The number of Ebola cases is surging in Sierra Leone as the country suffers from a dire lack of treatment centers, while lack of food and basic goods is forcing some people to leave quarantine areas, the United Nations said Wednesday, adding to a growing number of alarming reports warning of a “crisis situation” in the West African country.
The U.N. Mission for Ebola Emergency Response (UNMEER) said in its weekly report that a total of 1,062 people had died from the virus in Sierra Leone, with the outbreak particularly virulent in the western areas around the coastal capital Freetown. The new report comes just days after the African Governance Initiative released startling new figures showing that in some parts of the country, the virus is spreading nine times faster than just two months ago.
Strapped for medical staff and lacking in the resources needed to treat the 5,338 suspected cases, the numbers are soaring: in the past 21 days there have been 1,174 new Ebola cases in Sierra Leone, almost triple the 398 new cases in Liberia and more than quadruple the 256 new cases in Guinea, according to figures released Wednesday by the World Health Organization.
Shortage of treatment beds
While Sierra Leone accounts for almost two-thirds of new cases, there are only 288 beds spread across four Ebola Treatment Centers (ETCs) in the whole country. As of Sunday (Nov. 2), those four ETC’s were providing care for a total of 196 patients confirmed to have the disease, UNMEER said. However, the UN agency said they suspect an average of 50 percent of cases of the Ebola virus disease (EVD) are not being reported across Sierra Leone, so the majority of patients are not making into treatment units.
UNMEER said a total of 1,864 beds were needed by December to handle future Ebola cases and control the outbreak. Ten new treatment centers are currently planned, with a capacity of 1,133 beds. “An additional 731 safe beds need to be planned, secured and made available by the first week of December,” the agency said in its report, released late on Wednesday.
The international community is slowly responding but many more lives will be lost before the level of assistance approaches the need, UNMEER warned. “Lack of available beds in ETCs is forcing families to care for patients at home, where caregivers are unable to adequately protect themselves from EVD exposure, thereby increasing transmission risk,” the report added.
More warnings against travel bans
The UN agency also urged against the use of mandatory quarantines and other medically unnecessary restrictions on returning health workers, saying a lack of clarity of such procedures was deterring foreign and national medical staff from coming forward to run the units. Several U.S. states, including New York, New Jersey and Illinois, have imposed a mandatory quarantine on healthcare workers returning from the region.
Earlier this week, Doctors Without Borders warned that the policies were already having a “chilling effect” on humanitarian efforts to fight the disease. “This will present significant operational disruptions at the field level for [Doctors Without Borders] 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,” Sophie Delaunay, the executive director of the aid group, told Reuters.
Other leading medical authorities have come out against state-imposed quarantines for returning aid workers. One of the most prestigious peer-reviewed medical journals in the world, the New England Journal of Medicine, called the policy “unfair and unwise” in a recent editorial. Dr. Anthony Fauci, a top official at the National Institutes of Health, has said that isolating health workers who aren’t displaying any symptoms is “draconian.” The Association for Professionals in Infection Control and Epidemiology, the leading group for doctors working to combat contagious diseases, has emphasized that these quarantines are totally unnecessary because Ebola is not contagious when people are not displaying symptoms.
Rising toll from indirect effects of Ebola
UNMEER also reported a growing incidence of families leaving their quarantined homes due to lack of food and non-food items, but did not provide further details. It said that the World Food Program (WFP) has been distributing one-month rations to quarantined household and communities in the hard-hit area of Waterloo, in the outskirts of Freetown, where 80 percent of people in need have already received rations.
The warning by the UN agency came as Madina Radman, Sierra Leone’s Deputy Minister of Health, said Ebola had so badly damaged public trust in the West African country’s health system that many people were dying from other diseases as the sick refused to come to clinics for treatment. She said the country’s failure to clearly separate its Ebola treatment centers from its regular health facilities had destroyed confidence in hospitals and clinics.
“We are struggling to regain confidence in our health facilities because of this mistake,” Radman said at a WHO conference in Benin. “About 50 percent of the deaths in the country are not Ebola but, because people fear to come to some of our healthcare facilities, they die needlessly in the community due to other treatable diseases.”
The rise of new cases in Sierra Leone is particularly startling because its population of 6 million is about half the size of Guinea’s 12 million. Liberia, with the smallest population of the three countries with 4.2 million people, has been hardest hit overall, suffering more than half the estimated 4,800 deaths in the outbreak.
Possible resurgence of Ebola cases in Guinea
In another grim reminder that the crisis is far from over, recent reports from health agencies on the ground in West Africa suggest the outbreak might be escalating again in Guinea, where the first case of the virus was confirmed nearly 8 month ago. Several times throughout this outbreak, including twice in Guinea, officials have thought the disease’s spread was slowing, only to surge again later.
Marc Poncin, response coordinator for Doctors Without Borders in the Guinean capital of Conakry, recently told NPR’s “Goats and Soda” that the epidemic had “re-launched” with “a much higher number of cases compared to the first and second peaks” of the outbreak during the spring and early summer.
“Since mid-August we’ve seen a regular increase of cases each week … The epidemic is now covering 14 districts out of 33 in the country. Some of those districts are highly affected,” Poncin said. “We don’t know if we’ve reached the peak.”