Sierra Leone's government placed the country's six million residents under a three-day lockdown this past weekend, barring them from leaving their homes under threat of arrest in an effort to curb the spread of Ebola in the West African nation.
Reports from the capital of Freetown described an eerie calm in the normally bustling city as health teams worked their way door-to-door through neighborhoods in search of unreported cases — an effort that successfully produced a spike in the number of reported potential cases that approached nearly 200 percent in parts of the country.
The stay-at-home period began on Friday and ended on Sunday. It was the second time the country had implemented such a measure since the hemorrhagic fever first crossed its borders from Guinea last May, infecting nearly 12,000 people in Sierra Leone over the following months. Officials and health workers feared that public awareness of the threat had diminished, and launched the campaign to uncover hidden and unreported cases of the virus while boosting community outreach.
"Since we had recognized a complacency with the general population… the stay-at-home campaign was needed," Roeland Monasch, the UNICEF representative in Sierra Leone, told VICE News. He explained that the endeavor sought to convey that the crisis was "not over yet."
The western portion of the country, where Freetown is located, saw an uptick in reported cases of 191 percent, while the rest of the country saw an average increase of 50 percent,according to Reuters. There have been 435 reports of illness since the campaign began, with more than 200 being deemed suspected cases.
Testing of samples from these potential transmissions is expected to yield results Wednesday evening. Four cases were confirmed on Monday and another two on Tuesday, while more than 170 came back negative — many of these will be put through another round of testing, as is typical for suspected patients.
Regardless of the test outcomes, Monasch said that the increase in reported cases reflected the success of the lockdown initiative, adding that it "shook up the population a bit" in terms of rooting out possible infections that the authorities had missed.
Sierra Leone's National Ebola Response Commission issued a report on Wednesday evaluating the lockdown, noting that the number of calls to the country's emergency response system regarding sickness and death "increased drastically," going up 79 percent from the previous three weeks.
New transmission rates were down from 248 cases in the first week in January to 33 in the week leading up to March 15. Monasch explained that the most important indicator is the number of cases coming from previously known infections involving individuals who were registered contacts of a patient and contract the virus, rather than those who fell ill without any known interaction with a contact.
Kayla Laserson, an epidemiology team leader for the US Centers for Disease Control in Sierra Leone, told VICE News that the drop in transmission rates showed improvement. She also highlighted the fact that relatively few cases have been confirmed after the lockdown.
"This situation in Sierra Leone continues to improve — for the past week there have been less that 5 new confirmed cases per day, whereas a few weeks ago new cases per day were in the teens," Laserson said.
The decline in cases has been sufficient enough to prompt authorities to begin what the World Health Organization describes as the "safe decommissioning" of treatment facilities. But considering that 84 percent of the new cases came from a known contact — up from 67 percent the week before — Monasch said that "surprise cases" remain a concern.
"Our worry is there is still a minority — 20 percent — of new cases where we haven't heard of these people before," he said. "If you want to fight Ebola, you have to reach these people and their contacts."
Public outreach was another main initiative of the lockdown, which went hand in hand with the uncovering of cases and the tracing of contacts. Reaching the last holdouts and educating them on the importance of awareness and reporting illnesses is crucial. Monasch noted that the social mobilization aspect of this campaign differed from the initial lockdown last September. The first stay-at-home order focused on educating people about Ebola, while this time the focus was on complacency and uncovering cases.
Lockdown orders disrupt the day-to-day affairs of the populace and are not taken lightly by the government. The level of intrusiveness was evident in episodes of unrest over the weekend. Reuters journalist Umaru Fofana reported that police deployed tear gas on the outskirts of Freetown and described civilians fighting over food. Freetown police denied spraying tear gas during the lockdown.
As Sierra Leone works to eliminate Ebola, the country is also focused on the eventual re-opening of schools, which have been postponed until April 14. Classes are back in session in Guinea and Liberia, which were both also hard-hit by the virus.
Teachers are currently being trained in Sierra Leone and officials are working to ensure that campuses are equipped with supplies and prepared follow infection control guidelines. Another focus is cross border control, especially where hot zones align along the porous border between Guinea and Sierra Leone. Guinea took action to shut its borders this week, while key players in all three countries have been working together to ensure measures are in place in recent months.
Meanwhile, Monasch is encouraged that cooperation and commitment between the government, international NGOs, and community groups has remained strong.
"People are realizing that they can't relax," he said.
Follow Kayla Ruble on Twitter: @RubleKB