On 16 March 2020, Liberia confirmed the presence of the coronavirus disease (COVID-19) within its borders. One week later, health authorities declared a public health emergency, and requested United Nations support in stopping the transmission of the virus.
It was an eerie reminder of the Ebola epidemic that gripped Liberia six years ago. During that crisis, UNFPA worked with the Government and other health partners to implement contact tracing, which systematically traces every person known to have been in contact with a confirmed case of the disease.
Today, UNFPA is working together with the World Health Organization to co-lead the COVID-19 surveillance effort and the coordination of contact tracing.
There are clear differences between today’s outbreak and the Ebola epidemic, with different disease symptoms, modes of transmission and fatality rates. But some issues are the same, including shame, stigma and widespread mistrust in the community.
Liberia – now with more than 100 confirmed cases of COVID-19 – has responded to the pandemic with movement restrictions across the country. Residents of Montserrado and Margibi counties, the epicentre of the outbreak, face more stringent quarantine measures.
Contact tracers are urgently being recruited, trained and deployed. They are tasked with identifying suspected contacts of confirmed infections, monitoring those people for symptoms, and referring suspected cases for testing. They also provide education on infection prevention to the community.
“The contact tracers are helping to speed up the identification, isolation and treatment of suspected individuals,” said Thomas K. Nagbe, the director of the Infectious Disease and Epidemiology Division at the National Public Health Institute of Liberia, which is partnering with UNFPA in these efforts.
The role is challenging.
“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.
Even then, contact tracers must battle mistrust and misinformation. Some people do not believe they could be sick if are not exhibiting symptoms, for instance. Others believe conspiracy theories that have them doubting authorities and the pandemic response.
“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,” Mr. Koon said.
“You sometimes realize that people would choose to lie or mislead you.”
Heroes on the move
Contact tracers like Mr. Koon know they are taking on risks to their own health.
“Contact tracing comes with fear and anxiety,” he said.
“Strict adherence to the guidelines and protocols offer some level of assurances,” he added.
Still, he knows he could fall sick at any time. “The issue of personal safety cannot be taken for granted,” he said.
But he and his colleagues also know that their work is essential for safeguarding the health and welfare of their community.
“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.
“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.”
Today, there are more than 200 UNFPA-supported contact tracers working with the Montserrado County Health Team, which covers both Margibi and Montserrado countires. 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. UNFPA's pandemic response in Liberia is financed through what are known as core funds, meaning unearmarked funding that can be deployed flexibly during a crisis.