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An ongoing epidemic of Ebola virus disease (EVD) is currently afflicting the West African nation of Sierra Leone. By 2 October 2014, it was estimated 5 people an hour were being infected with the Ebola virus in Sierra Leone alone. The number of infected has been doubling every 20 days. Ebola virus is not endemic to Sierra Leone or to the West Africa region and this epidemic represents the first time the virus has been discovered there.

Spring 2014: Early cases

In late March there were suspected but not confirmed cases in Sierra Leone. However, the government announced on 31 March 2014 that there were no cases in Sierra Leone.

In April Gambia banned flights from Sierra Leone.

The epidemic is thought to have started in late May when 14 people returned from a funeral of a traditional healer, who had been trying to cure others with Ebola in Guinea. The first person reported infected was a tribal healer. She had treated an infected person(s) and died on 26 May. According to tribal tradition, her body was washed for burial and this appears to have led to infections in women from neighboring towns.

By 27 May 2014 it was reported 5 people died from the Ebola virus and there were 16 new cases of the disease. Between 27 May 2014 and 30 May the number of confirmed, probable, or suspected cases of Ebola went from 16 to 50. By 9 June, the number cases had risen to 42 known and 113 being tested, with a total of 16 known to have died from the disease by that time.

Summer 2014: Continued growth, Khan dies

On 12 June the country declared a state of emergency in the Kailahun District, where it announced the closure of schools, cinemas, and nightlife places; the district borders both Guinea and Liberia, and all vehicles would be subject to screening at checkpoints. The government declared on 11 June that its country's borders would be closed to Guinea and Liberia; but many local people cross the borders on unofficial routes which are difficult for authorities to control. Seasonal rains that fall between June and August interfered with the fight against Ebola, and in some cases caused flooding in Sierra Leone.

By July 11, 2014 the first case was reported in the capital of Sierra Leone, Freetown, however the person had travel to the capital from another area of the country. By this time there were over 300 confirmed cases and 99 were confirmed to have died from Ebola. There was another case before the end of the month.

On 29 July, well-known physician Sheik Umar Khan, Sierra Leone's only expert on hemorrhagic fever, died after contacting Ebola at his clinic in Kenema. Khan had long worked with Lassa fever, a disease that kills over 5,000 a year in Africa. He had expanded his clinic to accept Ebola patients. Sierra Leone's President, Ernest Bai Koroma, celebrated Khan as a "national hero".

On 30 July, it declared a state of emergency and deployed troops to quarantine hot spots.

In August, awareness campaigns in Freetown, Sierra Leone's capital, were delivered over the radio and through loudspeakers. Also in August, Sierra Leone passed a law that subjected anyone hiding someone believed to be infected to two years in jail. At the time the law was enacted, a top parliamentarian was critical of failures by neighboring countries to stop the outbreak. Also in early August Sierra Leone cancelled league football (soccer) matches.

September 2014: Exponential growth, quarantines

Within 2 days of 12 September 2014, there were 20 lab-confirmed cases discovered in Freetown, Sierra Leone. One issue was that residents were leaving dead bodies in the street. By 6 September 2014 there were 60 cases of Ebola in Freetown, out of about 1100 nationwide at this time. However, not everyone was bringing cases to doctors, and they were not always being treated. One doctor said the Freetown health system was not functioning, and during this time, respected Freetown Doctor Olivette Buck fell ill and died from Ebola by 14 September 2014. The population of Freetown in 2011 was 941,000.

By 18 September 2014 teams of people that bury the dead were struggling to keep up, as 20-30 bodies needed to be buried each day. The teams drive on motor-bikes to collect samples from corpses to see if they died from Ebola. Freetown, Sierra Leone has one laboratory that can do Ebola testing.

