Liberia: Ebola contact tracing lessons inform COVID-19 response

Lessons learned during the Ebola outbreak in Liberia six years ago are helping the West African country to confront the COVID-19 pandemic, according to the UN Population Fund (UNFPA) which is working alongside the World Health Organization (WHO) on surveillance and the coordination of contact tracing.

UNFPA has been recruiting hundreds of contact tracers from local communities who are supporting health authorities in the most affected areas by identifying everyone who has been in contact with an infected person, monitoring their health for symptoms, and referring suspected cases for testing. “The work of the contact tracers is critical to breaking the chain of transmission of the disease in Liberia”, said Dr. Bannet Ndyanabangi, UNFPA’s representative in the country.

Shame, stigma and mistrust

Liberia has reported just over 100 cases of COVID-19 as of Friday.  The disease was first confirmed there on 16 March.  A week later, authorities declared a public health emergency and requested UN support.

For UNFPA, the situation was an eerie reminder of the Ebola epidemic that devastated Liberia, as well as Guinea and Sierra Leone, between 2014-2016.  During that crisis, UNFPA worked with the Liberian Government and other health partners to implement contact tracing. Although there are clear differences between the two outbreaks, UNFPA said some issues are the same, including shame, stigma and widespread mistrust in the community.

A tough job

In response to COVID-19, the Liberian authorities have implemented movement restrictions. Neighbouring Montserrado and Margibi counties are the epicentre of the outbreak, and residents there face more stringent quarantine measures. Contact tracers are urgently being recruited, trained and deployed. In addition to identifying and confirming infections, their duties also include teaching people about infection prevention.

“It is not easy to work as a contract tracer, especially when there is still a high level of denial and stigmatization at the level of the community”, said Octavius Koon, a contact tracer who has been assigned to follow five mortuary workers who had been in contact with a body that tested positive for COVID-19. To combat this mistrust, UNFPA is recruiting contact tracers who come from the most affected areas and deploying them within their respective communities. Still, they have to battle mistrust and misinformation.  

“Some of the contacts we are working with do not want to be identified by community members, fearing stigmatization. Some of them also believe it is a waste of time to keep checking on them for the period, 14 to 21 days, when they are not ill”, said Mr. Koon. “You sometimes realize that people would choose to lie or mislead you.”

Safeguarding health and welfare

Contact tracers also know that in doing their jobs, they are putting their own health at risk. Mr. Koon said strict adherence to guidelines and protocol offers some reassurance. “The issue of personal safety cannot be taken for granted,” he added. UNFPA has praised the contact tracers as they are essential for safeguarding the health and welfare of their communities. “UNFPA appreciates their efforts because, as frontliners, with direct contact with potential COVID-19 infected persons, they are getting involved with the fight against an infectious disease that may put their and their families’ lives at risk,” said Dr. Ndyanabangi the agency’s representative in Liberia.

Today, there are more than 200 UNFPA-supported contact tracers working with the Montserrado County Health Team, which covers both Margibi and Montserrado counties. Efforts are underway to increase that number to 400 tracers in the coming weeks. UNFPA has also contributed four pickup trucks, five motorbikes and 60 mobile phones to the National Public Health Institute of Liberia, to support surveillance efforts. 

UN ‘fully mobilized’ to support the Sudanese people, Security Council hears

The “exceptional circumstances” of the COVID-19 pandemic have impacted the peace process in Sudan as well as the drawing down of the United Nations mission there, the head of UN peacekeeping updated the Security Council on Friday.

Notwithstanding the “dire” situation, Under-Secretary-General for Peace Operations, Jean-Pierre Lacroix, assured the Council via video tele-conferencing that the UN is “fully mobilized” to continue supporting the Sudanese people.Noting progress on political reforms, accountability and women’s participation in decision-making, he said that “the Sudanese authorities and people have pushed ahead” with implementing their democratic transition. But, citing a March assassination attempt against Prime Minister Abdallah Hamdok, he informed that Sudan’s trajectory change remains fragile.

The peace process

Meanwhile, civil unrest, a sharp increase in attacks against farmers by pastoralists and human rights abuses, are some obstacles to the peace process.“These challenges underline the persistence of some of the conflict drivers in Darfur, which may go beyond the scope of the peace process and will require a heavy investment in peacebuilding”, said Mr. Lacroix.He also spoke of “worrying developments” in West Darfur at the end of the year that left some 65 people dead, over 46,000 internally displaced and an additional 11,000 who fled to Chad.“It is also critical to make progress on the Darfur track of the peace process and for the population of Darfur to see peace dividends”, he stressed.

Drawdown

In response to the COVID-19 pandemic, the closure of airports, seaports and land crossings along with the suspension of all peacekeeping rotations have severely impacted the African Union-UN Hybrid Operation in Darfur (UNAMID), rendering “impractical” an effective exit by 31 October.The peacekeeping chief maintained once decided by the Council, the follow-on presence’s structure, mandate and establishment timeline would “significantly impact the sequencing and overall timeline of UNAMID’s drawdown”.Considering the enduring threats to civilians and a high anxiety level among the most vulnerable populations over UNAMID’s exit, the drawdown process must be “managed carefully”, he stressed and should not signal the lack of “concerns related to the protection of civilians in Darfur”.

New mission

The top peacekeeper underscored that the follow-on presence would aim to “preserve and consolidate the gains made over the years” and “build on the peacebuilding work” of UNAMID and the UN Country Team have conducted.“Our objective is to achieve a smooth transition to a future UN mission that can help the UN better support the Sudanese people”, he said, adding that that this entails ensuring that every mandate has the Sudanese authorities’ full support.

‘Worrisome’ humanitarian state

Meanwhile, Under-Secretary-General for Political and Peacebuilding Affairs Rosemary DiCarlo informed of a “worrisome” humanitarian situation in the country.“The number of people who need humanitarian assistance across Sudan increased from about 8 million to 9.3 million by the end of 2019”, she said, attributing this to a deepening economic crisis.And with the risk of a wider COVID-19 spread, “the economic challenges could worsen”, she warned.“The situation in Sudan is clearly dire and the need for support is real and urgent”, spelled out Ms. DiCarlo.

Nuts and bolts

In planning a new mission she detailed the four targeted areas of meeting political benchmarks contained in the Constitutional Declaration; implementing peace agreements in conflict-affected areas; strengthening national-led peacebuilding and human rights and rule of law institutions; and facilitating international support for economic reforms.

“The protection of civilians is also an area of focus”, said Ms. DiCarlo, which requires “a comprehensive approach…a to be effective in the long-term”. While the coronavirus outbreak has prohibited a transition team on the ground, she assured the Council that planning is underway virtually and a team will be physically deployed to Sudan as soon as the situation allows. “I trust we all share this sense of urgency and collective responsibility to enable the success of the truly historic transition in Sudan”, she concluded.