EBOLA IN SIERRA LEONE:
A History of the 2014 Outbreak Based on National and International Reports
FACTS & FIGURES
Center for Disease Control and Prevention statistics show that as of December 3, 2014 there have been 13,703 recorded cases, with 4922 deaths. In Sierra Leone, specifically, 5,232 cases with 1,500 deaths have been confirmed. This unprecedented outbreak has taken a toll on the people of Sierra Leone, and with a current mortality rate of 59%, is sparking both national and international fears as case numbers continue to increase.
“In the 30 years I've been working in public health, the only thing like this has been AIDS...we have to work now so this is not the world’s next AIDS.”
- Dr. Tom Frieden, Director of the U.S. Center for Disease Control and Prevention
The deadly virus, described as "a glimpse of hell" by Ebola survivor Dr. Kent Brantly, is receiving significant amounts of unprecedented international attention. Looking at another virus that has origins on the African continent, HIV/AIDS specifically, it is interesting to compare the prevelence of the two epidemics with their respective international responses. AIDS-related mortalities are estimated at about 1.6 million per year, (World Health Organization, 2014) while the 2014 Ebola outbreak has barely reached 6,000 mortalities. (Center for Disease Control, 2014) This is not to undermine the impact of the Ebola virus, however, it raises the question of why this epidemic in particular has caused such an international frenzy.
Sierra Leone currently has one of the lowest rates of HIV transmission on the African continent. As of December 2013, Sierra Leone had an HIV/AIDS prevalence of 1.5% in the adult population, compared to the total Sub-Saharan Africa HIV/AIDS rate of 4.9%. (UNICEF, 2014) In fact, the Sierra Leonean government recieved the "Millenium Development Goal Award for its commitment and progress made towards combating HIV/AIDS" only four years ago. (UNAIDS, 2010) The success towards fighting HIV/AIDS in Sierra Leone should not go unnoticed, however, in the fight against Ebola, the Sierra Leone government appears to be at a standstill as the virus ravages through the nation.
Demonstrated by the World Health Organization map above, as well as individual statistical reports, the main concentration areas of the Ebola outbreak in Sierra Leone include the cities of Freetown, Kenema, Bo and Makeni. In an urban versus rural comparison, the Ministry of Health and Sanitation reports demonstrate that the Ebola virus is spreading more rapidly in cities than rural villages. As of December 7, 2014, there have been 1,403 official cases reported in urban areas, and 885 in rural communities. (Ministry of Health and Sanitation Report, 2014) According to the head of the UN Mission for Ebola Emergency Response, Anthony Banbury, the cases in Freetown and surrounding areas "account for about 65% of the country's new infections." (Wall Street Journal, 2014)
Similarly, the main hospitals for Ebola patients reside in these urban areas, including the Doctors Without Borders Ebola treatment center in Bo and the British-run hospital just south of Freetown. This raises a question about potential discrepancies between the abilities of urban dwellers and rural villagers to receive proper treatment. However, it appears that the country as a whole is still struggling to accommodate all patients, despite a certain location. According to Dr. Cancedda of Partners in Health, "Ebola kills so many people here [in Sierra Leone] because there's not the resources to take care of patients properly." (National Public Radio, 2014)
An Urban vs. Rural Comparison
The Basics
A Doctors Without Borders treatment facility in Kailahun, Sierra Leone
(ABC News, 2014)
Comparison to HIV/AIDS
"There is as yet no proven treatment for EVD," (World Health Organization, 2014) however, the majority of Ebola research is currently focused on producing a vaccine sufficient to prohibit the further spread of Ebola zaire in West Africa. The National Institute of Health is working in conjunction with pharmaceutical company GlaxoSmithKline towards producing a safe and viable vaccine. Phase 1 of a 3-phase trial program has "shown 100% protection in nonhuman primates at 4 to 5 weeks after single doses were administered." (New England Medical Journal, 2014)
According to Dr. Anthony Fauci, leader of the NIH vaccination effort, "based on these positive results from the first human trial of this candidate vaccine, we are continuing our accelerated plan for larger trials to determine if the vaccine is efficacious in preventing Ebola infection." (U.S. News & World Report, 2014). While the actual vaccine may not be ready for months, this serves as a significant milestone in the race to stop Ebola transmission.
The Race Towards Vaccination
President Barack Obama speaking at the NIH
(The Baltimore Sun, 2014)
"We can't just fight this epidemic, we have to extinguish it"
- President Barack Obama
The Future of Ebola in Sierra Leone
Recently, the international Doctors Without Borders president stated that “across West Africa we are no longer seeing exponential growth and, in some areas, a steady decline.” (The Zimbabwe Standard, 2014) However, in regards to Sierra Leone, specifically, the Ebola outbreak is "far from under control." While the countries of Liberia and Guinea have both seen a decrease in Ebola cases in the month of November, numbers continue to surge in Sierra Leone. New York Times correspondent, Jeffrey Gettleman, believes "the Sierra Leonean government isn’t as open to international aid as its neighbors" (Public Radio International, 2014) and has experienced government workers "making people get out and wash their hands in a bucket of dirty water that supposedly has some bleach." While opinions on the health infrastructure may vary, numbers do not lie, and statistics paint a grim future for the epidemic in Sierra Leone without immediate, sustainable intervention.
The graphs above depict the case numbers and mortalities for countries affected by Ebola. The left displayes the statistics as of December 3, 2014, and the right, an updated count as of February 11, 2015. These Ebola Situation Reports compiled by the World Health Organization demonstrate the increasing number of Ebola cases over time. While the recent reports indicate that Ebola is on the decline, (World Health Organization, 2015) the 22,894 deaths are a representation of the devastating impact that this disease has left in West Africa.
