(1)    The proposed three-day stay at home has generated much controversy, with some opposing it. I think it is too little too late. An extreme situation, such as we have now, calls for an extreme response. If the incubation period is 21 days, then the stay at home period should be at least 21 days.  This should help greatly in reducing the transmission of Ebola. The stay at home could be mitigated somewhat by emergency distribution of food, or by a daily lifting of a curfew for a few hours to enable citizens to obtain food and other necessaries. This would have to be carefully managed to avoid panic and riot.

If for political reasons only a 3-day lock down is authorized, restrictions on changing one’s residence during the period of this emergency could be introduced, such that special permission would be required to set up residency in a new area.. Chiefdom law used to require strangers to report to the chief immediately upon arrival. Perhaps this is the time to reintroduce this law if it has lapsed and to extend it throughout Sierra Leone, including Freetown and other cities. Neighbourhoods should be on alert to report all new arrivals. Ebola spreads to new areas when Ebola patients travel from their place of residence, so this restriction should help to curb the spread of the disease.

(2)    We need isolation centers more than we need treatment centers. The two purposes are often intertwined, but they are actually quite distinct. Treatment can’t stop this epidemic, because, as of now, there is no effective treatment. Isolation, on the other hand, could stop this epidemic. If it were possible to effectively isolate all current Ebola patients the outbreak would be over in 21 days. Finished. Period. So what we can not currently do with treatment, we might be able to do with isolation.

The whole issue of the treatment of Ebola is problematic. Whichever way you look at it, whoever’s numbers you believe, the success rate of Ebola treatment is poor. And treatment of Ebola patients by medical workers carries with it the very serious risk of these medical workers themselves becoming infected and then going on to infect others in their institutions and their families and in any private practice they may have. We have seen this time and again. It has happened everywhere Ebola has appeared. It has happened to medical workers from Sierra Leone, Liberia, Guinea, America and Britain among others in this crisis. One of the prime methods by which Ebola spreads is the medical worker, because the medical worker comes into close contact with so many patients, Ebola and non-Ebola, during the course of the working day. Given that the success of treatment is very poor to begin with and it carries with it the spread of further infections through the medical worker, we should  ask ourselves whether it makes sense to continue using health care workers to treat Ebola. We have a limited number of health care workers who we need for other illnesses that can be addressed successfully. We already have lost a significant percentage of our health care workers in a thus-far losing cause. In Liberia the health care system has virtually collapsed. In Uganda, in a much smaller outbreak, there was  a near-revolt at the main Ebola hospital. The WHO and MSF’s solution is to throw more medical resources at the problem. More treatment centers, more doctors, more nurses. This is understandable. These are medical organizations and they are looking for a medical response. But even if you could recruit the required medical workers (probably thousands not hundreds) from abroad, which is doubtful, Ebola would love this response. BECAUSE EBOLA KNOWS IT CAN SURVIVE AND SPREAD THROUGH THE HEALTH WORKER.  From East Africa to West Africa, health workers have been infected through their PPEs and no one has been able to conclusively explain how it has been happening. In tropical African conditions these protective suits are reportedly virtually impossible to wear and work with for any length of time. Isolation centers, as opposed to treatment centers, would reduce or eliminate the need for PPE-clad health care workers to be in direct contact with symptomatic Ebola patients.

(3)    So who would tend to the Ebola patients in the isolation centers? Who would perform the routine duties of cleaning up and assisting with feeding? Why would Ebola sufferers ever consent to admit themselves into a facility without doctors and nurses? For a start these facilities would still be provided with all the range of medicines that are currently being used to treat the symptoms of Ebola. And the administration of these medicines would be under the overall direction of qualified health care workers, albeit ones not in face to face contact with the patients (in a similar manner to which a general in war never sees the troops he’s fighting). Hands-on care of patients would be effected by two classes of people: relatives of patients and Ebola survivors. And what incentive would these classes have to perform these duties? MONEY. PAY THE PATIENTS AND PAY THE RELATIVES AND PAY THE SURVIVORS. ATTACK EBOLA MORE DIRECTLY WITH MONEY. USE MONEY TO CHANGE THE BEHAVIOUR OF THOSE WHOM EBOLA HAS DIRECTLY AFFECTED. We should pay the relatives and the survivors even more handsomely than we are now paying the doctors and nurses to look after Ebola patients. Not only that, we should pay for the Ebola patients themselves to come into the isolation centers. And we should pay them daily to stay in the centers. Even if, in the process we end up paying millions for some ordinary headaches. The overall goal is to isolate all potential Ebola patients from the rest of the populace. If we were to announce, say, that every Ebola patient who enters an Ebola facility accompanied by a relative would receive an immediate cash payment of one million leones, surely, surely we would quickly discover many new Ebola patients. Some genuine, some not so genuine, but these could be quickly weeded out by temperature test, clinical examination and a blood test. Survivors and relatives of genuine patients would be required to stay in separate facilities on the Ebola premises and to provide day to day care for their patients. They would have full access to PPEs. And they should be paid on a daily basis exactly as though they were doctors or nurses. Patient care by relatives carries added advantages: it eliminates the anguish and guilt that surely prevents many from bringing in their relatives for treatment (imagine a mother giving up her only child to a distant Ebola center); and it eliminates the fear among some sections of the populace that the Ebola facilities might themselves be poisoning patients. However these relatives would themselves need to be monitored after their duties at the center have ended, to ensure they themselves have not become infected. Patient care by relatives transfers the risk of infections arising within the hospital from the health care worker to the patient’s relative, but with a significant reduction of that risk: the relative is responsible for one patient, not many as with the health care worker. Ebola survivors, who are supposed to have immunity, could be used to care for those patients who present without relatives. They too should be paid equally handsomely on a daily basis. The Ebola isolation centers should provide care givers and patients with all the necessities of life, including three nourishing meals daily.