The three-day Ebola lockdown
prescribed by the Sierra Leone government from March 27 to 29, 2015, is
the second such in Sierra Leone since the start of the Ebola outbreak
in West Africa. The order was received with little public comment or
debate, although some privately questioned the rationale behind it. The
first such lockdown took place in September last year, and although
government officials deemed it a success they provided no conclusive
evidence to justify this claim. Data from natinpasadvantage (Ebola
Chart)
is inconclusive: it shows the infection rate increasing week on week
almost till the end of the year.There was no sharp spike in the data
in September followed by a fall back, as perhaps might have been
expected if the
lockdown had had a marked effect.
For the current lockdown two separate questions could be asked: Will
the lockdown enable detection of a significant number of infected who
otherwise would not have been detected? And is this the best or even a
cost-effective method of discovering these infected? For the first
question we shall have to wait until the numbers are released by the
authorities. For the second question a few estimates can be made.
The latest figures from the National Ebola Response Committee, NERC,
reveal that there are about 80 Ebola patients currently admitted at
Ebola centers around the country. The latest
(March 25) WHO Ebola update
reveals that there were 144 new infections in Sierra Leone during the
previous 21-day incubation period of the disease. It seems reasonable
to assume then that there could not be more than perhaps 200
Ebola-infected remaining undetected out in the communities. This could
be used as the maximum number that could be detected by the three-day
lockdown. How much will it cost to detect this number?
Let us use only the cost of lost national income and ignore all other
costs, the costs of the "volunteers" employed in community
sensitization, cost of soap, media announcements, security,
international monitors etc, etc. Let us also assume no lost production
on Saturday and Sunday, which are non-working days for much of the
population. Let us further assume a per capita GDP of 400 USD, or about
$1 per day. The cost of the three-day lockdown in lost national income
can then be conservatively estimated at $6 million, assuming a
population of six million. Assuming 200 detected
Ebola-infected, this
gives a cost of $30,000 USD per detected Ebola infected., not including
treatment. This is a hefty cost. Might there be a better way to
do this?
For $6 million, one could employ an army of workers on sensitization,
surveillance and contact tracing for a month. Paying generously, at the
rate of Le2 million per month, one could employ 15,000 workers for a
month, sensitizing, going round communities, tracing
contacts and looking for evidence of unexplained illness or death.
Direct payments to Ebola victims is another possibility. As the
number of Ebola infected reduce, unquestionably, national lockdowns get
less and less effective. They turn into a search for the proverbial
needle in the haystack. The government is holding down the entire
population in search of fewer and fewer targets. More precise methods
need to be employed as the outbreak hopefully draws to a conclusion.