WHO estimated on 21 September that Sierra Leone's capacity to treat EVD cases falls short by the equivalent of 532 beds. Experts pushed for a greater response at this time noting that it may destroy Sierra Leone and Liberia. At this time it was estimated that if it spreads through both Liberia and Sierra Leone up to 5 million could be killed. (The population of Liberia is about 4.3 million and Sierra Leone is about 6.1 million.)

In an attempt to control the disease, Sierra Leone imposed a three-day lockdown on its population from 19 to 21 September. During this period 28,500 trained community workers and volunteers went door-to-door providing information on how to prevent infection, as well as setting up community Ebola surveillance teams. The campaign was called the Ouse to Ouse Tak in Krio language. There was concern the 72 hour lock-down could backfire.

On Monday 22 September, Stephen Gaojia said that the three day lock down has obtained its objective and will not be extended. Eighty percent of targeted households were reached in the operation. A total of around 150 new cases have been uncovered, but the exact figures will only be known on Thursday as the health ministry is still awaiting reports from remote locations. One incident during the lock-down, was when a burial team was attacked.

On Wednesday 24 September, President Ernest Bai Koroma added three more districts under "isolation," in an effort to contain the spread. The districts include Port Loko, Bombali, and Moyamba. In the capital, Freetown, all homes with identified cases will be quarantined. This brings the total areas under isolation to 5, including the outbreak "hot spots" Kenema and Kailahun which are already in isolation. Only deliveries and essential services will be allowed in and out. A sharp rise in cases in these areas was also noted by WHO.

As of late September about 2 million people are in areas of restricted travel, which include Kailahun, Kenema, Bombali, Tonkolili, and Port Loko Districts.

The number of cases seemed to be doubling every 20 days, which led to the estimate that by January 2015 the number of cases in Liberia and Sierra Leone could grow to 1.4 million. After January 2015 if that level of growth continued the number of cases could grow to 100 million by June 2015, 1 billion (1000 million) by August 2015, and to the rest of population before 2016. For comparison there are about 1 billion people in all of Africa.

On 25 September there were 1940 cases and 587 deaths officially, however, many acknowledged under-reporting and there was an increasing number of cases in Freetown (the capital of Sierra Leone).

The last district in Sierra Leone untouched by the Ebola virus has declared Ebola cases. According to Abdul Sesay, a local health official, 15 suspected deaths with 2 confirmed cases of the deadly disease were reported on 16 October in the village of Fakonya. The village is 60 miles from the town of Kabala in the center of mountainous region of the Koinadugu district. This was the last district free from the virus in Sierra Leone. All of the districts in this country have now confirmed cases of Ebola.

October 2014 : Responders overwhelmed

In October it was noted hospitals are running out of supplies in Sierra Leone. In the week prior to 2 October there were 765 new cases, and Ebola was spreading rapidly. At the start of October there were nearly 2200 laboratory confirmed cases of Ebola and over 600 had passed away from it. The epidemic also claimed the life of 4 doctors and at least 60 nurses by the end of September 2014. Sierra Leone limits its reported deaths to laboratory confirmed cases in facilities, so the actual number of losses is known to be higher.

Sierra Leone was considering making reduced care clinics, to stop those sick with Ebola from getting their families sick with the disease and to provide something in between home-care and the full-care clinics. These "isolation centers" would provide an alternative to the overwhelmed clinics. The problem the country is facing is 726 new Ebola cases but less than 330 beds available.

More than 160 additional medical personnel from Cuba arrived in early October, building on about 60 that had been there since September. At that time there were about 327 beds for patients in Sierra Leone.

Canada announced it is sending a 2nd mobile lab and more staff to Sierra Leone on 4 October 2014.

There were reports of drunken grave-diggers making graves for Ebola patients too shallow, and as a result wildlife comes and digs up and eats at the corpses. In addition, in some cases bodies are not buried for days, because no one comes to collect them. One problem is that it has been hard to care for local health care workers, and there is not enough money to evacuate them. Meanwhile other diseases like malaria, pneumonia, and diarrhea are not being treated properly because the health system is trying to deal with Ebola patients.

