Forty-Two Days: Ebola Free!

9th November 2015

I am the doctor covering the Ebola isolation unit at the hospital today.  All patients that attended the hospital for treatment during the outbreak were screened before entering the grounds.  They have a temperature check from a contactless thermometer and they complete a screening questionnaire that enquires about fever, relevant symptoms and any contact with potential cases of the disease.  If they meet the case definition for Ebola, they are admitted to the isolation unit and are nursed by staff in full personal protective equipment (PPE) until their blood results are available.  All patients are prescribed broad spectrum antibiotics, antimalarial drugs and fluids; oral rehydration therapy if they can drink or intravenous therapy if they are vomiting or too weak to drink. 

Screening continues for the time being and there is one name on the board this morning, a lady who was referred with fever, diarrhoea and vomiting. These are typical symptoms of the disease but at this stage, are much more likely to be due to gastroenteritis.  Over the weekend, on November 7^th, the country achieved a fantastic milestone; it was declared officially free of Ebola by the World Health Organisation (WHO), having reached 42 days (2 incubation periods) since the last patient was discharged from hospital.  The approach to our patient, however, is no less cautious than before as the country observes a ninety-day period of heightened surveillance.

Twelve months ago, the chances of this patient having Ebola would have been much higher and the board would have been full of names.  When I arrived in Sierra Leone, there were a handful of cases still being treated in-country but none had been reported in Freetown for some time.  The previous year, the situation was very different.  The first case was confirmed in the South East of Guinea on 23^rd March 2014.  By May, it had spread to Liberia and crossed the border into Sierra Leone.
 

Although several other countries were affected, it was these three West African nations that bore the brunt of the epidemic with tragic consequences.  It has been well described that the international community was slow to recognise and respond to the epidemic but by August the UN had declared an international public health emergency.  The health systems of the 3 countries were completely overwhelmed by the epidemic and no-one had experience of dealing with such an emergency.  Previous epidemics had been relatively small and contained – this was different.  The virus spread across the country and ,alarmingly, quickly reached Freetown and it’s densely populated urban sprawl. 

At the height of the epidemic, hundreds of cases were being reported on a weekly basis and huge international efforts were mobilised to assist the countries to deal with the epidemic.  It is suspected that over 11,000 people died of the disease.  The Sierra Leone National Ebola Response Centre (NERC) website states that there have been 8704 confirmed cases of which 3589 died in Sierra Leone.  221 of these were health care workers.     The isolation unit at Connaught has treated in the region of 500 positive patients and here too, Ebola has left its mark amongst the staff.

On the evening of November 6^th, we joined a candle lit procession of thousands of people through the streets of the city, ending at The Cotton Tree in the centre of town.  The vigil was held in honour of all the health care workers who had selflessly continued to work in the face of danger and uncertainty to provide care to their patients and ultimately lost their lives to the disease.  It was a lively march, led by a military brass band and while there was much celebration and dancing, there was also an ambience of reflection and a sense of weary relief amongst many in the crowd who have been present, working tirelessly throughout the last 18 months. 

The following day, at a conference in Freetown, the president declared an end to the state of emergency and the WHO representative announced that transmission had been stopped and commended the county for their herculean efforts to contain the virus.

“The strong leadership of the Sierra Leone Government, working with partners from around the globe, mobilized the necessary expertise needed to contain the outbreak... Sierra Leone achieved this milestone through tremendous hard work and commitment while battling the most unprecedented Ebola virus disease outbreak in human history.”

This was achieved through establishing appropriate facilities to manage cases, enforcement of strict infection control policies, setting up safe and dignified burial teams and strong community engagement.

On the evening of November 7^th, King’s held a party in town for the isolation unit staff to recognise their massive contribution towards ‘getting to zero’.  The team of staff include nurses, screeners, surveillance officers, security, cleaners and they are all true heroes that have risked their lives by turning up to work every day throughout the outbreak.  I am in awe of them but they are not the only ones.  There are staff throughout the hospital that also looked after patients, unsure if they would be infected and in total over 35,000 Sierra Leoneans were registered as Ebola response workers.

My patient today is fortunately Ebola negative and well enough to be discharged.  The count remains at zero and the ninety-day surveillance period continues.  Despite this momentous achievement, the country must remain vigilant.  Sierra Leone cannot afford to let its guard down now.