From the Editor’s Keyboard

Risk Management in Public Health Emergencies

1 April 2020 at 19:32 | 591 views

Risk Management in Public Health Emergencies: How Lessons from Ebola Come in Handy for Sierra Leone

By Mustapha Wai, CPA, Dumfries, Virginia, U.S.A

The first confirmed case of Ebola in West Africa was reported in Guinea on March 24, 2014. The case was mysteriously traced to a 2-year-old boy who had died on December 6, 2013. The boy died just a few days after falling ill in the village of Guekedou. Within a week, the boy’s mother, his 3-year-old sister, and his grandmother all died one after the other. All of them showed symptoms of fever, diarrhea, and vomiting, but no one knew what had befallen them. Two mourners who had attended the grandmother’s funeral took the virus home to their respective villages, infecting relatives and healthcare workers.

On March 24, 2014 — three months later — the strange sickness was confirmed to be Ebola. By that time, dozens of people had died in and around Guekedou, and suspected cases were beginning to emerge in the south-east neighboring country—Liberia. To the south across the border in Sokoma village, Sierra Leone, lived a traditional healer—whose healing powers were well known across border towns in Guinea and Sierra Leone. As the outbreak continued to spread in Guinea, desperate patients struggling for their lives reached out to her for cure. The healer reportedly traveled across the border to Guinean villages where she treated patients. In the event, she became ill and died. Upon her death, hundreds of mourners reportedly came to her burial from nearby towns. Unknown to them that she had died of Ebola; many participated in the traditional burial rituals including touching of the corpse.

Although the virus had been spreading in neighboring Guinea for months, many died in Sierra Leone before the first case was confirmed on May 25, 2014. A young woman who had been admitted following a miscarriage tested positive for Ebola. By October 2014, infection rates had risen to as many as 5 cases per hour in Sierra Leone. Initial calls on Government to act fell on deaf ears as conspiracy theories about the outbreak spread unabated. The window of opportunity to prepare for and contain the outbreak before it got out of hand had been lost.

With the current global Coronavirus outbreak, the narrative for Sierra Leone — one of eight countries in Africa yet to report a confirmed case of the virus is evidently different this time. Three nights ago, in Bo, Southern Sierra Leone, an internal memo from local health officials reporting on a suspected case after a recently traveled patient had shown symptoms consistent with Coronavirus was leaked to the public. The patient, whose personal identifiable information, including address was included in the memo went viral in a matter of minutes. In about thirty minutes later, reports came from Bo that activists in and around the community where the patient’s home is located had mobilized and mounted checkpoints urging each incoming and outgoing person to get their temperature screened and hands washed. By the next morning, the Ministry of Information had put out a public statement reporting that the patient in question had tested negative for Coronavirus. This is the extent of public alertness, awareness and readiness to tackle the Coronavirus in the former Ebola-ravaged country. While some critics argue that Coronavirus outbreaks in African countries are not being reported correctly because testing is not being done, this does not appear to be the case — at least not for Sierra Leone.

In fact, evidence of readiness is not only observed among the public, but also evident is the preparedness of the government to respond timely and appropriately in the event of an outbreak. On reports of a suspected case in neighboring Guinea on February 4, 2020, measures were immediately put in place at the national airport to screen all incoming passengers. On March 18, 2020 information about an Italian man with the family of four onboard a Kenya Airways flight bound for Sierra Leone had manifested signs consistent with symptoms of Coronavirus mid-air. The information which was reportedly leaked while the flight in question was in transit in Liberia quickly made rounds on social media and went viral—putting airport and health officials on ground in Sierra Leone under pressure and alert. By the time the flight arrived, measures were put in place to screen and quarantine all passengers onboard the flight for fourteen days. On March 19, 2020 all flights to and from Sierra Leone were grounded effective immediately until further notice. On March 24, 2020, the president of Sierra Leone, Julius Maada Bio passed a Public Health State of Emergency to pave way for appropriate preventive and/or response measures to the Coronavirus.

Today, the Sierra Leone Government has closed all land border entry points with neighboring countries. In addition, former Ebola response personnel, including response management team, physicians, contact tracers and burial teams have been activated and refresher training is currently underway according to reports.

While these measures have not gone without some challenges, government’s response to these challenges have been nothing but a notable commitment to improve the overall prevention and response framework. From dealing with the challenges of improving surveillance, care and living conditions of incoming travelers currently in quarantine, to promptly responding to and addressing misinformation in the media, officials have been on their toes working hard to stay ahead. All these alertness, awareness and preventive measures have been put in place in a country with no reported case of Coronavirus. Defying all odds and pessimism about the preparedness of African countries to manage a Coronavirus outbreak, Sierra Leone has wasted no time in tapping into the lessons learned from the Ebola crises.

Key notable lessons include the need to quickly build public trust from the unset, impose relevant restrictions within the legal framework, establish capable and appropriately located isolation and treatment centers, deploy adequately trained and equipped response team, and design and implement effective internal controls in the response management process. The next volume in this series will examine each of these lessons; the risks inherent in them; and how other countries— including the United States of America which has not experience such an outbreak in recent times — can learn from the lessons and leverage underlying best practices.