Sierra Leone: Few steps to Ebola free

There are clear signs that the days of the deadly Ebola virus are numbered in Sierra Leone, EMEKA EJERE, writes

At the height of the outbreak Sierra Leone was reporting more than 500 new cases a week. Last week, for the first time since May last year, there were zero new cases.

But authorities are warning against complacency. OB Sisay, Director of the National Ebola Response Centre (NERC), said: “This does not mean Sierra Leone is suddenly Ebola free.

“As long as we have one Ebola case we still have an epidemic. People should continue to take the public health measures… around hand-washing, temperature checks, enhanced screening.”

Use of rapid response teams and strong community involvement in finding Ebola virus disease cases and contacts is yielding results in Sierra Leone. An epidemiological week has now passed with no new Ebola cases for the first time since the beginning of the outbreak.

“This is very good news but we have to keep doing this intensive working with communities to identify potential new cases early and to rapidly stop any Ebola virus transmission,” said Dr Anders Nordstrom, representative of the World Health Organisation (WHO) in Sierra Leone.

The Ebola response has moved to “phase 3″’, focusing on tracking each and every chain of Ebola virus transmission and closing down the remaining chains as quickly as possible. Sierra Leone is now down to a single chain of transmission, which started in Freetown but sparked a cluster of cases in Tonkolili, in the northern region of the country.

Effectively tracking chains of transmission means finding every person who has been in contact with someone proven to be infected with Ebola, monitoring them closely for symptoms for 21 days and rapidly moving them to a treatment centre if they develop symptoms of potential Ebola.

In Tonkolili, a young man, who worked in Freetown but returned to his home village every month to bring food and money to his extended family, died in a hospital where he was being treated for malaria. As is done with all deaths, to ensure no case of Ebola is missed, a swab was taken. It tested positive for Ebola.

Findings reveal that Tonkolili had not seen a case of Ebola virus disease for more than 150 days, but the lessons learned during the outbreak in December 2014 had not been forgotten. The government, WHO and other UN and international partners sent a rapid response team into the district and worked with the village chief and village taskforce to identify and monitor everyone who had been in contact with the young man.

595 people graduated from quarantine in Tonkolili

The entire village of Massessehbeh was then put in quarantine for a period of 21 days, as was Masenga Hospital where the young man died. A water supply was established in the village and food was brought in daily. Psychosocial workers and social mobilizers provided information and support, while contact tracers checked everyone daily for symptoms of Ebola.

Two more people, both of them from the young man’s family, developed symptoms and tested positive for Ebola. They were treated at an Ebola Treatment Centre which had been on standby and run by International Medical Corps (IMC). There they were cared for by a team that included Ebola survivors, who provided much of the physical and psychological care they needed. Both are now recovering.

Last Friday, 595 people “graduated” from quarantine in Tonkolili. This included members of the community and patients, pregnant women, nurses, doctors and other staff who were released early on Friday morning from the hospital where they had been confined for 21 days. Later same day, a formal ceremony was held at Massessehbeh during which the President of Sierra Leone formally cut the quarantine tape.

Joyful villagers streamed through the cut quarantine tapes, women linking arms to dance along the road, children beating water bottles in time to the singing and dancing. However, the occasion was not joyful for everyone. 43 people remain quarantined until the end of this week. Another 38 people remain in quarantine in Freetown until the 29th of August.

Speaking in New York on Monday, United Nations Ebola Chief, Dr David Nabarro said the overall outbreak of the virus in West Africa would end “in the foreseeable future”.

“The general trend lines are that increasingly, new cases are known contacts of people who’ve already got the disease, and also when cases are detected they’re brought under treatment quickly,” Nabarro told The Associated Press news agency.

“And that means that we believe that it’s only a matter of weeks before the outbreak is ended in Sierra Leone,” he said, “and that’s because of strong participation of communities, a very coordinated national response, and strong leadership from Ernest (Bai) Koroma, the president.”

Ebola in Sierra Leone  

In 2014 it was discovered that samples of suspected Lassa fever showed evidence of the Zaire strain of Ebola virus in Sierra Leone as early as 2006. Prior to the current Zaire strain outbreak in 2014, Ebola had not really been seen in Sierra Leone, or even in West Africa among humans.

It is suspected that fruit bats are natural carriers of disease, native to this region of Africa including Sierra Leone and also a popular food source for both humans and wildlife.The Gola forests in south-east Sierra Leone are a noted source of bush meat.

Bats are known to be carriers of at least 90 different viruses that can make transition to a human host. However, the virus has different symptoms in humans. It takes one to ten viruses to infect a human but there can be millions in a drop of blood from someone very sick from the disease.

Transmission is believed to be by contact with the blood and body fluids of those infected with the virus, as well as by handling raw bush meat such as bats and monkeys, which are important sources of protein in West Africa. Infectious body fluids include blood, sweat, semen, breast milk, saliva, tears, feces, urine, vaginal secretions, vomit, and diarrhea.

Even after a successful recovery from an Ebola infection, semen may contain the virus for at least two months.  Breast milk may contain the virus for two weeks after recovery, and transmission of the disease to a consumer of the breast milk may be possible. By October 2014 it was suspected that handling a piece of contaminated paper may be enough to contract the disease.

Contamination on paper makes it harder to keep records in Ebola clinics, as data about patients written on paper that gets written down in a “hot” zone is hard to pass to a “safe” zone, because if there is any contamination it may bring Ebola into that area.

One aspect of Sierra Leone that is alleged to have aided the disease, is the strong desire of many to have very involved funeral practices.For example, for the  people who inhabit part of Sierra Leone, it is important to bury the bodies of the dead near them.

Funeral practices include rubbing the corpses down with oil, dressing them in fine clothes, then having those at the funeral hug and kiss the dead body. This may aid the transmission of Ebola, because those that die from Ebola disease are thought to have high concentrations of the virus in their body, even after they have died.

For the 2001 outbreak of Sudan virus in Uganda, attending a funeral of an Ebola victim was rated by the CDC as one of the top three risk factors for contracting Ebola, along with contact with a family member with Ebola or providing medical care to someone with a case of Ebola virus disease.

The main start of the outbreak in Sierra Leone was linked to a single funeral in which the WHO estimates as many as 365 died from Ebola disease after getting the disease at the funeral.