Ebola epidemic: house-to-house search in Sierra Leone reveals 358 new cases
Teams of volunteers also find hundreds of unburied corpses, according to leaked email from senior American diplomatWednesday 24 September 2014
Door-to-door searches during a three-day curfew in Sierra Leone identified more than 350 suspected new cases of Ebola, according by the top US diplomat in the country.
Charge d’affairs Kathleen Fitzgibbon said teams of volunteers had also discovered 265 corpses, of which 216 have since been been buried, in an email to organisers of the curfew that has been seen by the Guardian.
Fitzgibbon said the home visits had identified a preliminary 358 new suspected cases, with 85 patients sent to treatment centres.
Although there had been some “challenges” during the curfew, which saw the normally chaotic streets of the capital Freetown replaced by eerie silence after the government ordered everyone to stay in doors, it could be seen as the “beginning of the end” of the Ebola epidemic, which has killed more than 2,800 people, primarily in Liberia, Sierra Leone and Guinea.
“The challenges included the late arrival of some materials, a rumor that the soap was infected with Ebola. Some people fled to the bush to avoid the house-to-house [checks] but came back for the last day,” she said, adding that there had also been a “slow response to pick up corpses”.
American public health institute the Centers for Disease Control has been heavily involved in the emergency response in Sierra Leone and is running the laboratory in Kenema, Sierra Leone’s third biggest city.
“Our team decided the three-day stay-at-home was a ‘watershed moment’ whose momentum must be turned into specific activities to ensure that we can reach our goal of isolating 70% of positive cases to reverse the upward trend of the epidemic,” Fitzgibbon said.
“The public needs to understand that this campaign did not end Ebola but can be the beginning of the end if everyone remains vigilant,” she added.
The email said one of the priorities was to ensure all bodies were buried correctly as funerals have been identified as one of the ways the disease has spread, with relatives touching the bodies of the deceased.
She said she was “extremely saddened” to hear of two incidents of the disease spreading recently, one in the area of Moyamba in which 24 people had died “as a result of participating in this funeral” and another in Kenema, in which 17 infections were traced to a funeral.
Fitzgibbon described one man in Kenema government hospital as a “hero”. He survived the disease and stayed in the hospital helping other patients, “in particular a young child whose parents are dead”, because he knew he was immune to contracting the virus again.
“We need to celebrate this man’s contribution ... survivors should not be stigmatised, but instead celebrated,” she said.
In Makeni, a large town three hours from Freetown, an Irish nun helping at a holding centre said 138 suspected cases had been identified with 19 bodies buried and 39 patients send five hours away for treatment.
“The good thing is we have had some survivors. One man and four women came back and they addressed the emergency people. It seemed to give them back the energy, because they are all exhausted,” said Sr Mary Sweeney.
Full email
From Charge d’Affaires Kathleen FitzGibbonSeptember 23, 2014
The House-to-House campaign met its objectives, thanks to public participation. Preliminary information indicates that the teams were able to reach between75% to 85% of the 1.7 million households throughout the country. Here are some of the lessons learned. Interpersonal communication is the most effective way to deliver messages. Most misconceptions were dispelled by the teams. Neighborhood watches will continue helping communities connect with service providers. It will be important to sustain the holding and treatment facilities as those who were ill self-reported or were identified by neighbors. The public needs to understand that this campaign did not end Ebola but can be the beginning of the end if everyone remains vigilant.
Sierra Leoneans voluntarily went to holding or treatment centers. A preliminary number is that 358 suspected cases were transferred to holding centers for testing, with 85 transferred to treatment centers. There were 285 bodies found during the exercise and 216 of those have been buried. Corpses are swabbed and tested to determine cause of death. We still await the official data as the districts are still reporting results so these numbers are not final. Public acceptance of the campaign was high. It is important to get all cases of Ebola into care centers.
The challenges included late arrival of some materials, a rumor that the soap was infected with Ebola, some people fled to the bush to avoid the House-to-House but came back for the last day, and improved but still slow response to pick up corpses. Another constraint was that some of the holding centers were opened late. For sure, small businesses and poor residents faced more challenges than most, but independent monitors report that many of them stated that campaign was important enough to participate.
Today, our CDC team shared with President Koroma what our team has been doing and will continue to do in support of the response. In Dr. Frieden’s words, we are with Sierra Leone through the entire epidemic. Our team described this three-day stay-at-home as a “watershed moment” whose momentum must be turned into specific activities to ensure that we can reach our goal of isolating 70% of positive cases to reverse the upward trend of the epidemic.
CDC is running the laboratory at Kenema, assisting the Ministry of Health and Sanitation with data management, supporting the Emergency Operations Center at the national and local levels, and will be doing more to strengthen the district health teams. This is where the fight will be won. The data is important to allow us to target where the new infections are coming from. CDC also recommends that all bodies are buried in a medically safe manner. This is what we are aiming for and you can be assured that all the donors are working closely with the government to support the burial teams. We are supporting the International Federation of the Red Cross to train and manage burial teams in several districts. We also are funding treatment centers.
I was extremely saddened to here of two recent instances, one in Moyamba and a second in Kailahun, where prominent persons died and the communities conducted burials. In Moyamba, 24 persons are dead as a result of participating in this funeral and there may be others. In Kailahun, the same scenario, with some 17 deaths traced to this funeral. Please, save yourselves and your community, let the Ministry of Health and Sanitation conduct all burials. We know that these teams are overwhelmed, but be persistent in insisting that corpses are handled only by trained personnel.
Let’s end on a high note and talk about a hero. There is a man in the Kenema Government Hospital treatment center who has recovering from Ebola. He is now immune. He stayed in the treatment center helping with other patients, in particular, a young child whose parents are dead. He could have left, but he chose instead to remain and help this child, who is unrelated to him. We need to celebrate this man’s contribution to the fight against Ebola. Survivors should not be stigmatized, but instead celebrated and enabled to be an important component of the response. Bravo
http://www.theguardian.com/world/2014/sep/24/ebola-sierra-leone-curfew?CMP=twt_gu
