World Health Organisation rings Ebola alarm bells for Kono district in Sierra Leone

Sierra Leone Telegraph: 11 December 2014

Ebola riotingToday’s report by WHO on the true extent of the Ebola crisis in Kono district, must send shivers down the spine of government officials and health workers in Sierra Leone.

There are fears that hundreds of people may have died of the virus in remote villages of the district, far removed from the single, overwhelmed hospital that serves the entire district.

Investigators sent to Kono by WHO and CDC were horrified at what they saw in those villages.

“In eleven days, two teams buried 87 bodies, including a nurse, an ambulance driver, and a janitor drafted into removing bodies as they piled up at the only area hospital, ill-equipped to deal with the dangerous pathogen.

“In the 5 days before the team arrived, 25 people died in the hastily cordoned off section of the main hospital serving as a makeshift Ebola holding center. As of 9 December 2014, this district of over 350 000 people officially has 119 reported cases.”

On the 25th May 2014, when news broke of the first Ebola deaths in Sierra Leone, it was WHO that made the announcement, that it had been notified “on May 25, 2014, of an Ebola virus disease outbreak in Sierra Leone. Preliminary information received from the field indicates that one laboratory confirmed case and four community deaths have been reported from Koindu chiefdom.”

By Wednesday 6th August 2014, Ebola was beginning to spread exponentially throughout Sierra Leone.

ebola victim - APDespite the massive under-reporting and massaging of the Ebola figures by the government, a total cumulative confirmed cases of  623 were recorded in Kailahun 364, Kenema 218; Kono 1; Kambia 1; Bombali 5; Tonkolili 1; Port Loko 8; Pujehun 2; Bo 12; Moyamba 4; Bonthe 1; Western Area Urban 6. And Koinadugu district claimed by the government as the only district that had not registered any confirmed cases of Ebola in Sierra Leone.

But by 29 September 2014, the number of cumulative confirmed cases in Sierra Leone had trebled to 2,095, with the number of cases rising to 18 in Kono district.

And by 31 October 2014, this figure had more than doubled in Kono to 39 cumulative confirmed cases, in line with the national trend, which had seen the number of cumulative confirmed cases doubled to almost 4,000.

On the 30th November 2014, the total number of cumulative confirmed cases in Sierra Leone had again doubled to almost 6,000, with Kono recording more than double the previous month, with a cumulative total of 88 cases.

And by yesterday, 10th December, the total number of cumulative cases in Kono had risen to 123.

So what is alarming different about the crisis in Kono district, from what is happening in most of the other districts, especially in the north and the capital Freetown?

This is WHO’s report:

Racing to fact check an ominous spike in Ebola cases from the remote diamond district of Kono in eastern Sierra Leone, bordering Guinea, a World Health Organization rapid response team found a worse-than-expected scene.

WHO and the U.S. Center for Disease Control (CDC) joined forces with the Sierra Leone National Ebola Response Center (NERC) and Ministry of Health and Sanitation (MoHS) to sound the alarm.

And are now rallying all-comers in a massive build up to contain this burgeoning Ebola outbreak, which ran the risk of continuing to grow and remaining hidden as world attention focuses on urban centers.

“Our team met heroic doctors and nurses at their wits end, exhausted burial teams and lab techs, all doing the best they could. But they simply ran out of resources and were overrun with gravely ill people,” explains Dr Olu Olushayo, WHO National Coordinator, Ebola Epidemic Response.

“In districts like Kono, with moderate transmission confined to limited villages and chiefdoms, the best chance of eliminating transmission is through aggressive and comprehensive case investigation and contact tracing,” he said.

Scattered villages in 8 of the 15 chiefdoms are affected.

Reacting on intelligence from the Ministry of Health of Sierra Leone, WHO sent a seasoned field epidemiologist to Kono 10 days ago to tease out whether reported Ebola cases told the whole story.

Cases go unreported for a variety of reasons and are exacerbated when overwhelmed and under-resourced frontline workers are unable to reach remote areas to get the truth from reluctant villagers.

The surveillance officers had no vehicles. WHO and CDC quickly sent more investigators and rugged trucks.

They uncovered a grim scene. In 11 days, 2 teams buried 87 bodies, including a nurse, an ambulance driver, and a janitor drafted into removing bodies as they piled up at the only area hospital, ill-equipped to deal with the dangerous pathogen.

In the 5 days before the team arrived, 25 people died in the hastily cordoned off section of the main hospital serving as a makeshift Ebola holding center.

As of 9 December 2014, this district of over 350 000 people officially has 119 reported cases.

Upon hearing the WHO findings, Dr. Amara Jambai, MoHS Director of Disease Prevention and Control harkened a local saying to describe what remains yet to be discovered, “we are only seeing the ears of the hippo.”

Help is arriving daily. The NERC and MoHS for the Government of Sierra Leone and UNMEER with WHO support are connecting ready-to-help partners, with an all-out multi-agency response to critical needs on the ground.

WHO field staff are sharing their expertise with surveillance investigators, community mobilizers, infection controllers, and coordinators.

The doctors from Partners in Health and Wellbody Alliance who supported the overwhelmed holding center, are willing to stay on board to support care at the source in outlying health posts.

The International Federation of the Red Cross will build a new Ebola Treatment Center on a tight timetable, while they disinfect the hospital with MoHS and create a temporary safe holding unit. The IFRC Kenema Ebola Treatment Center will take Kono patients until these solutions are in place.

CDC has staff on the ground. UNMEER has lent it’s helicopters to the effort in support of the UN family (WHO, UNICEF, UNFPA, WFP, and others) engaged in building up capacity for staff and volunteers through training, materials and logistical support.

International Rescue Committee is supporting infection prevention activities in the district. Funders such as DIFD and USAID are making much of the fast response possible.

The race is on in this frontier fight against the virus, as Ebola responders dash to get ahead of the epidemic rather than chasing its tail.

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