On the 7th November 2015, Sierra Leone was officially declared free of Ebola. The disease infected 8,704 people and took 3,589 lives; however, it is a testament to the collective international effort, particularly by Médecins Sans Frontières and the Red Cross, that 5,115 of those infected survived the disease.
The healthcare system in Sierra Leone is practically non-existent, with one doctor to every 45,000 people. The country is one of the world’s poorest, ranked 183 out of 187 in the UN’s Human Development Index, and has a typical life expectancy of just 48 years.
The virus is thought to infect via contact and symptoms begin between 2 days to 3 weeks post infection. Symptoms include fever and muscular pain, followed by vomiting and diarrhoea. Some patients have also shown internal and external bleeding. Once infected, several types of immune cells are “targeted”, which carry the virus to the bloodstream, spreading throughout the body.
There are three reasons why one may be sceptical that Sierra Leone is “Ebola Free”. Firstly, efforts to tackle Ebola have been hindered by fierce resistance from local communities, suspicious of any outside intervention. Cases have gone unreported, with deceased victims buried secretly at night, without safety precautions. Thus, there may still be people infected with Ebola or people possessing infectious materials, as Ebola has been found to survive for up to several weeks outside of a host. In fact, Sierra Leone’s first diagnosed case of Ebola was a pregnant woman who contracted the disease attending an “unofficial” funeral (i.e. a funeral with no health and safety precautions) of an infected healer.
Sierra Leone could still be at risk as it shares a border with Guinea, the source country of the outbreak. Whilst Sierra Leone has declared that it will take heightened security and health screening measures at their shared border, the country simply does not have the means or resources to do this. Signs and symptoms of Ebola, such as a fever, only manifest, on average, 2 days to 3 weeks after infection. This means that people incubating the virus can pass through the borders and reintroduce the disease to Sierra Leone.
Lastly, Sierra Leone could have another Ebola outbreak, with no direct stimulus, such as an infected person travelling into Sierra Leone. It is possible that Ebola is a latent virus: a virus that is able to lie dormant within a cell. Recently, a UK nurse and survivor of Ebola, Pauline Cafferkey, was admitted to the Royal Free Hospital’s isolation unit after suffering from an apparent relapse. A statement released claimed that “Pauline has become unwell by meningitis caused by the Ebola virus”, and that “this is the original Ebola virus that she had many months ago, which has been lying inside the brain, replicating at a very low level probably, and has now re-emerged to cause this clinical illness of meningitis”. Due to the poor resources of the infected African countries, we have no way to tell if this is the only case of relapse, however, Cafferkey’s case shows that the Ebola virus can have effects months after the patient is cleared of the disease, implying that the Ebola virus may be latent.
Lack of education and knowledge has, arguably, been the crux of the 2014 Ebola outbreak. The lack of doctors in West–African countries has contributed to the mortality rate, and the people do not understand or believe that a virus could kill their loved ones so quickly, leading to some hospitals being “invaded” by mobs with doctors being accused of killing their patients. With only a small number of outbreaks, research and knowledge is limited; we are still discovering the virus’ pathophysiology. Scientists have had to quickly learn how to treat patients and how to protect those caring for victims. Hopefully the country has learnt, after 18 months of infection, how to best cope with Ebola and reduce fatalities if the virus should reappear.
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