Fluctuating numbers… and “living with Ebola”

As Liberia succeeds in the battle against Ebola… and Sierra Leone continues to struggle… I’m starting to wonder about something. Can a country “live with” Ebola?

Getting to zero new cases… and then going through two rounds of 21-day incubation periods without any new cases seems like a long, long way off. Is it even possible in Sierra Leone???? Some districts have succeeded… But, fluctuating numbers… ineffective quarantines, corruption, disbelief, resistance to behaviour change, cultural practices, mismanagement of administration, nonsensical policy flip-flops, etc. has lead me to this momentary pessimism… and got me thinking.

Perhaps Ebola has been in Sierra Leone for a long time… and was just “recognized” internationally last May. Perhaps people have been dying of Ebola for years… and we (in Sierra Leone) just failed to recognize what it was. Perhaps the isolation of small villages and poor road networks masked and prevented a large-scale outbreak like the one we’re experiencing right now.

Remember… the healthcare system here was abysmal. There were no laboratories to detect Ebola. The number of doctors, especially in the countryside, was appallingly low. Hospitals were understaffed and under-resourced. People often died for unexplained reasons. People died… Some said “witchcraft.” Some said “the cold” or “the breeze”. Some said “malaria-typhoid”. Some said “low pressure”. Etcetera.

Granted, this outbreak has killed a shocking number of people – families, farmers, healthcare workers, market women, traditional healers, etc. And, it truly is an international threat, as headlined by the WHO. But… is this something to think about???

I’ve heard, time-and-time again, “one case is too many…” One case is how this whole thing started. That’s why we MUST battle our way to get rid of Ebola in this region – for good. I agree!!!! According to official tracking documents, one case in the Kailahun District has accounted for over 3,100 deaths in Sierra Leone and well over 8,000 cases.

But, can a country “live with” Ebola? I’ve asked this of a number of doctors, disease experts and epidemiologists. They all say, resoundingly, “NO”. I agree… but let me speculate.

Let’s say Sierra Leone and other countries had a very quick, efficient way of testing for Ebola… a test that was easy to use and could be distributed to small health clinics across the country. Let’s say there was a vaccine to prevent Ebola. (Vaccines are being tested).

Now… because early Ebola symptoms are similar to malaria symptoms, each patient exhibiting sudden fever, body aches, vomiting and diarrhea could be immediately isolated and tested for malaria, typhoid and Ebola. No one would touch that patient till adequately tested. If it were confirmed to be Ebola – that patient would be safely transported to one of four existing Ebola treatment centres… one centre in each region of Sierra Leone… that have been built during this crisis.

Then, a team of vaccinators and permanent Ebola communicators/healthcare workers would go to the village or area and administer a vaccine to everyone in the area. The trick or aim would be to stop the chain of transmission of Ebola to prevent the disease from becoming an epidemic – like it’s become now.

Let’s also say that the “new” infection prevention and control behaviours that we’ve seen during this crisis were to continue… indefinitely. We’d all be healthier, I’m sure… all that hand washing is bound to help. And, cultural practices like genital cutting, washing and anointing dead bodies, gathering to sympathize with the sick… would have to change. But, as we’ve seen during this scourge, those practices can be curtailed.

After all this international attention and intervention, let’s hope some of these behaviours and resources will be utilized into the future. Let’s hope there’s a positive remnant of what Sierra Leoneans (and Liberians and Guineans) have gone through. Of course, successive governments will ultimately be responsible… (another jolt of pessimism strikes me).

Sierra Leone now has ambulances, a 117 call centre for emergencies, trained healthcare workers, survivors, laboratories, treatment centres, personal protective equipment, gloves for nurses, adequate pay for healthcare workers, dead body management teams, trained burial staff, contract tracers, etcetera. And, we have a different mindset… an awareness of disease and infection that Sierra Leoneans probably never had before. Let’s hope… some of this continues but my pessimism somewhat overwhelms me at this point.

I’m not suggesting that we stop the fight against Ebola… The battle must continue. But, I’m speculating… and wondering… What will we carry forward? What will life be like a year from now? Will we still be living with Ebola? And, how do we???