Nov 7, 2015
Sierra Leone Declared Free of Ebola

Today, November 7, after the loss of considerably in excess of 3,500 Sierra Leonean lives to Ebola, and with the heroic efforts of many within Sierra Leone and around the world, the WHO has declared Sierra Leone free of Ebola. In a ceremony in Freetown this morning, the WHO's country representative, Anders Nordstrom, made the formal announcement, the country having gone 42 days, equivalent to twice the disease's incubation period, without reporting any new cases. Mr. Nordstrom, stated that the country would now enter a ninety-day period of enhanced surveillance, to prevent a recurrence of the outbreak.

A big, big thank-you goes to all who helped in this effort. A huge thank-you to the Cuban and Chinese governments, the very first countries to step into the disaster, with money and medics directly involved in treatment of Sierra Leoneans. Truly, ideology and principle have never been more positively demonstrated than in their response. A big thank-you to all the other governments, big and small, who contributed. A big, big thank-you to the Sierra Leonean doctors and nurses, many of whom paid the ultimate price, to the other hospital staff, the burial workers, ambulance drivers and all other Sierra Leoneans who courageously played a part in battling the scourge of Ebola. A big thank-you to the research scientists all over the world, even including normally profit-seeking multinationals, who toiled round the clock, with some success, for a vaccine and/or therapy for Ebola. A huge thank-you to MSF, a private organization, with us heroically in the thick of the battle, from the first to the last.

When we first reported an Ebola crisis in Sierra Leone in June last year, very few people were taking the matter seriously. Certainly not the Government of Sierra Leone, which at best was ignoring the outbreak, at worst was doing all it could to conceal the problem. Indeed, President Ernest Bai Koroma had in May all but declared the Ebola outbreak in the region over. As late as August, 2014, he had to be persuaded that his country was indeed in a crisis and this was not the time to be going on a jaunt to the US for the US_Africa summit. The Sierra Leone Ministry of Health was unable to perform simple statistical calculations relating to the outbreak. Meanwhile, the reflex reaction of the lunatic elements within ruling party supporters was to label the bearers of the bad news “detractors” and “saboteurs”. Among others not taking the crisis seriously at the time was the World Health Organisation, WHO, which spent many weeks ignoring all the indications that there was a very serious, unexplained viral haemorrhagic outbreak in Eastern Sierra Leone at exactly the same time as Ebola had been confirmed in neighbouring Guinea and Liberia.

Credit goes to Osmond Hanciles, who, by some margin, was the very first writer we found to warn of the dangers to Sierra Leone of the impending crisis. Credit also to Sylvia Blyden, also early to spot the danger. Credit, too, to Yahya Jammeh, President of Gambia. Whatever other criticisms one might have of him, he was the earliest of all the West African leaders to understand the threat Ebola posed to his country and others in the region.

Our assessment of the defeat of Ebola, based not on scientific analysis but on close observation of day to day events, is that the advice of the medical experts was correct from the start: Ebola spreads through close contact with symptomatic patients and corpses. Focus on this and the disease can be defeated. Ignore this, or focus elsewhere and the disease will spread. Our assessment, again based not on scientific analysis but on close observation of events, is that many of the preventive measures put in place, to the extent that they diverted focus away from the dominant mode of transmission, were not helpful in the fight. The state of emergency, mass quarantining (as opposed to quarantining of identified high-risk locations)  and lockdowns (which we at one point supported) in the end, in our layman’s view, probably did not contribute much to the defeat of Ebola. All the restrictions on economic activities  and public gatherings, in the end, in our layman’s view, probably did not contribute much to the defeat of Ebola, especially when one considers that the income and energy lost in these measures could have been utilized in more precise Ebola-specific measures. We heard of not a single instance of Ebola being contracted in public transport or in a crowd (and despite Ebola, crowds were

congregating in markets every day). The origin of the disease in almost all specific cases we heard about could be readily traced to one or other of the dominant modes of transmission. Handwashing and improved personal hygiene have other health benefits, but in our layman’s view, the ubiquitous handwashing buckets did not contribute much to the defeat of Ebola. Liberia ended its Ebola outbreak remarkably early even though it had long lifted its state of emergency, whereas Sierra Leone's state of emergency still exists today.

From our layman’s perspective improved testing, infection control procedures in medical facilities, medical surveillance, contact tracing, targeted quarantining, public education, social mobilisation and monitoring of deaths and burials were some of the key factors in the defeat of Ebola. This was actually more or less what experts who had faced down Ebola previously had told us from the beginning. Sometimes, in the face of an enemy that inspires mass terror and with infected corpses rotting in the streets, it is easy to ignore the advice of experts. Overcoming distrust of the government health authorities and their message was also a key part of the problem.

It was a terrifying time for Sierra Leone, a country that has had its share of terrifying times. At the height of the epidemic, it looked from here on the inside as though we would not escape. We hope, but are by no means confident, that lessons have been learnt from it, that we now understand as a nation the need to be globally and/or regionally competitive in all things. In health care, in education, in agriculture, in our environment, in income generation, in infrastructure. In all areas of serious human activity Sierra Leone at the very least should be competitive with its neighbours. The tendency to fall behind even the relatively low standards of the West African region is a sure road to national disaster. We simply cannot afford to continue to ignore global best practice, brush aside serious criticism, and downplay all the negative developmental indicators revealed by global bodies. There is much work to be done to ensure Sierra Leone never again faces these terrifying times.