Liberia’s Incident Management Team On COVID-19 Pandemic Response

Although as of 13, August, 2020, Liberia officially registered 1,252 confirmed cases of coronavirus, 82 deaths and 738 recoveries, the country’s Health Minister, Dr. Wilhelmina Jallah and Madam Mary T. Broh, National Coordinator for COVID-19 Response, remain hopeful that the disease, which the World Health Organization (WHO), had earlier declared as a pandemic, worldwide, will be defeated in Liberia sooner than later, if citizens and residents fully adhere to its prevention protocols. Liberia reported its index case of COVID-19 on 6, March, 2020.
Since then, and as part of its fight against the lethal disease, Liberia’s National Incident Management System (IMS), a few months back, carried out a thorough review of its response activities, and identified more partnerships and action plans among others.
Attended by more than 71 stakeholders such as Representatives of the donor communities, senior officials of the Ministry of Health, Finance and Development Planning, UN agencies, local non-governmental organizations among others, the virtual conference, chaired by Health Minister Jallah, was also aimed at meeting the basic health needs of the Liberian nation.
Recently, THE IMAGES magazine’s Editorial Team separately spoke with the Minister of Health, Dr. Wilhelmina Jallah and Mary T. Broh, National Coordinator for COVID-19 Response.

Dr. Wilhelmina Jallah
Minister Jallah pointed out that the Incident Management System (IMS) is a conglomeration of institutions-public and private, set up to respond to the Coronavirus outbreak in Liberia.
The Ministry of Health plays a key role in coordinating the health and safety aspects, and Dr. Jallah remains in the vanguard, coordinating the activities of the IMS.
Based on the number of COVID-19 cases including coronavirus deaths around the world, Minister Jallah said it is fair to say Liberia is doing well in the COVID-19” fight.
According to the Liberian Health Minister, of the 1,252 confirmed cases, and 81 deaths, nine of the deaths occurred at the COVID-19 treatment units, while the rest took place in the communities.
She disclosed that the number of confirmed cases is reducing as compared to the past few months and that Liberia stands a better chance to be declared free if citizens and residents follow the health protocols including regular hands washing, wearing of nose or face masks, social distancing, just to name a few.
The Liberian Health Minister asserted that while the State of Emergency (SoE), which was previously imposed by President George Manneh Weah in the fight against COVID-19 has been relaxed, the Public Health Law of Liberia remains in place, and as such, it must be vigorously enforced for the good of all and sundry.
This, according to the Health Minister, makes it imperative for people to get adapted to hands washing and for effective exercise of social distancing among others.
Giving reasons as to why confirmed COVID-19 cases in Liberia are lower than other countries, Dr. Jallah pointed out that unlike western countries, Liberia, an African country, has a predominately youthful population and that many of its people have good immune systems, capable of preventing them from contracting COVID-19.
Moreover, the Liberian Health Minister said, most of the people who contracted COVID-19 in Liberia do not have underlying health problems, a situation which often caused more health problems for coronavirus patients.
She further indicated that an estimated 45% of COVID-19 cases in Liberia involve people whose ages ranged from 0 to 35 years.
In a Special Way, the Liberia Health Minister lauded President George Manneh Weah, for his support towards the fight against the novel coronavirus in Liberia.
“The President has been supportive to the fight; he has undertaken a one million masks production, and it has enabled us to distribute the masks among marketers, commercial bike riders and many others,” she added. Dr. Jallah also praised the nation’s health care personnel including nurses and Doctors as well as other medical technicians and specialists for their courage, commitment, hardwork, and professionalism in the service of their country.

Mary T. Broh, National Coordinator for COVID-19 Response:
Similarly, Madam Mary T. Broh, National Coordinator of the COVID-19 Response, told THE IMAGES: “I thank the President, His Excellency George Manneh Weah, for giving me the opportunity to serve my country in another key capacity. My work is about taking the message of COVID-19 to the people to keep safe, and I can say that things are going on fine.”
She said with the support of President Weah, the COVID-19 Incident Management Team (IMT) has secured at least half of one million masks for onward distribution to citizens and residents, many of whom cannot afford to buy face/nose masks for themselves.
