COVID 19 RESPONSES IN ACTION: THE PROSPECTS AND CHALLENGES IN SIERRA LEONE

By Abu Conteh and Joseph M Macarthy (Sierra Leone Urban Research Centre, a member of the ARUA Africa Network on Urbanization and Habitable Cities)

As at Monday, 20^th April, Sierra Leone had a cumulative total of 43 cases of corona virus. This might seem very small when compared to other countries, but it has wider implications for the country’s economy and the health of the population – especially the urban poor who toil daily for their living. Since 31^st March when Sierra Leone experienced the first Covid-19 case, there has been continual fear and anxiety among the population. This is so because of the swiftness with which the virus has been spreading and the gloom associated with it. As the COVID-19 continues to distress the world, there is fear that its impact on poorer nations will be more devastating especially in countries with weak public health systems.

Even before experiencing its first positive case, the Sierra Leone government had established a health emergency response machinery for Covid-19. This outfit has been working assiduously to not only prevent the spread of the disease through taking proactive measures (e.g. border closure, travel restrictions, lockdown, curfew etc.) including enforcing personal protection procedures (e.g. washing of hands, use of hand sanitizers and face masks), but by also putting in place the needed public health infrastructure to respond to the pandemic. At the time of taking these actions, Sierra Leone was only one among a few countries in West Africa that had not recorded a case. The government also declared a state of emergency on March 24 to allow the country to apply extra measures to control the spread of the disease.

The first index case was a Sierra Leonean national who had returned from France and was kept in one of the quarantined centres near Freetown. Initially, health workers only tested people who showed symptoms before they complete their quarantine stay. With this approach, there were risk of people discharged from quarantine centres (after 14 days) without showing signs to aid the spread of the virus. For example, the country’s index case had already been released from a quarantine centre before he was discovered positive. This was only after he insisted on getting tested since he did not feel too okay.

Has Public health response been adequate?

There is widespread displeasure about the way quarantine and contact tracing are been managed by the health authorities. Most people tend to link the ineffective quarantine management procedures to the steady increase in the number of cases barely two weeks after the first case was recorded.  The president himself in a recent press conferences on 8^th April acknowledged some of the challenges faced in the Covid-19 response process.

As the country’s confirmed cases rises, there are concerns that the government may not have sufficient capacity and resources for effective case management. It is even assumed that fewer lessons were learnt from the EVD epidemic for the Covid-19 response to leverage on.  The government recently admitted that the country has limited bed capacity and testing labs. Regarding this, the key questions are: what will happen if the country begins to record high number of cases? Will there be adequate safety for the health workforce, patients and their communities? These are questions that require immediate answers to ensure that the country’s response capacity is not overwhelmed.

Socio-economic Impact of public health response

There have been several measures to prevent transmission of the virus including a ban on religious worships, a nationwide lockdown, inter-district travel restrictions and a nationwide curfew (from 9pm to 6am). These measures are intended to promote social distancing, trace contacts and restrict movement of potential contacts. The government estimates that these measures have been successful so far.

Freetown residents in search of water during lockdown in April

(Source: SLURC Field Study 2020)

However, there has been some unintended consequences. For example, some religious worshipers argue that places of worship are much safer than the entertainment centres that are being allowed to run. Other criticisms relate to loss of livelihoods which affect many people who rely on small-to-medium businesses like bars, shops, food stalls etc. There is yet no published estimates, but job losses may run into thousands. Cost of local foods have increased including those transported from the provinces. There is a stringent electronic pass system for transporting food items between districts, but this is reportedly being corrupted by drivers who transport passengers instead. Similarly, the varying levels of inequality, poverty and vulnerability of many Freetown residents were laid bare during the recent lockdown period with residents in slum-like informal settlements scrambling for water despite the social distancing rules.

Fake News

At the heart of the Covid-19 pandemic is the role of social media which has proven to be both a blessing and a curse.  Social media is not only the source of fake news which causes fear and unease among the Sierra Leone public, but It has also led to doubts about the disease. Similar to what happened during the 2014 Ebola outbreak, social media risks skewing vital public health messages into mischief. Nevertheless, social media is also used by the government to share updates on confirmed Covid-19 cases with added information on quarantine measures and contact tracing. There are concerns however that this form of health messaging may already be causing information drought to the digital illiterate.

Conclusion

Sierra Leone is very vulnerable to the risk of Covid-19 because of its weak economy and health system. The pandemic has shown multiple layers of vulnerability including poverty and inequality. If these issues are not tackled, they might worsen the impact of the outbreak on poor and vulnerable city residents. While the government’s measures are important to reduce the spread of the disease, they must be pro-poor to reduce existing levels of inequality.

Further readings

Covid- 19 – the experience of living a pandemic rather than researching one https://www.ids.ac.uk/opinions/covid-19-the-experience-of-living-a-pandemic-rather-than-researching-one/

The views expressed in this article are those of the author(s) and not necessarily those of the Centre for Housing and Sustainable Development or the University of Lagos, Nigeria