Ebola’s Decline in Liberia Prompts Fears of Complacency

A host of new evidence suggests the number of Ebola cases in Liberia has declined, but health care workers in the country treating the disease warn that it remains a grave threat, particularly in rural areas where a lack of awareness remains problematic.

“If we should be able to end this nightmare in our country, we must remain fully engaged and even more engaged in what we are doing individually and collectively to defeat this virus,” Fayiah Tamba, head of the Liberia National Red Cross Society, said in a presentation this week.

News that the Ebola outbreak might be weakening in Liberia began percolating in local media reports last week and has been reinforced by statements from international health officials. Health workers on the ground confirmed the downward trend to TIME. A local Red Cross branch recovered 175 bodies of deceased Ebola patients last week, down from more than 300 in mid-October. Burial numbers hit the lowest point since August. Many of the country’s Ebola-dedicated hospital beds remain empty, an International Medical Corps doctor said.

But the numbers don’t tell the whole story, health care workers said. While the number of Ebola cases in the country’s capital of Monrovia has declined, it’s difficult to assess the situation in rural regions. In some areas, large majorities of the population are “stuck with their beliefs” and still don’t understand the basics of the virus, according to Emmett Wilson, a program manager at FACE Africa in Liberia. Those regions remain at high risk without continued efforts to spread awareness, he said.

Pranav Shetty, an International Medical Corps doctor in Liberia, described the decline in cases as “one frame in an entire movie,” and said the nature of the disease means that improvements may only be temporary.

“Every single case has the potential has the potential to restart the epidemic,” he said.

A focus on rural areas is essential to preventing such a reoccurrence, and many health care workers said the lull in cases has allowed them to refocus their efforts outside the city. Shetty said free hospital beds have allowed health workers to reach residents of far-out regions.

“We have to concentrate our efforts and energy to the communities especially in rural communities more so that we don’t have a reoccurrence,” Tamba said.

In urban areas with higher levels of awareness, health care workers said it’s important that residents don’t grow complacent. A few weeks ago everyone was sanitizing their hands and following hygiene instructions carefully, Wilson said, but now, they’re “slacking.”

“We are involved in a fight,” he said. “When people start to get the impression that there’s a reduction in the number of cases, it sends a mixed signal.”

The concerns of health care workers on the ground have not escaped the attention of officials at international health groups. On Wednesday, World Health Organization assistant director general Bruce Aylward was careful to warn that much work remains to eradicate Ebola in Liberia, even as he made a bold statement that aid efforts were “getting an upper hand on the virus.”

“A slight decline in cases in a few days versus getting this thing closed out is a completely different ball game,” he said on a conference call. “It’s like saying your pet tiger is under control.”