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Reporting on Ebola: First rule is you don’t touch anyone

Lawrence Togbah, left, Moses Bryant, center, and Abraham Saye try to protect themselves from Ebola by covering their hands, feet and torso with plastic bags. They did not have proper protective gear like gloves or masks. (Michel du Cille/The Washington Post)

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.

That’s it. No hugs, no pats on the back, no high-fives. An arm around the shoulders? Unthinkable.

Most Liberians, of course, have no such luxury. They 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.

They are among the world’s poorest people. Few in the city have their own cars. They jam into battered yellow taxis to get to the market or anywhere else, never knowing whether the last occupant was a dying Ebola patient who had shed virus on the seat as he was rushed to a treatment center. Even as the disease races through their society, they have no choice.

“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 simply in labor. If it’s possible to sum up the entire horror of the Ebola epidemic in one short phrase, Sam had just done it.

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: high fever, vomiting, diarrhea, bright red eyes. This is why Liberians and health workers, not journalists, have been the virus’s more than 3,000 victims.

I knew this when I volunteered in early September to go to Africa and cover the world’s most important health story. On Aug. 1, I had written a blog post titled “Why you’re not going to get Ebola in the U.S.,” which was something of a reach at a time when Ebola was just penetrating our consciousness. I did it in response to Donald Trump’s tweeted demand that physician Kent Brantly, a missionary aid worker in Monrovia who was near death from Ebola, be barred from the United States because he might bring the virus here. I had interviewed infectious disease specialists and read up on Ebola, and I was pretty confident in my assessment.

Nevertheless, I did more homework before agreeing to go. I consulted with Washington Post reporter Todd Frankel, who had covered the Ebola outbreak in Sierra Leone. I e-mailed Norimitsu Onishi, the New York Times correspondent, who, remarkably, had been in Liberia for weeks, and Nurith Aizenman of NPR, a former Washington Post staffer who also had written from there. I talked to Clair MacDougall, a Times stringer who lives in Monrovia, as well as a friend of my wife’s who lives there and works for USAID. Then Post photographer Michel duCille, who had been to Liberia three times before, volunteered to go as well.

Their advice was always the same: Follow a few rules and you’ll be fine.

Here in the United States, the response to my decision wasn’t quite as calmly expressed. My father, a retired medical school professor with decades of experience in infectious disease, called me “a big [unprintable].” My best friend suggested I was having a midlife crisis and couldn’t add to previous coverage by endangering myself. A friend from college called to say he might no longer be comfortable sitting next to me at an Oct. 11 football game. He had done the math and it would be fewer than 21 days after I was scheduled to return, so I might still be incubating the virus.

“I think you’re out of your f---ing mind,” he said.

Only my wife and grown daughter, both of whom understood instantly why I wanted to cover this story, listened dispassionately to the pros and cons and gave the trip a wary blessing.

The rules 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 the floors with bleach.

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

A pre-arranged driver picked us up at the airport. Another would take us everywhere for the next 12 days, except when I rode in a U.N. vehicle, with a hotel driver or with a Western freelancer. No sane Westerner with any options would get into a public vehicle in Liberia, if they even existed.

Once we offered a ride to Massa Kanneh, a reporter for the local paper Front Page Africa who had helped me find someone I wanted to interview. That’s okay, she said, I’ll take a cab.

Kanneh is 26, a year younger than my older daughter, and aware. “A cab?” I asked incredulously. “You can’t take a cab. You have no idea who was in there before you.”

I have to get to work, she said matter-of-factly.

Another time I asked a fellow straddling a motorbike how he was feeding his family. Most people in Liberia are not working. Work sites, schools and other places where people might gather — except church — are closed, to slow transmission of the virus. He told me he gives people rides on his bike for a few dollars.

That’s not safe, I said. They could have Ebola.

He shrugged. I look them over carefully, he said.

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

Before I left, I had 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 one and 10 particles, he said.

Liberians love Westerners, and Americans most of all. Their nation of 4.1 million was founded by freed U.S. slaves. Their flag looks a lot like ours. Their currency is the Liberian dollar, though a lot of daily commerce is conducted in U.S. dollars. They are glad we are finally coming to help them, and many approached us to talk, often to air grievances about the mismanagement of the Ebola crisis and everything else.

But if they got within my comfort zone, I moved. If they came up behind me or in my peripheral vision, I changed my position. If they came closer as we talked, I backed up. At first, I worried that it was insulting, but not for long.

Inside Ebola treatment centers and a small private hospital I entered once, the rules become stricter. There, you touch nothing — not a wall, nor a desk nor a piece of paper. Though the virus most loves our bloodstreams and body temperature, it can survive on surfaces. No one is quite sure how long. Studies show it can be anywhere from two hours to two days.

Maintaining that constant vigilance, especially while wearing long sleeves and pouring sweat in the Liberian humidity, is mentally taxing. As is watching the virus’s mounting toll day after day. 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 quickly but calmly. “Come, wash your hands.” I spent a while at the chlorine keg, rubbing the liquid into my skin.

DuCille observed no such niceties. He 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 hellhole 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, time-consuming process. One mistake and you can get virus on your skin. I refused to go anywhere that would require PPE.

DuCille also took to dead bodies like a moth to a flame. A corpse lying in the open beneath a line of drying laundry is a stunning image. I wanted nothing to do with them. For one thing, I couldn’t interview them. For another, I couldn’t tell where they had bled, vomited or defecated as they died. This is why health workers must spray chlorine widely when a corpse is found in public or a home, which is becoming increasingly common.

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. The boys were sleeping in one big room, the girls in another. 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 been launched 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.

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