Ebola cases fall in Liberia, rise in Sierra Leone, and concerns persist

A healthcare worker in protective gear sprays disinfectant around the house of a person suspected to have Ebola virus in Port Loko Community, situated on the outskirts of Freetown, Sierra Leone. (AP Photo/Michael Duff)

The trend in Ebola cases for Liberia and Sierra Leone appears to be headed in two different directions. New cases of Ebola in Liberia are declining while it gets worse in Sierra Leone. The mixed progress may show how the two countries are managing to deal with the virus, but there is cautious optimism that Liberia’s dropping caseload points to towards the beginning of the end.

U.N. Ebola Chief Dr. David Nabarro said it is possible that the outbreak could be defeated in 2015. However, he was careful to say that it is not certain and there is still much more work to be done.

“So I must stress to you that we are really not saying to the world that the job is even half done or a quarter done. We’re simply saying we had a strategy and the strategy predicted that as things got implemented, numbers of cases wouldn’t increase at the rate they were increasing in August and September,” Nabarro told the Associated Press. “Well, that’s what’s happening. We’ve in some places got a slowed rate of increase, but I’m afraid I cannot say to you that it looks as if we’re over the worst.”

BuzzFeed’s Jina Moore broke the story two weeks ago that Ebola cases were falling in Liberia. Her interviews with health workers, government officials and body removal teams confirmed that things were slowing down. Only a few months prior, Moore and others reported that hospitals were struggling to keep up with the number of people arriving each day with Ebola. Now, some beds sit empty. What is not clear is why.

It is possible that the international response and awareness campaigns improved care and public knowledge enough that the spread of the virus is slowing down. Another possibility is people are not going to hospitals. The crisis has worsened, in part, because of infected individuals staying home. It contributes to the spread of Ebola and hampers efforts to understand who has it and where. Finally, the decline could be a lull in the epidemic that may soon resume its high rate of infecting people.

Ebola deaths through 29 October. Credit: BBC

Ebola deaths through 29 October. Credit: BBC

Doctors Without Borders warned today that the gains made in Liberia are at risk of sliding backward if the international aid response does not adapt to the changing conditions in the country. The emergency medical relief organization recommended the deployment of rapid response teams to new hot spots, to launch a comprehensive response in endemic areas of Liberia.

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“Priority should be given to a more flexible approach that allows a rapid response to new outbreaks and gets the regular health-care system safely up and running again,” said Fasil Tezera, Doctors Without Border head of operations in Liberia.

That flexibility means untying financial commitments so they can adapt to changing needs, argued the aid organization’s emergency coordinator Dr. Nico Heijenberg.

“Much of the international aid funding for the Ebola response is earmarked for specific projects. Instead, international donors and implementing organizations should deploy their resources with flexibility so that they can be used where they are needed most,” said Heijenberg.

The surge of cases in neighboring Sierra Leone is evidence of what is going wrong and what can happen to Liberia if the response grows complacent. Rural parts of Sierra Leone are witnessing the accelerated spread of Ebola. The U.K.-based Africa Governance Initiative found that Ebola is spreading nine times faster in rural Sierra Leone than it was only two months ago. The U.N. estimates that about 50 percent of Ebola cases in Sierra Leone are not being reported. Official reports indicate more than 1,000 people have died from Ebola in the country since the onset of the outbreak.

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Those who do end up seeking medical attention have trouble getting a hospital bed or are in understaffed facilities. A U.N. Mission for Ebola Emergency Response (UNMEER) report released last week said medical professionals were not going to Sierra Leone due to unclear evacuation protocols and insufficient hazard pay. Also concerning is the fact that the basic needs of people in Sierra Leone are not being met. The lack of food and other necessities is forcing people to leave quarantine areas, said UNMEER.

The tenuous progress in Liberia and the troubling number of cases in Sierra Leone are reason for continued concern, said U.N. Secretary General Ban ki-Moon. He urged international leaders to continue supporting the anti-Ebola effort in West Africa, in an OpEd for the Washington Post. He made clear that the long term solution involves strengthening the already weak health systems in Liberia, Sierra Leone and Guinea.

“Ebola will be beaten through a resolute and coordinated effort. We have initial evidence to prove that this can happen. But we must speed up efforts to first get the crisis under control and then bring it to an end,” said Ban. “Now is no time to let down our guard. We must keep fighting the fire until the last ember is out.”

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.