Rodney D. Sieh, [email protected]
Monrovia – At the height of the 2014 deadly Ebola virus outbreak in Liberia, some 2,000 Liberians were trained by international experts to trace the infected throughout the length and breadth of Liberia.
As health authorities struggle to trace those infected with the deadly Coronavirus outbreak in Liberia, an investigation by FrontPageAfrica has found that many of those trained to trace the infected during the 2014 Ebola virus outbreak are still around but are being sidelined.
We are not short of people to do contact tracing, data management, collection and do the response, it is only political interference and lack of leadership that is killing the Liberian response. We saw the same playbook under President Sirleaf from March 2014 to August 2014 before she got it right. President Weah should not reinvent the wheel but find the right people to coordinate the response. The system is there but it needs better coordination and support to save thousands of Liberians’ lives.
Mr. Tolbert Nyenswah, a Senior Research Associate and expert with the International Health Department, Bloomberg School of Public Health at the Johns Hopkins University and former Head of the National Public Health Institute of Liberia
That number, recruited to trace Ebola infected in all fifteen counties in 2014, is three-times less than the 6,000-recruits Monrovia City Mayor Jefferson Koijee announced recently as contact tracers responsible for “processing data on related health situations; doing regular temperature checks, accessing situations that show semblance of the [COVID-19] virus like cold, cough, severe breathing, etc.” The MCC release also stated that “all samples collected will be sent to MCC Data Center at our HQ; MCC Data Analysts will then send findings to NPHIL for action.”
Mayor Koijee recently said the “contact tracers” would be recruited from each community” around Monrovia.
The 2014 list, now obtained by FrontPageAfrica offers a glaring contradiction regarding the ulterior motives for recruiting some 6000 new tracers for the Coronavirus pandemic.
Frowning on ‘Political Interference’ in COVID-19
The pronouncement by the MCC boss has already drawn rebuke from Liberians including prominent infectious disease scientist, Dr. Dougbeh Christopher Nyan who strongly warned recently, against what he described as “the continuous political interference of the MCC in the work of the National Public Health Institute of Liberia (NPHIL) as the country fights the COVID-19 Pandemic.”
Dr. Nyan further stated that, “the MCC is not a healthcare entity and should not be involved in training or organizing contact tracers during this pandemic, a serious national security health threat that requires expert knowledge of medical doctors, scientists, and epidemiologist.”
Mr. Tolbert Nyenswah, a Senior Research Associate and expert with the International Health Department, Bloomberg School of Public Health at the Johns Hopkins University and former Head of the National Public Health Institute of Liberia says the country is not short of contact tracers. “From Ebola experience in all 15 counties there are tracers that can be ramp up through the County Health Surveillance Officers and District Surveillance Officers.”
Mr. Nyenswah said County Health Officers who are Doctors in each county know the people they worked with during Ebola.
The Field Epidemiologic Training Program (FETP) for the training was sponsored by US Center for Disease Control and Prevention offices in Monrovia, Liberia, US Embassy.
That training is still available and provided today through the Africa Field Epidemiology Network (AFENET), AFENET which has international staff from Uganda and Ghana station in the NPHIL office.
Resources from the Global Health Security Agenda, trained field epidemiologists about 300 across Liberia. Those were trained in Basics which is three months, Intermediate 9 months and Advance 2 years (in Ghana). We were training to incorporate this training in to UL for sustainability. They are all in Liberia in all 15 counties and 93 districts. There are paid by Government of Liberia, World Bank provides operational support for the Emergency Operation Centers in all 15 counties.
Nyenswah explained that during his term, some ten disease intelligence officers were sent to Atlanta Georgia at the US Center for Disease Control for a nine-months training and later employed with the National Public Health Institute. “These men and women had either first or second degrees (BSc, BPharm or MPH) before going to Atlanta for training.
So, we are not short of people to do contact tracing, data management, collection and do the response, it is only political interference and lack of leadership that is killing the Liberian response. We saw the same playbook under President Sirleaf from March 2014 to August 2014 before she got it right. President Weah should not reinvent the wheel but find the right people to coordinate the response. The system is there but it needs better coordination and support to save thousands of Liberians’ lives. The window of opportunity is getting shorter and shorter. Respiratory disease is not something to take likely. Ebola can kill but COVID-19 can spread faster and kill more people.”
His country invested a lot in Liberia public health institute from the Global health Security Agenda Money: They are training, supporting EOC, transporting or the samples or specimens supporting organization in Liberia call Riders for health.
Contact Tracing ‘Critical’ to Ending Ebola
A 2015 post-Ebola report authored by Nyenswah and other experts involved in the Liberia fight reported that during the Ebola epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. We describe the scope and characteristics of contact tracing in Liberia and assess its performance during the 2014–2015 EVD epidemic.
The experts performed a retrospective descriptive analysis of data collection forms for contact tracing conducted in six counties during June 2014–July 2015. EVD case counts from situation reports in the same counties were used to assess contact tracing coverage and sensitivity. Contacts who presented with symptoms and/or died, and monitoring was stopped, were classified as “potential cases”. Positive predictive value (PPV) was defined as the proportion of traced contacts who were identified as potential cases. Bivariate and multivariate logistic regression models were used to identify characteristics among potential cases.
The experts also analyzed 25,830 contact tracing records for contacts who had monitoring initiated or were last exposed between June 4, 2014 and July 13, 2015. Contact tracing was initiated for 26.7% of total EVD cases and detected 3.6% of all new cases during this period. Eighty-eight percent of contacts completed monitoring, and 334 contacts were identified as potential cases (PPV = 1.4%). Potential cases were more likely to be detected early in the outbreak; hail from rural areas; report multiple exposures and symptoms; have household contact or direct bodily or fluid contact; and report nausea, fever, or weakness compared to contacts who completed monitoring.
In their conclusion, the experts noted that contact tracing was a critical intervention in Liberia and represented one of the largest contact tracing efforts during an epidemic in history. While there were notable improvements in implementation over time, these data suggest there were limitations to its performance—particularly in urban districts and during peak transmission. Recommendations for improving performance include integrated surveillance, decentralized management of multidisciplinary teams, comprehensive protocols, and community-led strategies.
Contact tracing in the ongoing Coronavirus battle in Liberia remains a challenge. A data compiled by the County Incident Management & National Reference Laboratory this week noted that the NPHIL is continuing daily follow up of contacts traced to date and while additional contact tracing teams are to be trained and deployed, many are now wondering why, when trained Liberians are available.
All this as the 14th Military Hospital where many of the infected are being treated is running out of beds.
On Friday, Liberia has recorded 11 new cases of COVID-19 just a day after six new cases were discovered, bringing the total number of confirmed cases to 48. According to the National Public Health Institute (NPHIL) Liberia now has 40 active cases, three recoveries and five deaths. The NPHIL also says it is actively pursuing 444 contacts as of Friday.
NPHIL: Conflict of Interest
As the numbers continue to rise, new questions are being raised about the silence of Dr Mosaka Fallah, NPHIL over the MCC’s quest to recruit 6,000 for contact tracing.
FrontPageAfrica has learned that Mr. Fallah, prior to taking on the job as NPHIL Director, was head of the Non-Governmental Organization, Rescue Place international, now said to be part of the MCC’s 6000 Active Case Finders, preventing a potential conflict of Interest for the NPHIL boss.
Ironically, Fallah, during the Ebola virus outbreak formed a group which went by the name of Community-Based Initiative, which was one of the groups aiding NPHIL with active case finding for Ebola. That group, FPA has now learned was turned into and NGO after Ebola and is said to be one of the groups sidelined to aid the MCC trace Coronavirus contacts.