MONROVIA, Liberia — On a Tuesday evening in late August, Thomas Tweh was part of a team pleading with the Liberian government not to lock down his community.
The government was planning to quarantine West Point, an informal neighborhood
where Ebola cases were on the rise, and an angry crowd had overrun a newly opened transit center for suspected patients. Tweh and the 20 others negotiating with the government didn't dispute the need for government involvement, or even some kind of quarantine. But they wanted better plans in place for food and water delivery, and they wanted some time for the neighborhood's hustlers — the day-traders, fruit sellers, and fishmongers — to organize how to keep their businesses running without them.
"To our utter surprise, Wednesday morning, West Point was sealed up… They put barbed wire around the place, and there were men with guns," said Tweh, a community leader in one of the neighborhood's seven zones.
It was a top-down, draconian approach to disease, a move that even Liberian government officials concede was more about fear than science — and one that its neighbor used, too. In September, Sierra Leone kept its residents home for three days while teams made door-to-door visits to share health information and check for the sick.
But the political impulse to use quarantines turns out to be universal. In New Jersey last week, a Doctors Without Borders nurse named Kaci Hickox was taken from an airplane to a quarantine tent after returning from Sierra Leone, despite having no symptoms of Ebola. Connecticut is forcing into 21-day quarantine anyone coming from Ebola-affected countries in West Africa, and New York is requiring the same for returning health workers.
When it comes to quarantines, American officials might do well to take a page out of Liberia's notebook of lessons learned.
"Let me put it in perspective," said Lewis Brown, Liberia's minister of information. "We've learned more about the virus as we've gone along. Back in August, it was safe to say we didn't know enough."
It was one of several statements in a 40-minute interview with BuzzFeed News in which Brown skirted the question of whether the quarantines had actually worked. He repeatedly emphasized that the policy focus now is on raising awareness of Ebola and how to prevent it, tracing contacts of the sick, and transporting suspected cases to treatment centers — all work that, judging by a universally recognized drop in case numbers here, appears to be bearing its first fruits.
But there's virtually no one in Liberia willing to affirm that the quarantines accomplished what they meant to.
"When West Point was quarantined, we had even less information than we did before," said Dagney Olivares, a spokesperson with the U.S. Centers for Disease Control team in Monrovia. Without good information, "do we know enough to know that the quarantine is doing what it's supposed to do, which is separate the sick from the healthy?"
Henry Gray, the emergency coordinator for Doctors Without Borders, said quarantines — at a mass or at an individual scale — don't make sense from a health perspective.
"Keeping them in houses is not necessary, but it's also not practical," he said. "People need to eat, they need to work, they need to go to their clinic if they have other health problems."
In the face of all that human need, quarantines can do more harm than good. The approach "pushes people underground, and they basically will lose trust in the system, in those people that are trying to help them," he said.
Archie C. Gbessay, who runs the case investigation team in West Point that's in charge of actively finding Ebola patients, said that's just what happened. "The quarantine of West Point hurt in some sense. It built … more disbelief [of the disease], more distrust by of people of government," he said. "If you leave the community like that, closed up in the area, you create the idea that you're going just to let everybody die."
The biggest problem with quarantines may be people's desire to resist them. Hickox, who still shows no symptoms of Ebola and has had two negative Ebola tests, has vowed to disobey quarantine orders in Maine, attracting press attention this morning when she went for a bike ride. President Barack Obama on Wednesday echoed concerns that mandatory quarantines could discourage health workers from volunteering in West Africa.
Human psychology and behavior, even more than human movement, may be the key to stopping the disease. Sick patients need to go to hospitals when they have symptoms that may be Ebola — just like Dr. Craig Spencer did in New York, and just like dozens of Liberians here do every week. And prevention measures need to adapt to what people will, and won't, actually do.
"This is about people, and people are complex things," said Ian Bray, a senior spokesperson for Oxfam. "Working with what the community wants to do is really important. We all know in our own communities what the public does with health warnings on drinking or smoking. It's a universal issue, how to communicate health messages."
None of this surprises Brown, who is the only official in Liberia — other than the president who issued the order — authorized to speak on the highly sensitive issue.
"People don't want to be quarantined," Brown said. "It's a natural instinct. We don't want to be caged."