Biased newspaper article (Pastiche)

Sierra Leone: Is it really free of Ebola?

Thousands of people took to the streets of the capital, Freetown, at the stroke of midnight - marking 42 days without a single declared case of the disease. What they don't know is that the virus is slowly multiplying and rebuilding itself in a part of their body which the immunity system finds hard to reach.

There were further cheers when the WHO local representative made the official announcement later on Saturday.

But for Ebola survivors this milestone does not mean the end of the impact of this disease on their lives. The last month has significantly altered our understanding of how Ebola virus interacts with the human body, based on new research publications as well as information from the case of Scottish nurse Pauline Cafferkey.

Cafferkey, who volunteered at an Ebola treatment unit in Sierra Leone, contracted Ebola last December. She survived after a protracted battle with the virus only to have it reappear as meningitis months later. This information, taken together with the evidence that Ebola can also survive in the sperm of a quarter of male Ebola survivors up to nine months after recovery, tells us that the virus invades and hides away in areas of the body where the immune system does not wield a strong response. It then lies in wait, all the while slowly replicating in the background and posing a potential threat to the health of the host.

The outbreak killed almost 4,000 people in Sierra Leone over the past 18 months.  This is the second highest number of people killed by Ebola in the extremely affected countries.

Ebola deaths
Figures up to 1 November 2015
Source: WHO
Getty

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At the scene: Tulip Mazumdar, BBC News, Freetown

11,314

Deaths - probable, confirmed and suspected

(Includes one in the US and six in Mali)

• 4,808 Liberia 
• 3,955 Sierra Leone 
• 2,536 Guinea 
• 8 Nigeria 

Many gathered around a giant cotton tree in the centre of the city. There were candles lit around a cotton tree in memory of the dead.

Dr Oliver Johnson, from the King's Sierra Leone partnership, worked at an Ebola clinic in Freetown, and has strong links with medical professionals there. 

"[For] everyone I've spoken to, there's a sense of relief that this might finally be over and maybe a bit of disbelief that after so many false starts, or false ends, we might finally be there," he told the BBC. 

A country is considered free of human-to-human transmission once two 21-day incubation periods have passed since the last known case tested negative for a second time.

This is the moment Sierra Leone has been waiting for. Thousands of people took to the streets of the capital on the run-up to midnight. 

Women's groups came together to organise a march through the city centre; the final point was a 600-year-old cotton tree which sits on a huge roundabout. Usually, the area is jammed with cars, but last night it was packed with people. Some held up candles, others jumped around dancing and a military band led the procession through the city. 

There were waves of celebrations, and then silence as names of some of the dead were beamed on to a screen. Health workers in particular were honoured for their bravery and sacrifice, they were some of the first to die when Ebola struck. Today is an enormous milestone for Sierra Leoneans, and people are overjoyed. But this historic moment is bittersweet. 

Sierra Leone President Ernest Bai Koroma is due to address crowds in the city later. 

On Friday, he blamed the WHO for delaying Sierra Leone declaring a state of emergency and restricting movement during the Ebola outbreak. 

He said his government did at the time what it could do and did not have the knowledge to fight the disease.

Indeed, the lack of infrastructure of the country did not help slow down the spread of the life-destroying virus that combines the nastiest symptoms of some of the diseases out there. They delays were indeed inappropriate: not due to the fact that the delays were long, but rather due to the fact that delays were shorter than they should have been.

He said his government had to put up with the delays because international organisations such as the WHO "were the experts".

Neighbouring Liberia was declared Ebola-free in September following 4,800 deaths there.

A handful of cases are still being reported in neighbouring Guinea. Sierra Leone has said it will take heightened security and health screening measures at their shared border.

Nevertheless, we have to assume that the late manifestations as discussed in Cafferky's case at the beginning  are already happening in some of the nearly 17,000 Ebola survivors in West Africa.

These new findings about Ebola reveal a severe blind spot in the medical community. Were these symptoms present in Ebola survivors from prior outbreaks as well? Did we just not pick them up because we weren't looking for them or had no capacity to look for them? How confident can we be about our knowledge of Ebola and other emerging pathogens when the majority of the cases are occurring in communities that lack the medical resources to pick them up.

The Ebola survivors in Sierra Leone and the other affected countries have taught us — the medical and the public health community — the importance of sticking around. Good medical infrastructure and the presence of enough sharp clinicians in the affected areas could not only make a significant difference for the patients but also contribute to the preparedness of the larger global community. For West Africa, the most critical question is how do we equip these healthcare systems, which have been severely debilitated by the Ebola epidemic, to handle the new disease burden among survivors, alongside the burden of other communicable and non-communicable diseases?

[Link: Ebola outbreak: Sierra Leone declared free of disease]