Ebola and other Epidemics, Inadequate Healthcare Threatens Millions

[jimmy olsen]

Heartbreaking, so many more people are going to get sick and die.

http://edition.cnn.com/2014/08/25/health/ebola-contact-tracing/

Ebola contacts in Africa go missing
By Elizabeth Cohen, Senior Medical Correspondent
August 25, 2014 -- Updated 2151 GMT (0551 HKT)


(CNN) -- Earlier this summer, Kelsey Mirkovic, a disease detective with the Centers for Disease Control and Prevention, entered a hut with her team in Gueckedou, Guinea, to speak with a man who had Ebola.

Their mission: to get the names of everyone he'd had contact with while he was ill, so that they could stop those people from spreading the disease.

"Who lives with you here? Who has eaten off the same plate as you? Who has bathed you and taken care of you?" they asked him.

Just his wife, the man answered.

Mirkovic and her team knew that wasn't true.

They knew he had children, and they knew that in West Africa, families and even neighbors eat off the same plate and bathe and care for sick people. They explained to the man how important it was to stop Ebola, and that his friends and family would be treated with respect.

Their pleas didn't work.

Mirkovic saw this scene play out over and over again. One of her colleagues at the CDC who's worked in Liberia says preliminary data shows they could be missing 40 to 60% of the contacts of known Ebola patients.

"This is one of the hardest parts of the response," said Dr. Brett Petersen, a medical officer with the CDC.

Mirkovic agrees. She says she understands why Ebola patients don't want to name names: There was a rumor going around the communities she worked in that getting on a contact list meant you would die -- and the deaths would happen in the same order as they appeared on the list.

"I understand they're scared," she said. "But it's very frustrating."

The Ebola outbreak in the West African nations of Guinea, Sierra Leone, Liberia and Nigeria has killed nearly 1,500 people. Just one contact left un-traced could go on to start a whole new line of Ebola transmission.

"It's like fighting a forest fire. If you leave behind even one burning ember, one case undetected, it could reignite the epidemic," Dr. Thomas Frieden, the director of the CDC, told reporters at a press conference earlier this summer.

"Contact tracing is a formidable challenge," said Dr. Margaret Chan, director-general of the World Health Organization. "In some areas, chains of transmission have moved underground. They are invisible. They are not being reported."

There's no solid number of how many contacts have gone missing. Petersen said the CDC arrived at the 40 to 60% number because in some communities, each sick person has only listed an average of two contacts -- and households commonly have five or six people.

Mirkovic, an officer with the CDC's epidemic intelligence service, said when she and her team felt patients weren't being honest, they would try to get information from neighbors or community leaders.

Sometimes that helped, and sometimes it didn't.

"Unfortunately, there's nothing we can do," she said. "We can't force them" to give contacts.

The World Health Organization estimates that 10% of contacts will go on to develop symptoms of Ebola. Occasionally, some of these Ebola cases go missing as well.

"Many families hide infected loved ones in their homes," according to a WHO press release issued Friday.

Mirkovic, who left Guinea in the end of July, said she felt that the situation might improve as health care workers gain more trust in the community.

But there's another problem with that: the availability of workers to follow up with contacts.

For example, in Sierra Leone, there are 2,000 contacts that need following, but the group Doctors without Borders says they've only been able to follow up with about 200 of them.

The group's teams in Sierra Leone and Liberia are "stretched to the breaking point" as the epidemic is "spiraling out of control," the group wrote in a press release.

[jimmy olsen]

Liberia has fallen

http://www.npr.org/blogs/goatsandsoda/2014/08/26/343436300/cdc-director-on-ebola-we-are-definitely-not-at-the-peak

On Monday, Dr. Tom Frieden, director of the , arrived in Liberia to assess the Ebola outbreak. The situation "is overwhelming," he said.

The outbreak "really is a crisis and is affecting most if not all the counties in Liberia already," he told NPR from Monrovia, the capital city and first stop on a three-country visit. "This is absolutely unprecedented."

The CDC, Frieden said, "is working flat out on this, but this is huge and needs a global response. ... They need a lot of help from the world."

