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In Liberia, every touch carries Ebola risk

A Liberian health worker speaks to a 4-year-old boy in a holding center for suspected Ebola patients in Monrovia.
A Liberian health worker speaks to a 4-year-old boy in a holding center for suspected Ebola patients in Monrovia.
Published Oct. 4, 2014

MONROVIA, Liberia — I was goofing around with a small group of young children outside their home on a muddy, cratered road in the New Kru Town slum here. I made a scary face and the kids skittered, giggling, behind a low wall at the front of their shanty. Then they peeked out, hoping for more.

Finally the boldest of the lot, a little girl perhaps 5 years old, approached and stuck out her hand. "Shake!" she offered excitedly.

"No touching," I responded, keeping my hands at my sides, trying to hide my sadness. "No touching."

You don't touch anyone in Liberia. Not kids, not adults, not other Westerners, not the colleagues you arrived with. It is the rule of rules, because while everyone able is taking precautions, you just can't be sure where the invisible, lethal Ebola virus might be. Once the virus is on your fingers, it would be frighteningly easy to rub an eye and infect yourself.

In 12 days of reporting the Ebola story in Liberia, I touched two people (not counting the occasional "Liberian handshake," a soft bump of covered elbows). Once, I completely forgot the protocol and shook the outstretched hand of a newly arrived aid worker. Later in the trip, I asked a Washington Post photographer to lightly touch my forehead to see if I had a fever, one of the early signs of Ebola infection. I was concerned my thermometer wasn't working.

Most Liberians play a daily game of Russian roulette with their very lives. They press tightly together, front-to-back, in bus stop queues. They jostle and crowd at food distribution sites. They handle their own dead. In the capital, a city of 1.5 million, they live on top of one another, many people to a dilapidated home, often without running water, sanitation or electricity.

"My country is surviving by the grace of God," our driver and guide, Samwar Fallah, told me at one point. We were outside a treatment center, watching its director, a heroic physician named Jerry Brown, trying to determine whether a weakened woman on a bench was infected with Ebola or was simply in labor.

You wouldn't know it from the mushrooming number of deaths and infections in West Africa, but Ebola is rather difficult to contract. The virus is not airborne, like SARS. You have to come in contact with an infected person's bodily fluids — blood, vomit, feces, urine, sweat, saliva — to get it and that has to occur when he or she is showing the symptoms of infection. This is why Liberians and health workers, not journalists, have been the virus' more than 3,000 victims.

The rules on Ebola become crystal clear the moment you arrive at Liberia's decrepit airport. Workers wearing rubber gloves took our temperature with infrared (no touch) thermometers before we entered the first building. Our hotel, like anywhere else in Liberia that can afford it, had a small keg with a spigot outside the entrance, the kind that dispense Gatorade on the sidelines of football games. It is filled with a solution of chlorine and water, which kills the virus. Everyone is expected to wash his hands each time he enters the hotel or its adjacent restaurant. Workers constantly swab floors with bleach.

Each entrance also has a small trough where you rinse your shoes in the same liquid. We carried it in spray bottles in our car and used it liberally.

Our first day of reporting took us to all of Monrovia's treatment centers. All were full, or nearly so. Outside of each one were very sick people who couldn't get in. As I interviewed them, I stood 4 to 6 feet away, as New York Times correspondent Clair MacDougall had suggested, in case the person I was talking to sneezed, coughed, spit or — worst of all — vomited.

I asked an expert how much virus is in each droplet of body fluid. At time of death, when the viral load is highest, he told me, it's probably 500,000 to 1 million particles. And how much virus would it take to become infected? Somewhere between 1 and 10 particles, he said.

Inside Ebola treatment centers and a small private hospital I entered once, the rules become stricter. You touch nothing — not a wall, nor a desk nor a piece of paper. Though the virus most loves our bloodstreams, it can survive on surfaces. No one is sure how long.

Maintaining that constant vigilance, especially while wearing long sleeves and pouring sweat in the Liberian humidity, is mentally taxing. It's almost impossible not to slip. Once I put my hand on a slim wood railing on the path to the entrance of Brown's treatment center. "Don't touch that," he said calmly. "Come, wash your hands."

Post photographer Michel DuCille washed with chlorine as often as I did, but he has long ago shed the human instinct for self-preservation, maybe when he spent seven months shooting photos in a crack house or dodged gunfire in Afghanistan. He went inside the former Redemption Hospital, the transfer station for the sick and the dead in Monrovia, where bodies litter the floor as they drop.

This required him to cover every square inch of his skin with "personal protective equipment," the moon suits that have become a visual emblem of the epidemic. Putting this outfit on and taking it off is an arduous process. One mistake and you can get virus on your skin. I refused to go anywhere that would require PPE.

Early in our visit, UNICEF and the Liberian government took us to a small building where community members were caring for orphaned children and others whose relatives were being traced. All the kids had tested negative for Ebola, we were told, so don't worry about them being infectious. We spent about three hours there, doing interviews and shooting photos.

A few days later, UNICEF's public affairs officer called. A mistake had been made, and one of the children — a charismatic little girl we had focused on — was now showing symptoms of Ebola infection. An investigation had begun to determine how this could have happened.

We hadn't touched anyone, of course, but my mind began racing. Had I sat in the same spots she had? Had I gotten too close? She wasn't symptomatic when we were there, so we were probably fine. But what about the other children, and the adults who were watching them? And what about Liberians and West Africans who remain unprotected from the virus?

As yet, there are no answers.

Lenny Bernstein blogs health issues for