On 7 October 2014 Canada sent a C-130 loaded with 128,000 face shields to Freetown.

In early October 2014, a burial team leader said there were piles of corpses south of Freetown.

On October 9 the International Charter on Space and Major Disasters was activated on Sierra Leone's behalf, the first time that its charitably repurposed satellite imaging assets have been deployed in an epidemiological role.

On 14 October 2014, 800 Sierra Leone peacekeepers due to relieve a contingent deployed in Somalia, were placed under quarantine when one of the soldiers tested positive for Ebola.

Healthcare capacity

On 26 August, the WHO shut down one of two laboratories after a health worker became infected. The laboratory was situated in the Kailahun district, one of the worst-affected areas. It was thought by some that this move would disrupt efforts to increase the global response to the outbreak of the disease in the district. "It's a temporary measure to take care of the welfare of our remaining workers," WHO spokesperson Christy Feig announced. He did not specify how long the closure would last, but said they would return after an assessment of the situation by the WHO. The medical worker, one of the first WHO staff infected by the Ebola Virus, was treated at a hospital in Kenema and then evacuated to Germany. By 4 October 2014, it was announced he has recovered and left Germany.

As the Ebola epidemic grew it damaged the health care infrastructure, leading to increased deaths from other health issues including malaria, diarrhoea, and pneumonia because they were not being treated. Sierra Leone lost three of its top doctors by the end of August, because they died from Ebola. A fourth doctor became ill with Ebola in September and died that month.

By 23 September 2014 about 61 health workers had died out of 91 known to have been infected with Ebola in Sierra Leone.

WHO estimated on 21 September that Sierra Leone's capacity to treat EVD cases falls short by the equivalent of 532 beds.

On 27 August 2014 Dr. Sahr Rogers died from Ebola after contracting it working in Kenema.

Dr. Olivette Buck was a Sierra Leone doctor who worked in Freetown, who tested positive for Ebola on 9 September 2014 and passed away on the morning of 14 September 2014. Her staff thought she got exposed in August and eventually went to Lumley Hospital on 1 September 2014 with a fever, thinking it was malaria. After a few more days of sickness she was admitted to Connaught Hospital.

Evacuations

Since the beginning of the outbreak in Sierra Leone in late May 2014, several people have been evacuated. An increasing lack of hospital beds, medical equipment, and health care personnel makes treatment difficult.

On 24 August William Pooley, a British nurse, was evacuated from Sierra Leone. He was released on September 3, 2014.

On 21 September 2014 Spain evacuated a Catholic priest who had contracted Ebola while working in Sierra Leone with Hospital Order of San Juan de Dios. By 25 September 2014 the priest passed away in Madrid, Spain. On 6 October 2014 a nurse who treated the priest tested positive for Ebola.

A doctor from Senegal contracted Ebola while working in Sierra Leone for the WHO, and was evacuated to Germany at the end of August 2014. By 4 October 2014, it was announced he has recovered and returned to Senegal.

In late September, a doctor working for an International Aid organization in Sierra Leone, was evacuated to Switzerland after potentially being exposed. He later tested negative for the disease.

In late September 2014, an American doctor working in Sierra Leone was evacuated to Maryland, USA, after being exposed to Ebola. "Just because someone is exposed to the deadly virus, it doesn’t necessarily mean they are infected”, said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH.

In early October, a Ugandan doctor who contracted Ebola while working in Sierra Leone was evacuated for treatment to Frankfurt, Germany. The doctor was working at Lakaa Hospital and flown out from Lungi Airport.

