Mar 29, 2015

How Much Does an Ebola Lockdown Cost?

...Is it an effective technique against Ebola?...

The three-day Ebola lockdown prescribed by the Sierra Leone government from March 27 to 29, 2015, is the second such in Sierra Leone since the start of the Ebola outbreak in West Africa. The order was received with little public comment or debate, although some privately questioned the rationale behind it. The first such lockdown took place in September last year, and although government officials deemed it a success they provided no conclusive evidence to justify this claim. Data from natinpasadvantage (Ebola Chart) is inconclusive: it shows the infection rate increasing week on week almost till the end of the year.There was no sharp spike in the data in September followed by a fall back, as perhaps might have been expected if the lockdown had had a marked effect.

For the current lockdown two separate questions could be asked: Will the lockdown enable detection of a significant number of infected who otherwise would not have been detected? And is this the best or even a cost-effective method of discovering these infected? For the first question we shall have to wait until the numbers are released by the authorities. For the second question a few estimates can be made.

The latest figures from the National Ebola Response Committee, NERC, reveal that there are about 80 Ebola patients currently admitted at Ebola centers around the country. The latest (March 25) WHO Ebola update reveals that there were 144 new infections in Sierra Leone during the previous 21-day incubation period of the disease. It seems reasonable to assume then that there could not be more than perhaps 200 Ebola-infected remaining undetected out in the communities. This could be used as the maximum number that could be detected by the three-day lockdown. How much will it cost to detect this number?

Let us use only the cost of lost national income and ignore all other costs, the costs of the "volunteers" employed in community sensitization, cost of soap, media announcements, security, international monitors etc, etc. Let us also assume no lost production on Saturday and Sunday, which are non-working days for much of the population. Let us further assume a per capita GDP of 400 USD, or about $1 per day. The cost of the three-day lockdown in lost national income can then be conservatively estimated at $6 million, assuming a population of six million. Assuming 200 detected

Ebola-infected, this gives a cost of $30,000 USD per detected Ebola infected., not including treatment. This is a hefty cost.  Might there be a better way to do this?

For $6 million, one could employ an army of workers on sensitization, surveillance and contact tracing for a month. Paying generously, at the rate of Le2 million per month, one could employ 15,000 workers for a month, sensitizing, going round communities, tracing contacts and looking for evidence of unexplained illness or death.

Direct payments to Ebola victims
is another possibility. As the number of Ebola infected reduce, unquestionably, national lockdowns get less and less effective. They turn into a search for the proverbial needle in the haystack. The government is holding down the entire population in search of fewer and fewer targets. More precise methods need to be employed as the outbreak hopefully draws to a conclusion.