How Vulnerable is Liberia to COVID-19?

Even the most privileged of countries are struggling to stop the spread of coronavirus. Which begs the question – how are developing countries, with much poorer health care systems, going to fight the transmission of the virus?

The Ebola epidemic killed over 11,000 people in West Africa. In Liberia, it killed 1 out of 10 of the country’s health care workers. Now, Liberia has seen its first cases and its first deaths from coronavirus.

The weakness of Liberia’s public health system was a large factor during the Ebola epidemic. There are many other factors that can impact the transmission of a virus, like COVID-19.

The Africa Center for Strategic Studies mapped the vulnerability of African Countries by several risk factors. Here’s what the study shows regarding the trajectory of coronavirus in Liberia, when compared with other African countries:

Public Health System:
Unfortunately, Liberia does not have a strong public health system. Although, according to this study, the system is not as weak as its neighbors – Sierra Leone and Guinea – it is still low in comparison to others on the same continent. This is a factor that makes Liberia more vulnerable to the pandemic.

International Exposure:
The initial exposure, through international travel, was detrimental to many African countries. However, according to this study, this risk factor is not as highly ranked for Liberia, although the first case diagnosed was after a Liberian returned from Europe. Only certain chartered flights are allowed into Liberia. Now is the time to be worried about transmission within the continent and country itself.

Density of Urban Areas:
Liberia is one of nine African countries that have the lowest density of people living in its urban areas, according to this study. This density is measured by “the average number of people per kilometer living in a country’s built-up areas.” Liberia does not have the high-rise apartment buildings found in some African cities, but we must keep in mind that places like West Point will be at a very high risk of infection due to the crowded environment, which is what happened during the Ebola crisis.

Total Population of Urban Areas:
Larger populations in urban areas also increases the vulnerability of a country because it becomes much harder to inform, monitor, and if necessary, isolate people. This study states that Liberia is on the low end of this risk, compared to other African countries.

Population Age:
Liberia has a much younger population overall. About 80 percent of deaths due to COVID-19 occur in populations over 60, therefore Liberia is not as vulnerable when we consider this particular risk factor.  This study notes that there are other issues affecting the mortality rates of younger populations, such as malaria, malnutrition, and HIV/AIDs.

Government Transparency:
Trust in the government is important during a pandemic, so that the populations believe in the awareness messages and restrictions that may be put in place. Unfortunately, this study shows Liberia feels there is much less government transparency than in other countries.

Press Freedom:
Liberia’s freedoms of the press scores fall right in the middle, according to this study. This is important to consider in a pandemic, as journalists are responsible for sharing information to the masses. Additionally, they serve as a check on the government, and can often prompt them into taking action during a crisis.

Conflict Magnitude:
Unlike the Democratic Republic of the Congo, South Sudan, Sudan, and Somalia, Liberia is not currently experiencing armed conflict. This issue disrupts everything from the public health system to the food and water supply.

Displaced Populations:
When there are high populations of refugees in a country, many public health organizations are already investing time and resources into those groups and can become overwhelmed. Liberia does not currently have a high population of refugees when compared with other parts of the continent.

FOL Board Member Dr. Richard Nisbett has earned graduate degrees in anthropology, community ecology and public health. He began working in Liberia in 1988, collaborating with many organizations including World Health Organization.

Dr. Nisbett hopes the conclusion that Liberia is at lower risk is true, however, he is cautious. Given his own experience in nearly every county of Liberia, he wonders if all the information for this study is accurate, particularly regarding the density of population in Liberia. He said, “Many of these urban and peri-urban areas in Liberia are no less dense than other African countries.”

Additionally, there are other factors to be taken under consideration for COVID-19, that the study did not mention.

“The key determinants left out of this analysis – and the risk factors that appear to be the most important for [the] COVID outcome – are particulate air pollution and hypertension. Particulate air pollution can come from vehicle or generator exhaust and other occupational exposures such as cement factories (of which there are a few in Liberia),” said Dr. Nisbett.

Additionally, he cautions anyone suffering from chronic obstructive pulmonary disease (COPD) or hypertension to take extra measures to prevent infection.

There were many lessons learned from the Ebola outbreak, which many are trying to put to use to help prevent the spread of coronavirus. President George M. Weah has issued a State of Emergency beginning on April 10^th, that will last for three weeks, in hopes of containing the spread. Movement between counties will be prohibited for the time being, and citizens are not to leave their homes except for essential outings.

According to the National Public Health Institute, Liberia has 31 confirmed cases of COVID-19 as of April 8^th, 2020.