He emphasized that the toll is "far larger than has been recorded, not because they are trying to hide anything but because they are really overwhelmed by these numbers." Beyond this, he said, the cases "are increasing at an extremely quick rate, and this is very alarming."

As bad as the Ebola situation is, Frieden warned that the worst is yet to come. "Unfortunately, we are definitely not at the peak. It's going to get worse before it gets better," he said. "The real question is how much worse will it get? How many more people will be infected and how much more risk to the world will there be?"

...

http://www.msf.org.uk/article/liberia-msfs-new-ebola-centres-already-overwhelmed

Liberia: MSF's new Ebola centres already overwhelmed
Brice de le VingneMSF Director of Operations
27.08.2014

Médecins Sans Frontières/Doctors Without Borders (MSF) is rapidly scaling up its operations in Liberia as the international response to the Ebola outbreak in West Africa continues to be chaotic and entirely inadequate.

In its first week, MSF's newest Ebola management centre – also known as ELWA3 – in the capital Monrovia, is already at capacity with 120 patients, and a further expansion is underway.

Meanwhile, in the north of the country, patients continue to flow into the newly rehabilitated Ebola management centre in Foya.

Serious lack of international leadership and coordination

"It is simply unacceptable that, five months after the declaration of this Ebola outbreak, serious discussions are only starting now about international leadership and coordination ," says Brice de le Vingne, MSF Director of Operations.

"Self-protection is occupying the entire focus of states that have the expertise and resources to make a dramatic difference in the affected countries. They can do more, so why don't they?"

The outbreak is spreading rapidly in Monrovia, overwhelming the few medical facilities accepting Ebola patients.

Emergency within the emergency

Much of the city's medical system has shut down over fears of the virus among staff members and patients, leaving many people with no healthcare at all, generating an emergency within the emergency.

"In the aftermath of an earthquake it would be unthinkable that there are so few places where women can safely deliver their babies, or where people can be treated for life-threatening conditions," says Lindis Hurum, MSF emergency coordinator in Monrovia.

"This is not only an Ebola outbreak – it is a humanitarian emergency, and it needs a full-scale humanitarian response."

The number of people seeking care at the newly constructed 120-bed centre in Monrovia, which opened on 17th August, is growing faster than the team can handle, both in terms of the number of beds and the capacity of the staff.

Patients are coming from nearly every district of the city. The staff are struggling to screen new arrivals, care for admitted patients, safely remove dead bodies and transport them to the crematorium...

http://nos.nl/artikel/691669-ebolapatienten-weggestuurd.html
Translation from here: http://www.flutrackers.com/forum/showthread.php?t=227003

"Ebola patients sent away"

Wednesday Aug 27 2014

"We have staff at the gate who do nothing but turn away people. This is not easy, because we don't know where they could go," said Karline Kleijer from MSF.

In West Africa, the Ebola epidemic is still spreading rapidly. To help patients MSF opened an emergency clinic last week in the Liberian capital Monrovia. After four days the clinic was full.

Currently there are about 200 patients in the clinic. According Kleijer that could have been more than 600 already if they had opened the doors. That can not be, because so many people infected with Ebola would be a danger to the employees of MSF.

Not administered
Because there are not enough emergency clinics and regular healthcare is not functioning most Ebola patients can not be administered. Therefore, the clinic expanded by another dozen beds. But even that is not enough. "We know that there are thousands of patients are walking in the street, infecting other people," says Kleijer.

According to her, there are not enough resources to detect the contacts of the patients. Thereforepeople who are also infected can not be identified . " The houses of patients must be decontaminated. It will not happen."

emotional
The work of the rescuers is heavy. It is very hot in the suits that they need and there is always the risk of getting infected with the virus.

Emotionally it is difficult, says Kleijer. "One of the worst moments is when people die when they arrive here. Often with family and then you get their grief too."

"But what I find the weirdest is that I talk with patients that I know they are dead a few days later."

[jimmy olsen]

Uncontained outbreak in Nigeria! 

http://saharareporters.com/2014/08/27/breaking-nigeria-records-new-ebola-death-port-harcourt#.U_5X64hNibA.twitter

Breaking: Nigeria Records New Ebola Death In Port Harcourt

The diplomat, who was part of the team who met with Patrick Sawyer in Lagos, flew to Port Harcourt, Rivers State for treatment, evading surveillance for the disease.

by Sahara Reporters Aug 27, 2014

A doctor, who secretly treated a diplomat who had contact with the index case, Liberian-American Patrick Sawyer, has died of Ebola in Nigeria.

