Freetown - Health workers in Sierra Leone began combing the streets of the capital Freetown for Ebola patients on Wednesday, moving house-to-house as the government launched a major operation to contain infection in West Africa's worst-hit country.
President Ernest Bai Koroma said on national television that, as part of "Operation Western Area Surge", travel between all parts of the country would be restricted and public gatherings would be restrained in the run-up to Christmas.
An encounter in the Devil's Hole neighbourhood just outside Freetown showed why the programme was vital. Ibrahim Kamara sat in a discarded vehicle tyre, his eyes glassy and his breath coming in gasps, as he tried to answer questions from Ebola surveillance officers.
"Is the body weak?" a surveillance officer shouted. Kamara, 31, nodded despondently while onlookers gathered round.
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"Vomiting," the officer asked. Kamara nodded again.
Sierra Leone, Guinea and Liberia are at the heart of the world's worst recorded outbreak of Ebola. Rates of infection are rising fastest in Sierra Leone and the country has more than half of the 18,000 confirmed cases of the virus.
House-to-house searches form one part of the month-long push in and around Freetown by the government, a British task force and international groups that aims to make a breakthrough against the disease within four to six weeks.
Kamara's wife, Adama, said they had tried to take a taxi to hospital but the driver made them get out when he discovered her husband was ill.
She said a neighbour died on Saturday from Ebola-like symptoms. Ibrahim had been taking anti-malaria medicine but his condition deteriorated, she said, starting to cry.
With the annual malaria season at its height, aid groups have distributed the free treatment in a bid to prevent people with malaria being misdiagnosed with Ebola, which has similar symptoms.
The surveillance officers wrote down the Kamaras' address and the names of five family members in their household before calling an ambulance. Nearby, a hearse drove by with the slogan 'dust to dust' painted on its back window.
Kamara's diagnosis was unconfirmed, but local chief Alhagi Ibrahim Sesay said Kamara's arrival in the area could mean Ebola has come to Devil's Hole, a community with no previous history of the virus.
"Today, on the day the government starts its house-to-house exercise, this man gives a problem in our area. As head man, I don't want any sick from another community," he said.
Health officials are alarmed by the widespread transmission in Freetown, which is similar to an earlier spread in the Liberian capital Monrovia now slowly being brought under control.
According to a government plan announced this week, health workers will seek victims and anyone with whom they have had contact, transporting those infected to new British-built treatment centres.
"Given the efforts we have undertaken we would expect to see a significant decrease in cases within several weeks," Tom Frieden, director of the U.S.-based Centers for Disease Control and Prevention, told Reuters during a visit to Freetown.
The programme showed some early signs of progress. Russell Macleod, a British military consultant with the surveillance team in the Western command and control centre in Freetown, told Reuters they received a record number of alerts this morning.
By lunchtime, they exceeded Tuesday's total by 50 percent with 140 alerts generated from an Ebola hotline. In response, the live case management team dispatched teams to 52 suspected cases, he said.
As part of the efforts, Koroma said worshipers on Christmas Day must return home after services and other festivities are banned. New Year's Eve services must stop by 5 p.m. local time (1700 GMT), while New Year's Day festivities are prohibited.
"This is the festive season where Sierra Leoneans often celebrate with families in a flamboyant and joyous manner, but all must be reminded that our country is at war with a vicious enemy," he said in his nationwide address.
The government was also imposing a ban on Sunday trading and the end of Saturday shopping at noon, Koroma said. He spoke one day after opening an Ebola Community Care Centre outside the capital.