While infection rates for the Ebola virus seem to be on the decline in Liberia, the World Health Organization's most recent situation report on the ongoing outbreak in West Africa confirms fears that cases are on the rise in Sierra Leone.
In just the past 21 days, Sierra Leone registered 1,174 confirmed, suspected, or probable cases of Ebola, while Liberia tallied 398, and Guinea registered 256. According to WHO, "intense transmission" in Freetown is a contributing factor to the rise. The capital city reported 115 cases in the last week.
The continued outbreak in the northern district of Koinadugu, which until October had managed to keep the deadly virus at bay with a quarantine policy, is also cause for concern. According to the Red Cross, more than 60 people in Koinadugu have been infected by the virus.
Kathryn Jacobsen, an epidemiologist at George Mason University who has worked in the field at the Mercy Hospital Research Laboratory in Sierra Leone, told VICE News that the outbreak was likely spread through a traveler from another part of the country.
"The new outbreak of Ebola reported in Koinadugu, in northern Sierra Leone, is a reminder that Ebola is not uniformly occurring across Guinea, Liberia, and Sierra Leone," Jacobsen said. "There are some places where the Ebola infection rate is relatively high, and there are some communities that have not yet been directly affected by Ebola."
This is not a new twist for the outbreak that kicked off in the Guinean prefecture of Guéckédou in December and has since killed at least 4,818 people. As the spread of the virus began to spiral out of control in Guinea, it quickly spread to Liberia in March, and landed in Sierra Leone by the end of May.
While cases in Liberia slowed for much of April and May, there was a resurgence in June. But even as cases showed up in the country's capital city of Monrovia, as of July it was Sierra Leone that was witnessing the brunt of the outbreak, along with bubbling civil unrest. By the end of July, the number of cases in Sierra Leone surpassed those in Guinea. By the time the WHO pushed Ebola response efforts to the forefront in August, the world's attention was fixated on the dire situation in Liberia, where hospitals became overcrowded and cases of infection soared.
And with Sierra Leone now facing rising infection rates, other problems — including food shortages — are surfacing as well. Aggressive quarantines are in place in cities and towns throughout the country, but thousands of people have had to violate the orders to find food, according to the Disaster Emergency Committee.
"The quarantine of Kenema, the third-largest town in Sierra Leone, is having a devastating impact on trade — travel is restricted so trucks carrying food cannot freely drive around," a statement from the Disaster Emergency Committee said. "Food is becoming scarce, which has led to prices increasing beyond the reach of ordinary people."
As food becomes a growing concern, Jacobsen said it is also important to ensure that healthcare workers, as well as ambulance and burial teams, have access to personal protective equipment, and receive proper training in order to stay safe.
As the WHO pushes its 70/70/60 plan — which sets a goal of treating 70 percent of patients and safely burying 70 percent of victims within 60 days — getting Sierra Leone's new surge in Ebola cases under control is imperative.
"The Ebola crisis that's affecting Sierra Leone, but also Liberia and Guinea, is so enormous," Save the Children head Justin Forsyth told the BBC. "We're in a race against time to make sure we can prevent it spreading but also to treat people who have got Ebola and to build on for the future."
Save the Children and the UK's Department of International Development will run the new Ebola treatment facility set to open in Kerry Town, Sierra Leone. The facility will have 92 beds, and is one of six that will be built over the following months to help tackle the Ebola outbreak, eventually adding a total of 600 beds.
Headway on the new facility comes as Australia changed course Wednesday, agreeing to help run one of the British field treatment centers and send hundreds of volunteers to Sierra Leone. The country has avoided sending manpower to the region, despite requests from Doctors Without Borders (MSF). In early October, MSF actually rejected financial support offered by Australia, asking for healthcare workers instead. Last week, Australia shut its borders to travelers from Ebola-affected countries
In a statement on Twitter today, MSF said it "welcomes" Australia's decision to "ramp up response efforts to the Ebola outbreak."
"Due to the unpredictable and unprecedented nature and scale of the Ebola epidemic in West Africa, we urge all responders that their intervention must be flexible and capable of responding to changing conditions and requirements on the ground, including the possibility of increasing their contribution," the statement read.
Also on Wednesday, President Barack Obama sought more than $6 billion in emergency funds from Congress to fight Ebola in West Africa and prevent the virus from spreading to the United States.
Follow Kayla Ruble on Twitter: @RubleKB