The doctor, who has yet to be named, died on Friday. His wife has also taken ill and has been quarantined in Port Harcourt. Interestingly, the diplomat the doctor treated is still alive.

The diplomat, who was part of the team who met with Patrick Sawyer in Lagos, flew to Port Harcourt, Rivers State for treatment, evading Nigerian federal government surveillance for the disease. The late doctor then took him to a hotel for treatment.

As a result of this, 70 people have been quarantined. The doctor's hospital, Good Heart Hospital in Rivers State, has been shut down. The unnamed hotel, where the secret treatment took place, has also been shut down.

The Minister of Health and the Rivers State government are expected to make a statement on the incident tomorrow.

Dogs are eating the dead in Liberia, and likely elsewhere. They can carry the virus, so that's another vector of transmission.
http://thenewdawnliberia.com/index.php?option=com_content&view=article&id=12468:dogs-feed-on-ebola-victims&catid=25:politics&Itemid=59

The residents of the Mount Barclay Community within the Johnsonville Township, outside of Monrovia woke up on last Friday morning in total dismay when the remains of dead Ebola victims were reportedly seen, eaten by dogs, something reminiscent of the brutal civil war here, when dogs ate dead bodies on the streets.

The Liberian Government, through the Ministry of Health and Social Welfare, buried some unaccounted-for corpses, suspected to have died from the Ebola Virus in that township few weeks ago.

The burial was done in a hurry at night following a standoff in the day between residence and the Ministry of Health burial team. The former had refused to grant the authority a piece of land to carry out the burial. The dogs, in their numbers, were seen pulling the bodies out of the shadowed grave and hastily eating them.

A resident, who spoke to the NewDawn, said that the action of the dogs has posed a serious health hazard to the entire Mount Barclay Community. Mr. Alfred Wiah noted that the dogs could easily spread the virus through further interactions with community dwellers.

According to Mr. Wiah, upon discovery of the dogs' behavior, some young men immediately contacted the Health Ministry, but to no avail. The young men also attempted to kill all of the dogs, but some escaped the scene, making the terrain very scaring for the residents.

He then expressed his disappointment in the manner and form the Liberian Government has treated the township. "We are very disappointed in the Health Ministry, especially the government that took an oath to defend and protect us; to see them act in such manner is unacceptable and we'll never allow the government come to bury any longer. They will be resisted by us because I think the government has failed to protect us- why bring Ebola bodies and mot bury them well,"? He explained in this paper.

According to him, some residents were deciding to leave the township in order to save their respective families, noting that since the incident occurred last Friday, the government has failed to clean the "mess"  by reburying the dead properly.  When the Commissioner of the Johnsonville Township, Mr. Melvin Bettie, was contacted yesterday, he confirmed the information, but added that his leadership was working with the community leadership to find a solution to the situation.

"I received the information already through the community chairman and I've sent a delegation there to see how we can revise the situation because it is embarrassing and it poses serious hazard to the community's dwellers," he said.

[Syt]

The internet never disappoints. Or always disappoints.

[PJL]

Sounds like the ebolalypse is upon us then.....

[alfred russel]

Imagine Tim giving updates on the Black Death back in the day.

[Ed Anger]

Imagine Tim giving updates on the Black Death back in the day.

imagine Tim getting the Black Death.

[derspiess]

[jimmy olsen]

Sounds like the WHO is still in denial. There are 3,000 known cases and they admit the true number is 2 to 4 times that and they say that it "may" end up infecting 20,000 people. If 6-12,000 people already have it then the case number is going to hit 20,000 in the next three to four weeks guaranteed.

http://news.yahoo.com/says-ebola-outbreak-could-strike-20-000-people-102050086.html

[The Brain]

The WHO?

[CountDeMoney]

It's not denial when they can't get reliable data points on an outbreak in stone age conditions, Dr. Twathead.

[Tonitrus]

The WHO?

