IN THE LONG RUN, THE ONLY THING THAT REALLY MATTERS in countries with Ebola circulating in the population is shutting down transmission.  After a continuous drop in the number of new cases per week since November 2014, we have now witnessed, for the past six weeks, a rate of spread that exceeds that of a majority of previous outbreaks.

In January 2015, Sierra Leone eased travel restrictions, and In February 2015, Liberia lifted the curfew, and re-opened its borders to Sierra Leone.  According to experts, people are becoming complacent.  Unsafe burials are being resumed.  People are letting their guard down.  Cultural norms like handshaking and hugging are more commonplace.  Instead of heading to Ebola Treatment Units for isolated health care, people are heading to regular hospitals.

There are hotspots to the east and west of Freetown in Sierra Leone.  Unfortunately, the practice of sick people hiding, and cultural misunderstandings on the nature of the illness, including belief that the disease symptoms are a result of a curse or a demon, continues to allow the virus to spread.  This renewed wave came from fisherman returning from the sea, and sharing a community toilet.  They had initially sought aid from traditional healers.

Sierra Leone has over 12,000 orphans from the epidemic.  Throughout West Africa, the CDC moved into a new phase of contact tracing as their primary mode of defense.  The UK had declined involvement of the US Army, and it is uncertain as to whether formal restrictions such as curfews and cordoned off “Ebola Resilient Capacity Zones”, which when isolated could be designated “Ebola Free Zones”.   This tactic has proven successful in other outbreaks such as the H1N5 influenza outbreaks in Egypt, Indonesia and Vietnam: it’s just easier to manage smaller, isolated geographic sections.  You can read more about this approach, and how policy decisions influence transmission risks in “Ebola: An Evolving Story” (World Press, 2015).

Hopefully the international community with step up their response and involvement.  Canada ceased their recruitment of new health care workers to help in Sierra Leone in early March.

With the uptick in cases, US pharmaceutical companies testing vaccines and treatments may have larger numbers of patients to enroll in their ongoing clinical trials.

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