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Sierra Leone Begins 3-Day Lockdown to Fight Ebola Outbreak Lockdown Begins in Sierra Leone to Battle Ebola
(about 11 hours later)
FREETOWN, Sierra Leone — One of the most stringent anti-Ebola measures to date began here Friday morning as Sierra Leone imposed a three-day national lockdown, ordering people off the streets and into their homes in an effort to stamp out the deadly disease. FREETOWN, Sierra Leone — The most ambitious and aggressive government campaign against the Ebola epidemic gripping parts of West Africa began on Friday when Sierra Leone ordered everyone in the country to remain indoors for three days, suspending commerce, emptying the streets and halting this beleaguered nation in its tracks in an attempt stop the disease from spreading.
Police officers patrolled the streets of the densely populated capital, telling stragglers to go home and stay indoors. Volunteers in bright jerseys prepared to go house-to-house throughout the country to warn people about Ebola’s dangers and to root out those who might be infected but were staying in hiding. Calling the struggle against Ebola a matter of life or death, the government mustered police officers, soldiers and nearly 30,000 volunteers to go house to house, hoping to educate the country about the dangers of Ebola and identify people who might pass the disease to those around them.
The normally busy streets of Freetown were empty Friday morning, stores were closed and pedestrians were rare on the main thoroughfares. “Some of the things we are asking you to do are difficult, but life is better than these difficulties,” President Ernest Bai Koroma said in an extraordinary radio address on Thursday night explaining the national lockdown.
The country’s president, justifying the extraordinary move in a radio address Thursday night, suggested that Sierra Leone was engaged in a life-or-death struggle with the disease. From the start, the limits of the government campaign were evident. The warnings, mobilization and exhortations quickly clashed with the reality that cases here are surging and the infrastructure to deal with them hardly exists.
“Some of the things we are asking you to do are difficult, but life is better than these difficulties,” President Ernest Bai Koroma said. There is no large-scale treatment center for Ebola patients in the capital, Freetown, so many patients have to be placed in a holding center until they can transported to a hospital hours away — that is, if an ambulance can be found to pick them up and if those packed hospitals have room.
More than 200 new cases of Ebola have been reported in Sierra Leone in the past week, according to the World Health Organization, with transmission described as particularly high in the capital; nearly 40 percent of cases in the country were identified in the three weeks preceding Sept. 14; and more than 560 people have died in Sierra Leone, about one-fifth of the total from this outbreak. The countrywide lockdown showed the desperation among West African governments — particularly in the three hardest-hit countries, Guinea, Liberia and Sierra Leone — as they grapple with an epidemic that has already killed more than 2,600 people and shows no signs of slowing down.
The campaign that began here Friday morning reflected the desperation of West African governments — and in particular those of the three hardest-hit countries, Guinea, Liberia and Sierra Leone — as they struggle with an epidemic that the health authorities have warned is showing no signs of slowing down. While governments in the region have already cordoned off large swaths of territory in hopes of containing the outbreak, none have attempted anything on the scale of what is being tried here. The government says it wants to visit every residence in this country of about 6 million people, with the aim of instructing people in how to stop the disease from being transmitted and to find out who is harboring sick people, with potentially deadly consequences.
No country has attempted anything on the scale of what is being tried in Sierra Leone, where more than 20,000 volunteers enlisted to help identify households where the authorities suspect people infected with the Ebola virus are hiding. “We have been sending lifesaving messages through radio, TV and print, but it’s not enough,” said Roeland Monasch, a representative for Unicef, which supported the government effort, providing money, advice and information materials. “We need to take information to where people are.”
Yet there were plenty of indications on Friday that the campaign promised more than it could initially deliver in this country of six million people, at least in the capital. In the streets of the capital on Friday, one woman lay curled in a fetal position, eyes shut, precariously balanced on cardboard sheets next to an open gutter in front of locked storefronts. From a wary distance, the anti-Ebola volunteers said she had high fever. Hours of calls had produced no ambulance.
Well into the morning, the house-to-house visits had yet to begin in Kroo Bay, a densely populated warren of iron-roof shanties where roughly 14,000 people live, despite officials saying they would start at dawn. A small crowd, including the police, soldiers brandishing guns, presidential advisers and spectators taking cellphone pictures of the immobile woman, milled about. A medical worker said two more bodies in the vicinity needed attention. But still there was no ambulance.
The neighborhood, a perennial home of cholera outbreaks, sits in a sea of muddy lanes and open sewers in which pigs forage. The police cruised into Kroo Bay on a pickup truck, yelling at lingering residents to go indoors and warning of imprisonment; people simply stared at the officers and continued lingering as the police drove off. “They are not responding; they say they have lots of cases now,” said a volunteer, Alhassan Kamara.
“The policeman is doing his thing, and I am doing my thing,” said Kerfala Koroma, 22, a building contractor who added that he was waiting for his breakfast. “We can’t even afford something to eat on a normal day. How can we get something now?” (Mr. Koroma is not related to Sierra Leone’s president.) Finally, a rickety ambulance pulled up, more than five hours after the initial calls, the volunteers said. But the loosely outfitted attendants refused to pick up the sick woman: they had no chlorine spray and said it was not their job. A loud anti-Ebola jingle played on a car radio. It took a second ambulance, and the president of a moped club who quickly suited up in protective gear, to get the sick woman bundled off to uncertain care.