They're putting on an Eminence Front.

[viper37]

Imagine Tim giving updates on the Black Death back in the day.

it would have been nice.  We could have laughed at europeans and their silly, non pragmatic customs.

[Eddie Teach]

http://www.usatoday.com/story/news/nation/2014/08/28/ebola-vaccine-trial/14716833/

U.S. officials announce Ebola vaccine trial launch
Liz Szabo, USA TODAY 11:32 a.m. EDT August 28, 2014
The USA plans to begin testing an experimental Ebola vaccine next month, but even in the best case, it won't become available until next year.

U.S. health officials announced that the first human trial of an experimental Ebola vaccine will start next week, and that trials of other vaccines will follow close on its heels.

The vaccine trial will involve 20 healthy volunteers at the campus of the National Institutes of Health in Bethesda, Md., with results expected by the end of the year, said Anthony Fauci, director of the NIH's National Institute of Allergy and Infectious Disease.

Although NIH has been developing the vaccine for more than a decade, the public health emergency in West Africa has pushed both the NIH and the Food and Drug Administration to accelerate its development, said NIH director Francis Collins, who said the agencies have taken "extraordinary measures" to launch the study as quickly as possible.

"This is a public health emergency that demands an all-hands-on-deck response," Fauci said.


USATODAY
Ebola outbreak could strike 20,000, WHO says
Fauci called the Ebola epidemic, which has killed half of the 3,000 people infected, an "uncontrolled outbreak" that needs to be contained using traditional methods, such as diagnosing cases, isolating those individuals to prevent them from infecting others, tracing their contacts and testing those people for the disease, as well.

Fauci has previously said that even an experimental vaccine would not be available until the middle of next year. The World Health Organization announced Thursday that it could take six to nine months to contain the current outbreak in Guinea, Sierra Leone, Liberia and Nigeria, and that the outbreak could grow to 20,000 cases.

In a significant announcement, Fauci said that drug giant GlaxoSmithKline (GSK) will co-develop the vaccine. That will make it much easier to "scale up" production of large quantities of the vaccine, if it proves effective, Fauci said. He noted that it has been difficult to produce enough doses of an experimental medication, called ZMapp, which is being developed by a small San Diego biotech company. That company has said that it has given away all of its doses and has none left.

Fauci stressed that the phase 1 study — the earliest of all human tests — is aimed at answering two very basic questions about the vaccine. Is the vaccine safe? Does it provoke the immune system to respond to Ebola? Scientists will be able to gauge the vaccine's prospects for preventing infection by measuring whether a volunteer's immune system mounts a strong response to the Ebola genes in the vaccine.

The vaccine will use a monkey cold virus as a "vector" to deliver Ebola genes to the body. Cold viruses are notoriously good at infecting the body, so they make good delivery vehicles. The viruses act only like delivery trucks, and cannot cause harm. The Ebola genes carried in those viruses can't cause someone to become sick with Ebola, Fauci said. But the genes would direct volunteers' bodies to create one Ebola protein. If the body recognizes that protein as foreign and dangerous, the immune system should create antibodies against it. Those antibodies would protect against a real infection, if the person were to be exposed to Ebola.

The vaccine is designed to protect against two strains of Ebola virus, known as the Zaire and Sudan species. The current outbreak in West Africa is caused by the Zaire strain.

Based on early results, scientists will be able to assess whether to go ahead with larger studies. The vaccine already has performed well in tests in animals, protecting them against Ebola infections.

Volunteers will be evaluated by NIH staff nine times over 48 weeks, Fauci says. To ensure safety of the volunteers — all healthy adults — scientists will give the vaccine to just three people at a time, pausing the trial to check for safety before vaccinating additional volunteers. Safety is "paramount" when testing an experimental drug against healthy people who are not sick or in danger.

Another U.S.-based vaccine study, also using 20 volunteers, will test a vaccine that protects against just the Zaire strain of the virus. That trial also will be conducted at NIH and is set to begin in October, Fauci said.

That vaccine also will be tested in the United Kingdom and the African countries of Mali and Gambia, Fauci said.

