I worked in Monrovia, Liberia at the start of the ebola epidemic and on various responses in the US. There were many things about Liberia that worsened the outbreak there. I want to talk for a minute about some of those issues (hint, this will tie into COVID at the end)

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First, the state of healthcare of Liberians was abysmal at baseline. Poor investments in health, extreme poverty, a number of other endemic diseases, and a number of other issues led to a high mortality rate. People were sicker, they got ebola more, and they died more.

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Hospitals were understaffed and underfunded. Monrovia was a resource-poor area. Hospitals didn't coordinate well with the ministry of health. The healthcare system wasn't able to deal with normal capacity let alone an epidemic. They were ravaged, and most hospitals shut down.

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Healthcare literacy and overall literacy was low, another effect of extreme poverty. This affected how public messaging worked, educating the general populace on how to avoid ebola, and generally how the public received the information. This probably also contributed

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Liberia was not too far removed from a civil war. There was still a great deal of potential for civil unrest. When the government tried to quarantine one township of Monrovia, there were violent protests. Police shot people in the street.

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There was a lot of fear and stigma around ebola. People would hide their infection, travel when they weren't supposed to, not follow social distancing guideline. They didn't want to be stigmatized.

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The thing is, when I saw all of this happening in Liberia, it was devastating. Some of my friends died. But, I was never super concerned that it would happen in the US (yes, this was very naive in hindsight).

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We're a rich country, I told myself. We have a well-educated populace. We have adequate supplies and resources. We have a robust public health system that would appropriately coordinate response.

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But now I'm seeing so many similarities -- lack of PPE, poor coordination from public health, fear and panic among our populace, the spread of misinformation, the willing disregard among the public of medical advice...

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It was naive and condescending of me to think that the US response would be better than that in Liberia. I'm devasted that we have so much hubris that we cannot learn lessons from previous outbreaks. So, so much of the wanton destruction was preventable. This is devastating

/end