Borders) in Brussels, told the Guardian “Airlines have shut down many flights and the unintended consequence has been to slow and hamper the relief effort, paradoxically increasing the risk of this epidemic spreading across countries in west Africa first, then potentially elsewhere. We have to stop Ebola at source and this means we have to be able to go there.”

Save the Children’s Forsyth agrees. He recognizes the concerns of airline staff, though, and says “It’s a big decision by anybody to go to work in one of these countries at the moment. We’ve got lots of people stepping forward to do it but it’s not an easy decision.”

The only option, Forsyth believes, is for governments to take the lead. “We need the airline industry to come together. This is where governments have a big role to play, to bring airlines together,” he says. “The other way to do it is to set up an air bridge paid for by governments or the military.”

TIME ebola

Ebola Cases Surpass 8,000

WHO stresses cases are being underreported in Liberia

Over 8,000 people in Liberia, Guinea and Sierra Leone have been infected with Ebola, according to new data from the World Health Organization (WHO).

The numbers show there were 2,799 new cases in the last 21 days. Of the 8,011 people infected, 3,857 people have died. “The situation in Guinea, Liberia, and Sierra Leone continues to deteriorate, with widespread and persistent transmission of [Ebola],” says the WHO in a statement.

The WHO cites problems gathering data in Liberia, and says it should be emphasized that “the reported fall in the number of new cases in Liberia over the past three weeks is unlikely to be genuine. Rather, it reflects a deterioration in the ability of overwhelmed responders to record accurate epidemiological data.”

This happened before in Guinea, when it appeared cases had slowed, but in reality cases went unreported or were hidden. The WHO says there is likely a lot of underreporting in Liberia, as fears and distrust of government grow, and that official estimates are likely lower than Liberia’s actual number of cases.

“There is no evidence that the [Ebola] epidemic in West Africa is being brought under control,” the WHO says. “Though there is evidence of a decline in incidence in the districts of Lofa in Liberia, and Kailahun and Kenema in Sierra Leone.”

TIME ebola

The Dallas Ebola Patient Is Getting Slightly Better

But he remains in critical condition

Ebola patient Thomas Duncan’s liver condition has improved, according to the Dallas hospital where he’s being treated, though he remains in critical but stable condition as of Tuesday.

Duncan’s liver function declined over the weekend, leading doctors at Texas Health Presbyterian Hospital to downgrade his status from serious to critical. Duncan is currently on a ventilator receiving kidney dialysis, while on Monday he begun taking the experimental Ebola drug brincidofovir, which the hospital says he will continue to receive.

While the slight uptick in Duncan’s status marks a sign of hope for his eventual recovery from the Ebola virus, Duncan’s doctors warn his liver function can still vary over the next few days. It’s also unknown whether the experimental drug is having an effect on Duncan’s status. It hasn’t been treated extensively on humans, so there’s little roadmap data available to which doctors can compare Duncan’s treatment. Like ZMapp, the other experimental drug given to some Ebola patients, it’s very difficult to suss out the impact of a drug that has not undergone human clinical trials. There’s no way to know for certain if a drug is helping, hindering, or irrelevant to a patient’s care.

Centers for Disease Control and Prevention Director Dr. Tom Frieden said in a press conference Tuesday that progress in the global fight against Ebola is being seen in Texas and abroad. So far, the 48 people with whom Duncan had some level of contact in Dallas remain healthy, Frieden said.

Frieden also confirmed that the CDC will be bolstering airport screenings for travelers headed to or from areas known to be Ebola hotspots, most notably West Africa.

“We are working very intensely on screening,” Frieden said. “We are looking at that entire process and seeing what more can be done.”

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser