1. Key tools to fight pandemic? Communication and respect, Ebola experts say.
It isn’t often that the United States takes public health advice from West Africa. But as the COVID-19 pandemic has ripped through societies unused to dealing with massive disease outbreaks, experts around the world are beginning to lean on the lessons from past epidemics – in particular, the 2014 to 2016 Ebola outbreak.
For instance, Massachusetts recently began an aggressive program to trace the contacts of every new case of coronavirus in the state, and then help them isolate to stop the disease from spreading. That project is led by Partners in Health, a medical charity that has honed its skills in contact tracing around the world, including during West Africa’s deadly Ebola outbreak that killed more than 11,000 people, largely in Liberia, Guinea, and Sierra Leone.
“We’re working on a method here that is not a theory,” Gov. Charlie Baker told the Boston Globe last month. “It’s been done, and been done well in many other places.”
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Unlike coronavirus contact tracing done in east Asia, however, the Massachusetts program is distinctly low-tech – relying not on digital surveillance but on one-on-one phone conversations between contact tracers and possible carriers.
And that, experts say, marks one of the most important lessons the fight against COVID-19 can learn from the fight against Ebola: It isn’t only medical technology that wins the war against disease. Sometimes, it also takes something much simpler – compassion.
“Building ties to communities is so important to the work we do, whether it’s in Massachusetts or Sierra Leone,” says John Welch, co-lead for Partners in Health’s contact tracing program in Massachusetts. “Sitting with people and asking, do you understand what this virus is and what you need to do to stay safe? Do you have the resources to stay home? That kind of knowledge happens through human connection at a person-to-person level.”
Those lessons seem especially pertinent in the United States in recent weeks, as thousands of Americans around the country have participated in mass protests in defiance of lockdown orders.
“We saw similar protests in West Africa” during the Ebola outbreak, and for similar reasons, says Khadija Alia Bah, a Sierra Leonean anthropologist who worked for the Ebola response in her country. In both the U.S. and West Africa, people received confusing, sometimes contradictory information on how to keep themselves safe. And their orders to stay home came from people they didn’t trust to keep their best interests in mind.
“I’m gonna do what I got to do to feed my family,” one protester in Pennsylvania told the BBC, explaining why he had defied the state’s lockdown order. “I don’t have any food and we’re scared,” a resident of Liberia’s capital, Monrovia, told Reuters during anti-lockdown protests there in 2014.
The protests weren’t exactly the same, of course. West African protests frequently were fueled by police violence used to enforce lockdowns. The American protests, meanwhile, have been deeply partisan, spurred on by encouragement from President Donald Trump. But they share an important common thread, says Nonhlanhla Tryphine Ngwabi, a Zimbabwean nurse who worked as an infection prevention and control officer for the World Health Organization in Sierra Leone during the West African Ebola outbreak.
“When people feel they are being treated like children, they treat responders like the enemy,” she says. “We forget over and over this simple lesson we learned in West Africa: Listen to communities. Listen to their fears. Listen to why they are skeptical. And then show them that their concerns matter.”
Like COVID-19, Ebola didn’t only make people ill. It warped the shape of daily life. Orders came from far away commanding that children be pulled out of school and businesses closed. Lockdowns and curfews became commonplace. The sick and dying, meanwhile, had to be isolated far from their families, scrambling what people understood about how to take care of the people they loved.
Those abrupt changes to daily life scared and confused people, Ms. Bah says, especially when they were delivered by officials who spoke the cold language of infection rates and confirmed cases – rather than discussing the disease’s impact in human terms.
“What experts tend to forget is that diseases live in people, and that it is people who must be at the heart of every disease response,” she says.
And to reach people, she and others say, you must go through leaders they trust.
“If you involve local communities and their leaders directly, they’re more likely to follow the rules,” says Kou Gbaintor-Johnson, a nurse, researcher, and community organizer in Monrovia, Liberia.
That might mean, for instance, hiring people in hard-hit communities to work as contact tracers or to care for the sick, as health organizations did during the recent Ebola outbreak in the eastern Democratic Republic of Congo. Or it might mean devoting more resources to training religious leaders, teachers, and other community leaders on how to provide clear, accurate information to those around them.
During Liberia’s Ebola outbreak, for instance, Ms. Gbaintor-Johnson was the community chairperson for a neighborhood in Monrovia. As the disease spread, she met with other community leaders and they made a plan. They’d canvas the area themselves, explaining one-on-one why the disease was dangerous, and that it was important to abide by the rules authorities had put in place to stop its spread. And then, she says, they listened to people’s concerns. If they were worried they’d go hungry because they couldn’t work, Ms. Gbaintor-Johnson’s team considered how to get them food. If they were scared for the future, she leveled with them: She was too.
“If people feel like we’re in this fight together, they’re going to try to do their best,” she says.
Confusion and inequality
In many countries, experts on the Ebola outbreak in West Africa say, the information given to the public on COVID-19 has been muddled and inconsistent, and the result has been fear and uncertainty. In the U.S., for instance, President Trump has publicly questioned the effectiveness of lockdowns and offered his own, scientifically suspect, potential treatments for COVID-19. In Britain, Prime Minister Boris Johnson initially flouted social-distancing advice. Soon after agreeing to impose stricter measures, he himself was diagnosed with COVID-19.
“When you see people rebelling [against restrictions to stop COVID-19], what’s really happening is a problem of trust,” says Ms. Ngwabi, the infection control and prevention officer during the Ebola outbreak. “People rebel when they feel voiceless.”
Experts see other lessons, too.
For instance, disease outbreaks often become a pretext for racism and xenophobia, says Kevin J.A. Thomas, a Sierra Leonean sociologist at Pennsylvania State University who wrote a book on African immigrants in Dallas during the Ebola crisis. In both the Ebola and coronavirus outbreaks, groups seen as close to the disease’s origins – West Africans and East Asians, respectively – have been the targets of hate crimes and discrimination.
For Mr. Welch, with Partners in Health, another important lesson from the Ebola outbreak is that infectious diseases never strike members of a society equally.
“The poor and the marginalized will always suffer in ways that are innumerable and preventable,” he says. Almost everywhere in the world, he notes, poverty is a kind of preexisting condition, limiting people’s access to accurate information and good health care, and often making them distrustful of those in power. “Now is the time to shine a spotlight on why that is, and get to addressing the root causes,” he says.
But even if COVID-19 is no social equalizer, experts hope it could be a source of global empathy. In the future, perhaps countries fighting disease outbreaks won’t be looked upon with distant pity, Ms. Bah says, or worse, with disdain for resisting the epidemic’s strange “rules.”
“No one has to imagine these fears anymore,” she says, “because we have all lived them.”
Editor’s note: An earlier version of this article mischaracterized New Zealand’s contact tracing program.