Exactly 530 days after the first person died from Ebola in Sierra Leone, the World Health Organization (WHO) declared on Saturday that the West African nation is now officially free of the virus.
After nearly 18 months, almost 4,000 deaths, and more than 8,700 infections, Sierra Leone has now gone 42 consecutive days without an active Ebola case inside its borders. Ebola has a 21-day incubation period, and WHO requires two full incubation cycles without a new infection in order to consider the spread over.
"The World Health Organization commends the government of Sierra Leone and the people of Sierra Leone for the significant achievement of ending the Ebola outbreak," Anders Nordstrom, WHO's representative in Sierra Leone, said during a formal ceremony on Saturday announcing and commemorating the milestone.
Nordstrom highlighted the actions that helped stem the spread of Ebola in West Africa, which he noted was the largest Ebola outbreak ever — both in scale and magnitude. The transmission began in Guinea in December 2013 when a 2-year-old boy is believed to have contracted the disease from a bat. WHO declared the outbreak in March of 2014, with the virus spreading into neighboring Liberia and Sierra Leone soon after. The virus has since infected more than 28,000 people in the three countries, with the death toll surpassing 11,000.
Sierra Leone marked Saturday's milestone with a formal ceremony attended by government and WHO officials, including President Ernest Koroma. Beyond this event, the country will not hold any elaborate celebrations as it is still reeling from the impacts of the public health crisis, according to Tunis Yahya, spokesman for the National Ebola Response Center (NERC).
'Ebola changed who we are as Sierra Leonians, it changed our way of life.'
"Ebola changed who we are as Sierra Leonians, it changed our way of life, what we are used to, we had to drop our warm nature of caring," he said. "So for us it is really a proud moment that we were able to gather together as a nation in unity to fight [the virus]."
As Yahya explained, the outbreak forced people to halt long-held traditions like shaking hands, burial practices that involve touching and washing corpses, and general close contact with others. Ebola carries symptoms like fever, vomiting, and eventually hemorrhaging, and the disease is spread through direct contact with bodily fluids of someone who is positive for the virus.
Local governments struggled to contain the disease in the early months of the outbreak, and many have slammed the international community for being too slow to act. While the outbreak was officially declared in March of 2014, WHO did not deem it a public health emergency of international concern until August, and response efforts from international governments did not really materialize until September and October.
During the height of the outbreak in August and September, the countries were recording hundreds of cases each week. Medical centers overflowed with patients, forcing terminally ill patients into the streets.
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The British government spearheaded the response in Sierra Leone. According to a recent study by infectious disease expert Adam Kucharski and the London School of Hygiene and Tropical Medicine, the UK supplied some 2,700 beds to facilities throughout the country, preventing 57,000 cases from ever occurring and therefore saving an estimated 40,000 lives. Had this been done just one month earlier in August, however, the study found that the number of cases in Sierra Leone over the past 18 months would have been cut in half to just 7,500 total.
"Our results highlight the importance of a swift, comprehensive response when dealing with a new outbreak," Kucharski said. "The early addition of beds could also have helped reduce the resources required in future."
Sierra Leone's government and international organizations will maintain heightened border control measures as Guinea continues to see a small number of new cases, with one reported in a newborn this week. Safe burial practices introduced during the outbreak will be phased out, according to NERC's communications coordinator Tunis Yayah, but will continue to be used for suspicious cases.
Yayah said the government will be working with Ebola survivors, particularly as research has found that the virus likely remains in a survivor's semen for up to nine months. Prior to the 2014 outbreak, experts believed this period only lasted 90 days. The US Centers for Disease Control and Prevention now recommends abstaining from sex or using condoms after Ebola recovery until patients receive two negative semen test results. Yayah said they are helping administer these tests to survivors and educating them on using condoms.
Similarly, there are thousands of survivors in the country who now need special medical care and attention to address the lasting impact of the hemorrhagic fever, which doctors are only now beginning to understand. The largest outbreaks previously saw just a handful of people who survived Ebola. As a result, the plight of survivors — who experience joint pain, vision problems, and psychological impacts such as flashbacks and depression — was largely unknown. Like Liberia and Guinea, Sierra Leone has established survivor clinics to continue treating and caring for these individuals.
Moving forward, Yayah said the rest of the world should recognize that Sierra Leone is now free of Ebola and travelers are not at risk for contracting the disease. The country's economy took a hard hit during the outbreak, particularly as fear of the virus caused airlines to cancel flights and businesses to halt activities.
"This country is now free from Ebola transmission… all the business that got shut down need to start coming back, the airlines need to start running again," he said. "We just want the world to know we are safe and open for business again."
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