According to Madam Broh who is also Head of the state-owned General Services Agency (GSA), the face and nose masks are being distributed to people in various communities; poor marketers, motorcycle union, and vulnerable groups who cannot afford to purchase masks.
Madam Broh, widely referred to as “General Broh” for her “no- nonsense” approach, cautioned Liberians to adhere to basic health protocols including hand-washing, social distancing, among others.
She said COVID-19 can be contracted in many forms, so everyone must continue to exercise proper healthcare.
As a National Coordinator for the COVID-19 Response, Broh ensures that logistical and financial support coming to the country goes across the country to impact the nation’s entire population.
“To get the work done with the involvement of the rest of those associated with the fight, institutions with defined responsibilities are made to give account of their roles,” Madam Broh who is also former Acting City Mayor of Monrovia said,
“For instance, the food distribution is headed by the Ministry of Commerce and Minister Wilson Tarpeh is in charge. The Incident Management Team (IMT) and the World Food Program (WFP) are working together to distribute the food items, and we and WFP have been working together for a long time after CARE,” Broh added.
According to Madam Broh, also known as ‘workaholic’ in many quarters of the Liberian nation for her dedication and commitment to implementing assignments and other duties, in order to have better safety measures in place as the COVID-19 situation requires, the Ministry of Internal Affairs and the Office of the National Coordinator work to ensure the distribution of safety masks among the citizenry. While the overwhelming news about COVID-1 seems to be reducing, Madam Broh noted that economic recovery is a future plan that international partners and the government are studying to see what strategies can be employed to address the impact of the pandemic on the lives of people.
The Liberian nation became confronted, like other countries of the world, with the Coronavirus pandemic in March 2020, when the country recorded its first case amid frightening reports about the raging effects of the lethal disease on the human population in other parts of the world.
Challenged by a broken and weak health system, and in its effort to mitigate the life-threatening situation, Liberia has begun taking stringent and other proactive measures aimed at not only curtailing the spread of the virus, but also decimating the disease from the country’s landscape.
Measures put in place included compulsory hand-washing and sanitizing, social distancing, avoidance of large crowd, wearing of nose and face masks, suspension of worship services at religious centers, closure of schools and certain businesses such as bars, restaurants, hotels and motels as well as beach party, sporting activities among others.
Beyond this point, the President of Liberia declared a State of Emergency (SOE) on April 8, 2020 upon realizing from health authorities that the COVID-19 situation was worsening.
The SOE was subsequently approved by the country’s bicameral Legislature which includes the Senate (Upper House) and the House of Representatives (Lower House).
As part of the SOE, movements between Montserrado and Margibi Counties; the first two epic centers of the novel coronavirus, were restricted, followed by Nimba and Grand Kru Counties.
The Liberian authorities set up the Incident Management System (IMS) which comprises five (5) pillars or components including the Emergency Preparedness and Response, Laboratory System Strengthening, Case Management and Clinical Care; Community Engagement, Risk Communication and Advocacy and Program Management; and Coordination, Monitoring and Evaluation.
Each of the five components has a specific function that is sequentially in line with others that seek to expel the deadly disease from the Liberian nation by means of coordination and collaboration.
The health pillar, under the Emergency Preparedness and Response Component, has field workers who collect samples, carry out contacts tracing, and conduct laboratory tests to establish whether or not a person is positive or negative of COVID-19.
The Emergency Preparedness and Response Component also has health workers ranging from nurses to medical doctors who are at the frontline in meeting the basic health needs of the citizens and residents and ensuring that preventive messages are propagated to avoid people contracting the lethal disease.
In this direction, the Incident Management System regularly brings together stakeholders to provide reports about the status of the virus in the country, highlighting progress or hindrances where they may exist.
The Minister of Health, Dr. Wilhelmina Jallah, serves as Presiding Officer of Liberia’s Incident Management System (IMS), as it relates to the health component of the pillar.
The Minister of Health, with the support of other members of the IMS team often provides update as it relates to the impact of the virus and approaches that health authority and other stakeholders are taking in response to the outbreak in the country.
It is in line with the responsibility of the Incident Management System that Dr. Jallah, on June 25, 2020, during a formal meeting held in Monrovia, pointed out that “The 30-day extension of the lockdown period” was an opportunity to reach out to the communities by doing more testing and sensitizing the people to use face and nose masks, and follow various health protocols on COVID-19 as outlined by the government and the World Health Organization (WHO).
