Ebola cases are continuing to rise “frighteningly quickly” in parts of Sierra Leone, an international campaign group has said.
In a situation assessment released on Sunday, the Africa Governance Initiative (AGI) warned that the virus is spreading nine times faster in rural parts of Sierra Leone than just two months ago.
“Whilst new cases appear to have slowed in Liberia, Ebola is continuing to spread frighteningly quickly in parts of Sierra Leone,” said the AGI report. Based on three-day averages of cases recorded by the health ministry, the report shows that Sierra Leone is now averaging 12 new cases of Ebola each day, up from 1.3 daily cases in early September.
Acknowledging the government’s measures to control the spread, AGI stressed that the situation was still “a full-blown crisis”.
“The Government of Sierra Leone is making real strides in tackling transmission by speeding up access to treatment and safe and dignified burial,” AGI chief executive Nick Thompson said. “But we can’t rest until Ebola has nowhere to hide. And we can see from growth in new cases in some rural parts of Sierra Leone that we still have no time to lose if we’re going to get on top of this.”
Though Sierra Leone’s rural areas have been worst hit, the group says the spread of Ebola is also increasing in the capital Freetown – which is recording six times more cases per day compared to two months ago. The virus has only started to slow in one region of Sierra Leone, Bombali, in the country’s north.
The stark assessment from AGI comes just days after the World Health Organization (WHO) released an updated situation report describing Ebola transmission in Sierra Leone as “intense” and “widespread”. Last month, health officials announced that the outbreak had reached Koinadugu, the last unaffected district in the country up to that point.
With more than 5,300 cases and 1,5000 deaths reported nationwide as of Oct. 29, Sierra Leone is one of three West African nations at the epicenter of the world’s worst outbreak of Ebola.
According to the latest numbers from the WHO, nearly 14,000 cases of Ebola and almost 5,000 deaths have been confirmed across Liberia, Sierra Leone and Guinea. Small clusters of cases have also reached Mali, Senegal and Nigeria, and isolated cases have been confirmed as far away as the United States and Spain.
‘Crisis situation’
To help respond to the growing crisis in Sierra Leone, a British naval ship, carrying hundreds of troops, medical supplies, helicopters and trucks, docked in the capital on Thursday. The ship will serve as a hangar and take-off and landing zone for the helicopters, which will ferry supplies and people to hard-to-reach areas of the country. 
“With all these facilities, they will go a long way in the ongoing fight against the Ebola disease,” Alfred Palo Conteh, the new head of the country’s National Ebola Response Center, said Thursday, as he greeted the arriving ship.
On Wednesday, Conteh had warned that more needed to be done to control the epidemic. “We are in a crisis situation which is going to get worse,” Conteh told a news conference. “What is happening now should have been done three months ago.”
The stark warning and call to action were echoed by others, even in neighboring Liberia, where the World Health Organization has said the rate of Ebola transmission appears to be slowing based on the numbers of cases and burials reported.
“We need to re-galvanize our efforts, accelerate the interventions, remain vigilant,” said Tolbert Nyenswah, the assistant minister of health who leads the Liberian government’s Ebola response.
Outbreak remains ‘unpredictable’
While they acknowledged progress in the region, WHO officials urged caution against assuming that Ebola was coming under control there or in any of the three countries most affected by the disease, saying the gains could be quickly reversed. “Getting a slight decrease in the number of cases on a day-to-day basis versus getting this thing closed out is a completely different ball game,” Dr. Bruce Aylward, WHO’s assistant director general, said last week.
Indeed, several times throughout this outbreak, including in Liberia, officials have thought the disease’s spread was slowing, only to surge again later. They have attributed those false lulls to cases being hidden because people were too afraid to seek treatment, wanted to bury their relatives themselves, or simply weren’t in contact with authorities.
“The present epidemic is unpredictable: We have seen a lull in cases in one area only to see the numbers spike again later. More aid is needed on the ground. It’s time now to step up contact tracing, safe body management practices and community surveillance,” said Fasil Tezera, head of Doctors Without Border’s mission in Liberia, even while noting that their 250-bed center in the capital is not at full capacity.
Liberia is the hardest hit country in the Ebola outbreak sweeping West Africa that has also ravaged Guinea and Sierra Leone.
‘No time to lose’ in Sierra Leone
Still, there are some signs of hope. AGI — an organization set up by former UK Prime Minister Tony Blair that operates in the affected countries — says burial management has “improved significantly” in both Liberia and Sierra Leone. Half of all Ebola infections are thought to come from the bodies of victims, as traditional burial rituals involve close contact with contaminated bodily fluids.
“The picture is certainly changing, but that’s all we can say for sure at the moment,” said Thompson, adding: “The pace of the spread in rural Sierra Leone shows we still have no time to lose.”
Based on the latest figures, the WHO estimates that another 5,000 foreign health workers are needed to help control the outbreak. The World Bank announced Thursday that it will give an additional $100 million to assist in that effort. The new funds will be used to train, pay and house health workers while they’re in the Ebola hot zone and provide medical care or evacuation for anyone infected.
Despite the uptick in international aid, AGI warns that unless more is done there could be a shortfall of over 6,000 Ebola beds in West Africa by December. According to the group’s analysis, almost half of the beds currently pledged by the international community have nobody to staff them – making an increase in health workers essential in the fight to contain and eliminate Ebola.
“The international community badly misjudged the impact of the Ebola epidemic in its first few months and is compounding that error by failing to act quickly enough now,” Thompson said.
Quarantines have ‘chilling effect’ on health workers
Complicating matters even further, several states in the U.S. have now imposed mandatory quarantines on returning health workers — a move that health officials warned could dissuade volunteers from going to the affected region. Those fears were confirmed over the weekend, as international aid group Doctors Without Borders said the quarantines were already having a “chilling effect” on their work.
The executive director of the aid group, Sophie Delaunay, said that health workers volunteering with Doctors Without Borders are already starting to change their travel plans due to concerns about how they’ll be treated when they return to the United States. Some of them are remaining in Europe for extra time to wait out Ebola’s 21-day incubation period to avoid “facing rising stigmatization at home and possible quarantine.”
“The risk of being quarantined for 21 days upon completion of their work has already prompted some people to reduce their length of time in the field,” Delaunay said in a statement, referring to her group by the acronym for the French version of its name, Médecins Sans Frontières. “Others will be less inclined to volunteer in the first place,” she said, noting that the group’s international volunteers all have full-time jobs as doctors, nurses, and other healthcare professionals in their home countries, and are using personal vacation time to make the trip to West Africa.
“This will present significant operational disruptions at the field level for MSF and other organizations, and lead to an overall shortage of desperately needed health workers, precisely when the Ebola outbreak is as out of control as ever,” Delaunay said.