Residents insisted that there had been no cases of Ebola in Kroo Bay, although there were loud complaints from some that the bodies of victims had been dumped in a nearby cemetery. On nearby streets, other volunteers were going house to house to warn people of the disease’s dangers. Normally clogged streets in the capital were empty, stores were shut down tight, and pedestrians were rare on the main thoroughfares.
As the morning wore on, the house-to-house volunteers began to assemble in a bare-bones community center, with several noting pointedly that they were not being paid. Others stressed the daunting challenge of covering thousands of households with a team of only 50. The senior United Nations envoy appointed to work on the Ebola crisis, Dr. David Nabarro, said he was struck by the yawning gap between the spread of the disease and the ability to fight it. The world needed to increase the efforts on the ground many times over, he said.
By 9 a.m., with two hours of daylight already gone, the volunteers were still being given their marching orders. That would include “the capacity to treat between 9,000 and 10,000 people within the countries at any time,” he said. “To get there, we need to get extra people and cash into the countries, obviously, but also we need fantastic organization and logistics that are second to none.”
“We told them to come at 6:30, but naturally, in this part of the world, people are not too time-cautious,” Sima Conteh, the volunteers’ coordinator, said with a grin. Elsewhere in town, groups of volunteers could be seen sitting on the sidewalk. Dr. Dan Lucey, an American who volunteered in an Ebola holding center at a Freetown hospital, described the situation as horrific. “There were not enough beds, space,” he said. “When you first see this, you say this is totally intolerable. It can’t be this bad,” he said after returning home. “It was an incredible, searing experience not like anything I’ve ever seen.”
Yet some volunteers expressed hope that their efforts would not be wasted. “You have the chance to get the people with the disease out,” said Emmanuel Cole, a 33-year-old taxi driver who said he had refused to take any passengers since the epidemic began, for fear of becoming infected. Without treatment units in the capital, he said, patients who tested positive for Ebola had to be driven at least four hours away. Those who tested negative could be exposed to Ebola while they waited. When Dr. Lucey volunteered, there was just one other doctor present. Patients were housed together in open wards with a plastic curtain between beds, awaiting their test results. At the foot of each bed were three buckets — one for urine, one for stool, one for vomit.
“The country is not moving now. We have got to help the country now,” Mr. Cole said. “It is not a normal time.” “There were body fluids everywhere,” he said. Fuel for the ambulances could be hard to come by. “It’s beyond belief until you see it day after day,” he said.
Dr. Oliver Johnson, a British physician currently working at the hospital with King’s Health Partners, said Friday that the 18-bed unit had received 10 patients during the first day of the lockdown and now had four physicians. He said two new isolation units had opened in the Freetown area in the past several days. “We’re starting to see more beds, more supplies. More staff are coming to work,” he said.
Sierra Leonean health workers, who he said have worked bravely, are now being offered hazard pay. “Things are improving,” he said, but “the real question is whether we can get ahead of the curve. We’ve been seeing more new patients than we’ve been able to build new beds.”
The United States is planning to build as many as 17 Ebola treatment centers in Liberia, with about 1,700 treatment beds, while the United Nations is planning an expanded mission in the region, based in Accra, Ghana, according to Anthony Banbury, the United Nation’s Ebola operation crisis manager. It is intended to be more nimble than the United Nations’ notoriously bureaucratic operations, bringing in as many as 500 trucks and jeeps from other missions in Africa, possibly paying teams in one country to speed up safe burials, buying fuel for monitoring teams in another country, or offering helicopters to transport health workers where they are needed.
But even with the promises of help, international health officials are worried by what they describe as a rapid growth of cases here in Sierra Leone’s capital — a dense urban environment where containment is difficult and the ability to respond is limited.
“The situation in Freetown is very worrisome as cases increase,” said Michael Goldfarb, a spokesman for Doctors Without Borders. “Without an immediate, massive, and effective response, there could be an explosion of cases as has been witnessed in Monrovia,” he added, referring to the capital of Liberia.
Whether Sierra Leone’s lockdown will constitute an effective response is open to question. Despite the mobilization, the volunteers hardly appeared to be thick on the ground. In some neighborhoods, residents said they were yet to see any of the green-vested young men and women who had volunteered.
In other neighborhoods, the volunteers — many of them students, all working for no pay — complained that there was no response to their knocks at most houses. If they arrived without supplies like soap or chlorine, residents were not interested in speaking with them, the volunteers said.
Where there was a response, it was often followed by cursory admonitions to residents to wash their hands, report on neighbors suspected of illness and wear long-sleeve shirts at the market.
At one house, several volunteers talked loudly at once about hand washing, leaving the residents visibly dazed. At another, they were amazed to discover residents who were supposed to be under quarantine because of their suspected exposure to Ebola, but were actually unguarded and free to roam about. At still another, one gave out questionable information about the Ebola virus — seeming to contradict some basic precautions.
Well into the morning, the house-to-house visits had yet to begin in Kroo Bay, a densely populated warren of iron-roof shanties where roughly 14,000 people live, despite officials saying they would start at dawn. The police cruised into Kroo Bay on a pickup truck, yelling at residents to go indoors and warning of imprisonment. People simply stared at the officers and continued lingering as the police drove off.
“The policeman is doing his thing, and I am doing my thing,” said Kerfala Koroma, 22, a building contractor. “We can’t even afford something to eat on a normal day. How can we get something now?”