She issued a caveat that if the health protocols are not fully adhered to as it is being demonstrated in several parts of Montserrado County, COVID-19 cases will continue to increase.
She further disclosed that as part of the responsibility of the Incident Management System, it has been involved in the provision of face or nose masks to residents of local communities.
In his intervention at said meeting, the World Health Organization (WHO) provided an update about the virus globally, emphasizing where the COVID-19 infection has been increasing, why and how other countries are exerting efforts to defeat the virus.
WHO Country Representative to Liberia, Dr. Peter Clement, presented both global and African regional outlooks of COVID-19 pandemic.
Dr. Clement, in his presentation, attributed the increasing rate of COVID-19 in many African countries to the fact that “Africans are not used to social distancing.”
Up to press time, Liberia reported about 1,252 confirmed COVID-19 cases, 82 deaths, and 738 recovered. Interestingly, the country’s death rate for the virus remains in two digits while the recovery rate is at three digits.
By the month of June, 2020, COVID-19 cases were being reported in other counties of Liberia in addition to Montserrado, Margibi, Nimba and Grand Kru which were initially affected by the outbreak of the virus.
Giving reasons for the increasing rate of COVID-19 infection in the county, health officials said people are not only unwilling to use nose or face masks or wear them properly, but they are also hesitating to adhere to social distancing and other health protocols.
A member of the Health Pillar, Dr. Luke Bawo, disclosed at the forum that the virus has been concentrated in clustered areas in Montserrado County, citing Sinkor, Lakpazee, and the Old Road Communities as the incident points.
In addition to the places mentioned above are Congo Town around the St. Joseph Catholic Hospital and Duport Road in the Paynesville belt. Others are Gbarnga, Bong County, where cases were; up to press time, speedily emerging leading to the closure of the Phebe Hospital due to contraction of the virus by some health workers.
Dr. Bawo also reported at the meeting that the Sugar Hill and Den-L Communities in Bong County were also the concentration areas of the virus.
According to him, some south-eastern counties including Grand Gedeh and River Gee were however doing well and prepared to battle the virus in that region.
He pointed out that with the exception of Sinoe County where a COVID-19 case was recorded at the time of the report, the rest of the counties in the Southeastern region were best positioned as they had no incident of increase or new report of infection.

Contact Tracing
On the record, the Contact Tracing Department of the Emergency Preparedness and Response Component also told the IMS meeting that people who came in contact with suspected cases of COVID-19 were generally not willing to adhere to isolation, and responders were not receiving remuneration or compensation for their services.
By the time of said IMS meeting, the Department disclosed that 4,870 contacts were being recorded across the country and 13% of these contacts were health workers.
In order to make contact tracing effective, it was recommended that removal of cases in communities should be prompt and a contact list prepared to direct tracers.
However, some health workers observed that vigorous enforcement of face masks wearing remains a major challenge for the Liberia National Police (LNP) and other relevant security institutions as people are regularly seen in large public gathering in various communities with many not wearing face masks or observing social distancing.
Other observers said many of the 12 grade students who were recently authorized by the Government, through the Ministry of Education (MOE) to return to class are often seen on their various campuses freely interacting with each other, and at times with school administrators and teachers without wearing nose masks.
They called on the education authorities to ensure that masks wearing becomes compulsory for both students and teachers.

NPHIL’s Approach and Concerns
The National Public Health Institute of Liberia (NPHIL), the public health regulator of the country, has been proactive in reaching out to various communities, sensitizing citizens and residents on the use of nose or face masks.
NPHIL explained that the use of nose or face masks is the safest way of preventing the rapid spread of COVID-19 in the country.
Dr. Mosoka Fallah, Director General of NPHIL, asserted that his institution has therefore launched a “Masks for All” campaign.
According to Dr. Fallah, “This campaign took into consideration the empowerment of Tailors Union of Liberia financially for the Union to produce face masks locally in abundance, and for affordable price of L$25.00 each.”
Dr. Fallah also told the IMS meeting that “Even if the poorest of the poor cannot afford the L$25.00, a financially potent person could purchase some quantities of the masks for the purpose of distributing them to those who cannot afford the price of L$25.