NIH scientists also are working with the Department of Defense on an early-stage trial of a third Ebola vaccine, developed by the Public Health Agency of Canada and licensed to NewLink Genetics. That trial will begin this fall at Walter Reed National Military Medical Center.

In addition, the Centers for Disease Control and Prevention has begun talks with the Nigeria's ministry of health to conduct vaccine tests there, Fauci said. The CDC has not yet announced which vaccine it will test in Nigeria.

"We will share data from our studies as quickly as they become available," Fauci said.

The USA has been working on an Ebola vaccine partly to protect against a bioterrorist attack.

The experimental vaccine set to be tested next month was designed by scientist Nancy Sullivan, chief of the biodefense research section in the National Institute of Allergy and Infectious Disease's Vaccine Research Center. She worked with researchers at the U.S. Army Medical Research Institute of Infectious Diseases, and Okairos, a Swiss-Italian biotechnology company bought by GSK last year.

[jimmy olsen]

Ugh, this quarantine is just going to accelerate the spread of that disease within the slum and to rest of Monrovia.

http://www.nytimes.com/2014/08/29/world/africa/in-liberias-capital-an-ebola-outbreak-like-no-other.html?_r=0

As Ebola Grips Liberia's Capital, a Quarantine Sows Social Chaos

By NORIMITSU ONISHIAUG. 28, 2014

MONROVIA, Liberia — Some people are swimming in and out of the Ebola quarantine zone in this seaside capital. One man slips out every day to reach his job at a Western embassy. Another has turned his living room into a tollbooth, charging others to escape through his apartment at the edge of the cordoned area. Countless others have used a different method: bribing their way out with fees that soldiers determine according to a person's appearance, circumstances and even gender.

Christian Verre, a 26-year-old clothing salesman, sneaked out through an abandoned building with his girlfriend, Alice Washington, 21, and eight friends. "Go back! Go back!" soldiers and police officers yelled, he recalled, but the conversation quickly took on a different turn: "What do you got?"

Those carrying goods handed over more than $8, Mr. Verre said. Traveling light, he was charged $4.25 for his girlfriend and about $6 for himself, "because I'm a man." The couple now share a shack a few blocks outside West Point, the vast, sprawling slum that was placed under an Ebola quarantine last week.

"I didn't want to stay in West Point for 21 days," he said, referring to Ebola's maximum incubation period. "I wouldn't die of Ebola but of hunger."

The five-month outbreak here in West Africa, already worse than all other Ebola epidemics combined, is for the first time spreading uncontrollably in a major city — one in which a third of Liberia's 4.5 million people is estimated to rub shoulders, often uneasily. Though Ebola reached Monrovia three months after its appearance in the rural north, the city has become, in a few short weeks, a major focal point of the epidemic.

The outbreak has overwhelmed the government of President Ellen Johnson Sirleaf, who has won the Nobel Peace Prize and the admiration of leaders around the world. But her management of Liberia has long drawn criticism at home, and now her handling of the Ebola epidemic has presented her with a political crisis that is galvanizing her opposition.

"We suffering! No food, Ma, no eat. We beg you, Ma!" one man yelled at Ms. Johnson Sirleaf as she visited West Point this week, surrounded by concentric circles of heavily armed guards, some linking arms and wearing surgical gloves.

"We want to go out!" yet another pleaded. "We want to be free, Mama, please."

International Ebola experts and her own health officials advised against imposing the quarantine in West Point, worried that it would antagonize a population whose cooperation the government desperately needs to stop the epidemic. But Ms. Johnson Sirleaf sided with the army, which was the strongest proponent of the quarantine and took the lead in enforcing it, especially in the first two days.

"Putting the police and the army in charge of the quarantine was the worst thing you could do," said Dr. Jean-Jacques Muyembe, a Congolese doctor who helped identify the Ebola virus in the 1970s, battled many outbreaks in Central Africa and has been visiting Monrovia to advise the government. "You must make the people inside the quarantine zone feel that they are being helped, not oppressed."

Isolating communities has succeeded in some rural areas in past outbreaks in Central Africa. But the quarantine of an entire urban neighborhood, where an estimated 60,000 to 120,000 people are crammed into crumbling shacks, has proved to be more than just porous. It has also led to deadly clashes with soldiers and may even be helping spread the disease, experts say, forcing people to crowd together for basic humanitarian aid, like food relief.

