Introduction

On 31 March 2020, Sierra Leone reported its first case of COVID-19. Meanwhile, the rest of the world was already implementing curfews, quarantines and contact tracing to try and prevent the novel coronavirus from continuing to spread. Sierra Leone was experienced in implementing similar measures, being one of the three contiguous West African countries that suffered from the worst outbreak of Ebola Virus Disease (EVD) in history, from 2014 to 2016. Sierra Leone was finally deemed Ebola-free in March 2016, after 14,124 probable cases and 3,956 deaths out of 11,325 deaths worldwide (CDC, 2019).

Sierra Leone’s experience and lessons learned fighting Ebola are relevant today, as COVID-19 is present in nearly every country on earth. How did Sierra Leone manage to curb the spread of Ebola when the Centers for Disease Control and Prevention (CDC) projected that up to 1.4 million people would succumb to the disease? Not only did Sierra Leone rank 180 out of 187 on the UN Human Development Index in 2014, but it was also ranked among the world’s 10 poorest countries (World Bank, 2011). When Ebola hit, the country had only recently emerged from an 11-year civil war and local trust in the government was low. It had one of the weakest healthcare systems in the world, with an average life expectancy of 52.37 years (World Bank). The number of doctors for the population was dangerously low and rural roads were in such poor condition, with clinics so far away, that it made it nearly impossible for people to seek healthcare – and they might be unwilling to go anyway, given the rumours circulating about Ebola. Some believed that the disease was introduced by the ruling political party to kill their rivals. Others simply believed that Ebola was a death sentence: if you went to an Ebola treatment unit (ETU) you would die and the doctors would not return your body to your family for a traditional burial, despite its cultural importance. The high death rate was also tragically reflected in the number of local healthcare workers who succumbed to the disease: out of the 307 who were infected in Sierra Leone, 221 died (Raven et al., 2018).