The NPHIL boss also disclosed that it has introduced what it calls “No Mask, No Service” campaign to ensure that individuals traveling on both public and private vehicles have masks on.
“Without wearing a mask, a commuter or individual should be asked to disembark any vehicle or out of any public gathering,” he said.
Dr. Fallah further informed the gathering of IMS members that the measures are being enforced by the Liberia National Police and other state securities to ensure that people coming in close proximity on any vehicle are kept safe from contracting the disease.
The NPHIL, according to Dr. Fallah, is also empowering local soap makers to produce more of their products for distribution at community entry points where hand-washing buckets are posted.
Communities that the NPHIL has engaged include the densely populated New Kru Town on Bushrod Island, West Point, and Caldwell, among others.
However, during the administration of the West African Secondary School Certificate Examinations (WASSCE), this year, 12th graders were generally seen wearing face or nose masks in various examination halls in addition to observing other COVID-19 preventive measures.
Nevertheless, They called on the education authorities to ensure that masks wearing is fully adhered to by both students and teachers.

Liberia Biomedical Research Lab
Speaking to The IMAGES magazine was Mr. Fahn Momo Taweh, Lab Pillar Lead, COVID-19 Incident Management System (IMS), who briefly highlighted the responsibility of the laboratory in the ongoing fight against the virus.
Mr. Taweh explained, among others, that in order to have people tested, the Lab Pillar is set with health workers collecting blood samples from people who want voluntary testing, or people who have been traced for their contact with affected persons, and also a person who is showing signs and symptoms of the disease such as coughing, sneezing among others.
Other laboratory personnel spoke with The IMAGES magazine during the tour. Among them was Leona T. Gbillah, a Physician Assistant assigned at the SKD Sports Complex where samples are collected.
She indicated that bio data, explaining a client’s case history are recorded with other basic information about the person’s occupation, family and those that he or she interacted with.
Clients are also coded and their information is handled with high level of confidentiality, she said.
When the samples are collected and packaged with information about each client attached to his or her sample, they are sent to the laboratory technicians who will have them tested to ascertain a positive or negative case. Tested people, based on their conditions, are either quarantined by the team or allowed to be self-quarantined until the test results are out.
Sowillie Lomax, Laboratory Technician and Team Head at the SKD Sample Collection Site, also said that everything is done cautiously with the application of health protocols and safety measures because without that, a person can contract the disease at any time.
On the sequential task interdependent channel, samples collected from the SKD Sports Complex are packaged and transferred to the Liberia Biomedical Research Laboratory in Margibi County.
There, lab technicians use different up-to-the-minute equipment to amplify viruses so that besides the prevailing one, the rest or other forms of the same virus can be detected and recorded.
Local technicians said vaccines for Tuberculosis and Hepatitis had been produced in this lab named in honor of one of Liberia’s respected scientists, former President of the University of Liberia, Dr. Emmet Dennis.
Entering to see through the glass wall what is done in this lab is fascinating and traumatic—traumatic especially when coming across an inscription: “Biohazard zone.”
In this zone, one is not to touch anything without having on PPEs, and coming from there requires thorough hand-washing and spraying with disinfectant to keep safe.
By the permission of the lab authority to enter this zone and other operational areas, The IMAGES team observed that there are many equipments in the research and testing rooms.
The #14 hospital is a newly constructed one level facility opposite the Edward B.Kesselly Military Barracks along the Roberts International airport (RIA) highway. Only two of this four wing complex owned by the Armed Forces of Liberia (AFL), have been partially completed which the IMAGES magazine Team was permitted to enter.
Among them is PCR Multi-platform Machine used for amplification, meaning that when a sample or specimen is placed into it, not only that particular virus under study will show, but also several other viruses in different forms.
The technicians, who spend not less than six hours on duty processing samples or specimen, will then extract the viruses and segment them with identities and report the findings.
“The ordinary air in the room you see is not good to inhale, this is why the health workers in there have on the 3M Air Respirator to breathe through because inhaling the air in the room is hazardous to their health,” said Fahn Momo Taweh during a tour.
Omeme Willie, a lab technician who acquired her knowledge in Tanzania in TB Cultures and Drugs Susceptibility Test, works at the Multi Drugs Resistance Laboratory where Tuberculosis (TB) is tested and researched.