Cordoned off from the city, young men in West Point squeeze together in dense lines for rice and water, pushing and shoving, sweat mixing, saliva flying, blood sometimes spilling. One morning, a man in a wheelchair trying to cut to the front was beaten, stripped and left sprawled in the middle of the road, urinating over himself.

"The quarantine is going to worsen the spread of Ebola," said Dr. Muyembe, the director of the National Institute for Biomedical Research in Kinshasa, Democratic Republic of Congo. "It's difficult to understand the motivation behind it. It's simply not a good strategy."

Lewis Brown, the Liberian minister of information, said the president made the decision based on both health and security concerns. Though Ebola has been spreading throughout other parts of the city, he said, the government singled out West Point because of its dense population and its potential for political instability, as shown when residents recently stormed an Ebola holding center that they did not want in the neighborhood.

"We're not saying that Ebola is any more present in West Point than other places in the country — that's not the argument we're making," Mr. Brown said. "But the potential is in the size of the area and the interaction with the city itself."

He added: "We're not claiming to be experts on Ebola. We've never had to deal with this kind of thing, but we've always had to deal with our people. We understand our people more than we understand this disease."

Ms. Johnson Sirleaf has made no public statement since the start of the quarantine and the fatal shooting of a 15-year-old West Point boy, Shakie Kamara, who was caught in a battle between soldiers and men trying to break out of the quarantine zone.

During her visit to West Point, she apologized to his family and looked at those calling for help with sympathy in her eyes, saying little. Walking several feet behind her, a man in a checkered shirt pulled out Liberian dollar bills from a backpack with his gloved hand and tossed the money to the loudest protesters. The money silenced their criticism but immediately set off fistfights.

A Toyota Land Cruiser took the president out of West Point. Her guards and entourage followed on foot, tossing their used gloves on the ground on their way out.

An Explosive Outbreak

No one knows yet why Ebola has succeeded in spreading at such an alarming rate here in the capital. Ebola has reached the capital cities of Freetown, Sierra Leone, and Conakry, Guinea — the two other West African nations most affected by the current outbreak — but the disease has been more effectively contained in those cities.

The first cases in Monrovia were reported only in June. Infections have multiplied quickly here in recent weeks, illustrating the speed with which Ebola can spread in a major urban area. The county containing Monrovia quickly registered the nation's biggest death toll — now 274 deaths out of a national total of 754, according to the Ministry of Health.

"The Conakry outbreaks have been very small, and they haven't exploded in Freetown," said Dr. Armand Sprecher, an Ebola expert for Doctors Without Borders here. "So something is different in Monrovia. It's something in the disease transmission behaviors in Monrovia that has done this. That's my guess. We've never seen this kind of explosion in an urban environment before."

Others point to a political system long dominated by an elite out of touch with the population and more focused on jockeying for power. Politicians, including members of the president's own party, publicly expressed doubts about the extent of the outbreak and even accused her administration of exaggerating it to collect money from international donors.

Among Liberians, still grappling with the consequences of a 14-year civil war that ended in 2003, distrust of the government runs deepest in Monrovia's poorest neighborhoods. Despite billboards and posters throughout the city declaring that "Ebola is Real," many Liberians believe it is not.

Dr. Moses Massaquoi, who has been heading Ebola case management for Liberia's health ministry during the crisis, said that high-level political denials delayed the expansion of a treatment center just as cases mushroomed last month.

"Unfortunately, Ebola is not waiting for politics," he said. "That was a missed window of opportunity."

As the situation worsened in the capital in mid-August, the government established the city's first Ebola holding center in West Point, Monrovia's biggest slum and political opposition stronghold. Locals ransacked and closed down the center within days.

On Aug. 20, under the president's orders, the army and police placed West Point under quarantine — the first time, some experts say, that a quarantine was attempted on such a scale. West Point reacted with fury: hundreds of young men tried to storm through the barricades. As soldiers fired live rounds to drive them back, the 15-year-old boy, Shakie, was killed. Only heavy rain starting around noon put a stop to the riots.

