How Outbreaks Shaped Africa, Before and After: Sierra Leone
By written by Dr Daniel Olaiya on 22nd May 2020
As a frontline doctor based in the UK, I can safely say it is no longer news that coronavirus has been labelled a pandemic. Of particular interest to my team and I at Afrohealth Initiative, is how specific African countries deal with outbreaks. In the first part of our blog series, we focus on COVID-19 in Sierra Leone. This beautiful country is of particular note because of the 2014 Ebola outbreak in Sierra Leone took centre stage.
Sierra Leone has a population of 7.1 million, of which at least 1 million people of the total population lives in the urban environs of the capital City Freetown.(1) Sierra Leone health care system is organised into two tiers of care: Peripheral Healthcare Units (PHUs) with an extended community health programme and secondary care which includes 21 district and three referral hospitals; there are also 45 private clinics and 27 private hospitals, mostly in the Freetown area. (1)
Due to the coronavirus outbreak, Sierra Leone declared a 12 month public health emergency on March 25th(2). On March 31st 2020, Sierra Leone recorded it’s first case of coronavirus as confirmed by its President. The first case was a 37-year-old man who traveled from France on 16 March and had been in isolation since (3). The declaration by the Government, before the confirmation of the first case, indicates the government’s proactiveness towards the diagnosis of the first case of coronavirus on the 31th of March. This declaration also raised public awareness on the reality of the public health challenge.
From the first recorded case of coronavirus in Sierra Leone, steps were taken to minimize the spread of the virus. After the 1st case of coronavirus, the Sierra Leone authorities announced that there would be a 3 day lockdown. Immediately after that announcement, the second case of coronavirus was confirmed on April 1st 2020 (3). On April 4th, two more cases were confirmed and a further two on April 5th bringing the total to 6 (3).
On April 9th, after the end of the 3 day lockdown, the government announced additional measures:
- Restrictions on all inter-district travel for 14 days
- A curfew from 2100–0600 was and still in effect
- Shops are to sell essential items only
- People are to stay at home unless they have good reason not to
- Face masks are strongly encouraged, especially in public places
- Suspended all international flights from March (except for emergencies) (4) (5).
Alongside these social measures, the government also prepared the country’s healthcare system. One of the notable actions by the government was the provision of a coronavirus testing facility in February 2020. Putting that in place made it possible for the government to discover the cases on time and limit its spread. It took 37 days from the first case of coronavirus to reach 231 cases on the 7th of May 2020.(6) Furthermore, the government’s ability to do contact tracing and quarantine those who had contact with confirmed cases is another of the methods that reduced the spread. Proper documentation of those quarantined and infected went a long way for decisive actions.
The lock down order by the government has impacted all sectors of the country, especially the economy. To cushion the economic challenges of the country, on April 2nd, the World Bank approved a $7.5 million International Development Association (IDA) grant to help Sierra Leone respond to the threat posed by the coronavirus outbreak and strengthen national systems for public health preparedness.(7)
It took 37 days from the 1st case of coronavirus for:
- Sierra Leone to reach 231 on 7 May (6)
- Nigeria to reach 214 on 4 April (8)
- South Africa to reach 2028 on 11 April (9)
- Egypt to reach 327 on 22 March.(10)
- Uganda to reach 79 on 28 April.(11)
From the above comparisons, it can be concluded that Sierra Leone is having a relatively average spread rate of the virus and this might be attributed to the fast policies of Sierra Leone government against coronavirus.
“What we have to understand is that in the context of this disease, there is no safe haven irrespective of how sophisticated your health system can be. There are diseases that can create serious challenges to any health system in the world. On such is the coronavirus,”
Logan told Deutsche Welle (DW) media — (Dr. Gabriel Gorbee Logan is regarded as an Ebola hero in Liberia because of his work at the forefront to contain the 2014 to 2016 epidemic).
“The lesson for me is that people need to learn, this time around, that sharing information is key.” Restrictions on the movement of people, especially when high risk destinations are involved, is important too (12).
There are a number of possible futures, all dependent on how the Sierra Leonean government and society respond to coronavirus and its economic aftermath. Hopefully , Sierra Leone will use this crisis to rebuild and continue to evolve. This experience alongside the public health acumen acquired during the Ebola crisis, we hope will allow Sierra Leone to keep Coronavirus from scaling out of control.