Ms. Willie showcased sample windows where samples are received for testing; the preparation room, the media preparation room, sample incubation room, and the main room where samples are tested and the results given out to medical authorities.
Also in the Multi Drugs Resistance lab is a section where Ebola, Yellow Fever, Measles, HIV and others are tested.
Viola Diggs, another trained technician, works in this area. Like Omeme, Viola took The IMAGES team on a guided tour of the facility, showing where a specific task is performed.
In the Coronavirus combat chain, results from the laboratory are now sent to the medical and clinical teams that treat patients with the disease.

Case Management and Clinical Care
On June 27, 2020, Dr. Jerry Brown, famously regarded in Liberia as “Ebola Hero” and current Head of the Case Management and Clinical Care Component, told the IMAGES team that of the 729 confirmed cases recorded on that day, 29 were health workers and of the 34 deaths, six were also health workers.
The Case Management and Clinical Care component is carried out by medical doctors, clinicians and nurses who are deployed at the 14-Military Hospital.
Dr. Jerry Brown explained that 128 patients were in admission and 300 discharged. The total number of death by then was put at 34. According to Dr. Brown, of the 128 patients in admission, there were mild, moderate, severe, and critical patients.
Mild patients are those tested positive for COVID-19 but show no signs or symptoms of the virus.
“They might have come in contact with someone with the disease and they decided to do voluntary testing, and admitting them is meant to stop them from infecting others. It is also meant to observe them so that when they are progressing in other states (moderate or severe), doctors will notice it quickly to address their problem. Moderate patients are showing signs and symptoms, but have not reached the severe stage,” Dr. Brown who is also Head of the state-owned JFK Hospital said.
The facility provides isolation and admission of individuals with the disease at the 14-Military Hospital and the newly built Lebanese clubhouse turned to the government to be used as a Treatment Center.
The 14 Military Hospital contains about 65 rooms, with each room containing three beds for three patients at a time. Each room has its own bathroom as well.
Patients or suspected ones who are asymptomatic undergo their test and the test is repeated after 72 hours.
When results continue to show negative, the patient is discharged.
However, when a result proves positive for a patient, another test is done after 72 hours and based on the result, a psychosocial counselor is assigned to counsel the person while other tests are done.
Along with the test done now is what Dr. Brown calls “CT Body.” CT Body shows how the virus leaves the patient’s body, or has the potential of infecting other people.
Dr. T. Juleo Karr of the 14-Military Hospital says “COVID-19 up to present, does not have a cure, but the medical team remains professionally supportive of patients.
“Some patients may be asymptomatic or symptomatic, but based on their symptoms, we treat them for what they show because when a patient has a medical condition, COVID-19 can make it worse, or the underlying medical conditions make COVID-19 worse,” he told The IMAGES team.
Dr. Karr noted that once a patient overcomes the “Replication phase,” that patient overcomes the disease. Therefore, he said, “The medical team has a combination of supportive therapies used for different signs and symptoms, some of them are oxygen antibiotics, and psychosocial counseling that help patients to recover.”
Since COVID-19 is a respiratory disease that comes with coughing, fever, sneezing and an attack of the lungs, Dr. Karr said drugs that are essential in treating diseases accompanying the host are given the patient.
This, he added, serves as a source of recovery for many patients who may be mild, moderate and in rare cases, severe and critical.
Underlying diseases such as Hypertension, Diabetes, and Asthma are some underlying health conditions that pose more problems for patients with COVID-19.
Like HIV/AIDS, COVID-19 has its psychosocial impact on affected patients, and this is the stigma that comes with it. By that, Dr. Heounohu Hessou said, “Isolation is the most difficult problem and challenge. A person may feel well, but when he or she is suspected of COVID-19, tested positive and isolated, the person comes down with the psychological effect as a result of isolation.”
Dr. Hessou however indicated that doctors and nurses are not worth the praises given to them but instead the patients who bravely avail themselves to go to the hospital to be isolated.
Arnesa Cooper, a nurse with a Master’s degree in Public Health and Bachelor of Science in Nursing, sees her work at the 14-Military Hospital as a “Call to duty” to serve her nation.
“In spite of the challenges that the medical profession entails, I am confident and courageous to perform my professional task at this critical time when the Liberian nation needs my service most.” she said.

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