In rural areas, quarantining communities can work if they are small enough and unified under political or traditional leadership, experts say.

"What is important is for the people to participate in the process; otherwise it becomes too difficult to implement effectively," said Dr. Nestor Ndayimirije, the World Health Organization's director for Liberia.

A week into the quarantine of West Point, life has been getting harder for those without the means or connections to get out. The price of goods that find their way into the quarantine zone — rice, water, coal, prepaid cellphone cards, soap — has doubled.

"People are fighting for food to eat," said Victor Nwanodu, who owns one of West Point's most popular public toilets and baths. Business has dropped, he said, as people can no longer afford to pay for a hot bath.

Serena Wallo, 31, was one of a few dozen people whose houses were washed away this week along West Point's heavily eroded shoreline. Unable to leave the quarantine zone, her family now has to stay with friends in the area, in the kind of overcrowded conditions where Ebola thrives.

"I'm not happy with the government," Ms. Wallo said. "They are treating us like we are slaves."

A Political Backlash

Like her counterparts in Sierra Leone and Guinea, Ms. Johnson Sirleaf was dealing with Ebola for the first time. She decided to do so with a firm hand by deploying the army — an institution that remains troubled despite being rebuilt after the civil war with American training and hundreds of millions of dollars in American assistance.

Mr. Brown, the information minister, said that it was necessary for the army to take the lead in the first couple of days of the quarantine. "If the military had not backed up the police the way they did, probably not only West Point would have been overrun, but the city center would have also been overrun," he said.

But the president's handling of the crisis is drawing new political challenges and leading to defections. Political parties and newspapers are calling for her resignation. This week, Ms. Johnson Sirleaf announced she had fired high-ranking government officials who refused to return to Liberia because of the Ebola outbreak. Though she inspired great hope among Liberians when she was first elected in 2005, becoming the first woman elected head of state in Africa, the crisis has fueled longstanding criticism that her reputation abroad was inflated by foreigners with little knowledge of the conditions in Liberia.

"This Ebola thing now has basically laid the thing out like this: the system is bad and the emperor has no clothes," said Samuel P. Jackson, who served as an economic adviser to the president until the end of July but is now backing, Benoni Urey, a businessman believed to be Liberia's richest man and a candidate in the next presidential election.

Mr. Urey, who for months has been criticizing the government's handling of the outbreak, said Ms. Johnson Sirleaf "must take the ultimate blame for everything." One of the greatest sources of public anger, he pointed out, has been the government's inability to pick up the bodies of the Ebola dead, which have often been left in people's houses or even dumped on public streets.

"Come on!" Mr. Urey said, calling it an example of the government's incompetence.

Jerolinmek Piah, the president's press secretary, said that Ms. Johnson Sirleaf was no longer giving interviews.

In a very brief exchange, Ms. Johnson Sirleaf said of the quarantine in West Point, "We are trying to make it go well."

Little the Hospital Could Do

Shakie Kamara, the 15-year-old boy who was killed in the clashes in West Point, was raised by his aunt. His mother died when he was a toddler, and his father a couple of years later.

On the morning of his own death, Shakie had gone to buy tea and bread for his aunt at a shop near the entrance to West Point, but apparently got caught between a crowd of rock-throwing men and soldiers firing live rounds.

"No pa, no ma," he said, pleading for help as he lay on the ground with wounds to both legs.

The defense ministry said the wounds were caused by barbed wire. But Dr. Mohammed Sankoh, the medical director of Redemption Hospital, where Shakie died, and two other hospital staff members said that the boy died after suffering deep bullet wounds. There was little that the hospital, where a doctor and several nurses had died recently of Ebola, could do, hospital workers said.

"There was no material in the emergency room," said Dr. Alphonso Gray. "The theater was not operating."

While visiting West Point, the president promised Shakie's family an investigation into his death.

Shakie's older brother, Lusine Kamara, 27, said he told the president he wanted nothing — just Shakie's body for a proper funeral. Shakie's aunt, Eva Nah, left the door open.

"She told me that after everything, she will get back to me," Ms. Nah said.

A couple of hours later, the military released Shakie's body to his family, and he was buried at Monrovia's Muslim cemetery.

Clair MacDougall contributed reporting.