The most recent Ebola Virus Disease (EVD) numbers from the hardest hit nation, Liberia are 4,262 cases and  2,484 deaths. Recently, the World Health Organization stated in a situation report that “Evidence obtained from responders and
laboratory staff in the country suggests that the situation in Liberia is getting worse, and that transmission remains intense in the capital, Monrovia.”

However, their is a bright spot where unique strategies established by Firestone Liberia kept the Ebola outbreak much more limited than elsewhere in the country.

Liberia map/CIA
Liberia map/CIA

According to a Morbidity and Mortality Weekly Report (MMWR) published today, Firestone Liberia, Inc. is an affiliate of Firestone Natural Rubber Company, LLC, a division of Bridgestone Americas, Inc., that operates rubber tree plantations in Liberia. The original plantation was established in 1926 by the Firestone Tire & Rubber Company. The company harvests natural rubber and wood from a plantation area of approximately 120,000 acres (185 square miles) in the Firestone District of Margibi County. The populations of Margibi County and Firestone District are 238,000 and 69,000, respectively (Government of Liberia 2014 population estimates). Employees and their dependents reside within 121 communities inside the Firestone plantation. Nearly 16,000 students matriculate at 27 schools operated by Firestone. Although Firestone manages the plantation, the area is accessible to non-company residents from surrounding communities and includes roadways permitting passage of people and commerce.

Firestone operates an entire healthcare infrastructure that includes  a referral hospital, two clinics, and seven health posts, with 181 health care providers within the plantation area. The main hospital has an emergency department, labor and delivery department, intensive care unit, and 170-bed routine inpatient capacity with an additional 130-bed surge capacity for both adult and pediatric patients. Health posts are located within housing communities and staffed by non-physician primary care providers who reside in those communities. Firestone also operates a mobile medical unit that follows a daily route through the plantation area and surrounding communities.

The first Ebola patient in the Firestone District was the wife of a Firestone employee who had cared for a family member with confirmed Ebola in Lofa County, the epicenter of Liberia’s Ebola outbreak in March and April 2014. The company responded with rapid establishment of an incident management system, active and passive Ebola surveillance, immediate isolation of Ebola patients in a dedicated unit, procedures for early isolation of Ebola patients, and enforcement of standard Ebola infection control guidelines.

The Firestone response had several unique elements for West Africa:

  • Asymptomatic contacts with high-risk exposure were offered voluntary quarantine in dedicated facilities where they received health education, personal protective equipment, sanitary supplies, and essentials such as meals, communications, and prayer services. All of the 21 patient contacts who progressed to Ebola were among those who voluntarily quarantined.
  • Integration of health education and distribution of personal protective equipment and waste disposal equipment to family members of suspected Ebola patients. As Liberia currently lacks enough Ebola treatment units to meet demand, such minimal supportive care might limit Ebola transmission among family members who must care for patients in home or community settings.
  • Screening protocols permitted the hospital to isolate and care for Ebola patients in a separate, dedicated Ebola treatment unit while care for non-Ebola patients continued.
  • A survivor reintegration program prepared communities for the return of recovered Ebola patients. The program consisted of community education, explaining that the survivor was Ebola free and no longer contagious, and a welcome celebration attended by local health officials, Firestone staff, and clergy. The celebrations were broadcast on radio.

Firestone also implemented a robust risk communications and social mobilization campaign to boost community awareness of Ebola and how to prevent transmission.

During August 1–September 23, there were 71 Ebola cases (cumulative incidence 0.09%) in 39 families within Firestone’s health care catchment population, among the approximately 80,000 Liberians for whom Firestone provides health care, of which 57 (80%) were confirmed cases. Fifty-three Ebola cases were fatal, of which 39 were confirmed cases (mortality rate among confirmed cases = 68%).

During the same period, there were 536 Ebola cases in Margibi County (cumulative incidence = 0.23%).

“I went to see the Firestone hospital in Liberia at the end of August. I saw how careful and meticulous the staff is and how compassionately they care for Ebola patients and their families,” said CDC Director Tom Frieden, M.D., M.P.H. “This shows that it’s possible to contain Ebola with meticulous attention to detail and care for patients.”