On 6 October 2014, a female Norwegian MSF worker tested positive for Ebola virus and was subsequently evacuated. On the afternoon of 7 October, a medevac aircraft carrying the infected patient landed in the military perimeter of the Oslo Airport, Gardermoen. From there, medical personnel equipped with hazmat suits transferred the patient to a specially-equipped and sterilized ambulance. The convoy, which was accompanied by two reserve ambulances and a multi-vehicular police escort, moved the patient to the Ullevål University Hospital, where she was placed in isolation. A team consisting of about 30 doctors and experts, some of which are specially trained in the treatment of infectious diseases, were assigned to the supervision and treatment of the patient. Shortly after the medevac's arrival, Norwegian authorities reported that they had been granted a dose of the experimental biopharmaceutical drug ZMAb, a variant of ZMapp. ZMapp has previously been used on 3 Liberian health workers, of which 2 survived. It was also used on 4 evacuated westerners, of which 3 survived. (see List of Ebola patients)

Travel restrictions

There are various restrictions and quarantines within Sierra Leone, and a state of emergency was declared on July 31, 2014. Countries at higher risk for Ebola in Africa include Benin, Burkina Faso, Côte d’Ivoire, Guinea-Bissau, Mali, and Senegal.

• In April Gambia banned air travel from Sierra Leone.
• By June 11, 2014 Sierra Leone closed its border with Liberia and Guinea.
• In July airlines of Nigeria and Togo cancelled flights to Freetown.
• On August 1, 2014 Ghana banned air travel from several Ebola impacted countries including Sierra Leone.
• On August 10, 2014 Mauritania blocked entry of citizens of Sierra Leone.
• On August 11, 2014 Ivory Coast blocked travel from Sierra Leone, Liberia, and Guinea. The restriction was lifted on 26 September 2014.
• On August 21, 2014 South Africa banned travelers from Sierra Leone, Liberia, and Guinea, but its own citizens were allowed to return from these places.
• On August 22 a Kenyan airline put temporary restrictions Sierra Leone, saying the Ebola outbreak was underestimated.
• On August 22 Senegal blocked air travel to Sierra Leone, Liberia, and Guinea.
• In September 2014 bans on the Sierra Leone hosting federation football (soccer) games continued.

Concurrent events

The outbreak was noted for increasing hand washing stations, and reducing the prevalence of physical greetings such as hand-shakes between members of society.

In June 2014 all schools were closed because of the spread of Ebola virus.

In August 2014 the S.L. Health Minister was removed from that office. (see Cabinet of Sierra Leone)

In October 2014 Sierra Leone launched a school by radio program, that will be transmitted on 41 of the local radio stations as well as on the only local TV station. There will be a variety of subjects on the 6 day a week, 4 hour shows. Education Minister Minkailu Bah raised concerns on the difficulty of reaching many of the school children with a 25% radio ownership and less than 2% TV. However schools are not expected to open until early 2015.

September through October is the "malaria season", which may complicate efforts to treat Ebola. For example, one Freetown doctor did not immediately quarantine herself because she thought she had malaria not Ebola. The doctor was eventually diagnosed with Ebola and died in September 2014.

Culture

A Sierra Leone DJ uses his program which is transmitted on 35 stations in Sierra Leone to share knowledge about the Ebola. This helps inform people in rural areas about the disease. An example of radio station in Sierra Leone is Capital Radio Sierra Leone.

"Ebola in Town", a dance tune by a group of West African rappers warning people of the dangers of the Ebola virus and explaining how to react, became popular in Guinea and Liberia during the first quarter of 2014.

In August 2014, George Weah and Ghanaian musician Sidney produced a song to raise awareness about Ebola.

There are a number of Ebola-themed jokes circulating in West Africa to spread awareness.

See also

• Ebola virus epidemic in West Africa
• Ebola virus epidemic in Guinea
• Ebola virus epidemic in Liberia
• Ebola virus disease
• Health in Sierra Leone
• 2010–13 Haiti cholera outbreak
• Contact tracing
• Biosafety level

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External links

• Website of the Ministry of Health & Sanitation provides also situation reports for Sierra Leone
• Sierra Leone compared to Ireland in area
• Inside Sierra Leone's Ebola clinics
• Inside the history of Ebola

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