STAT News: Addressing the Ebola epidemic

23 May, 2019

The extracts below from STAT News illustrate some of the many complexities of how to address the ongoing epidemic. Full text: https://www.statnews.com/2019/05/22/the-ebola-containment-effort-is-stru...

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By HELEN BRANSWELL @HelenBranswell MAY 22, 2019

With Ebola response teams struggling to contain the outbreak in the Democratic Republic of the Congo, the World Health Organization and its partners can make changes to shore up their effort and try to prevent the crisis from escalating further, according to a handful of experts surveyed by STAT...

“I don’t think there is a good record of what’s going on. I don’t think there’s a good database,” said Dr. Pierre Rollin, a veteran Ebola responder who retired earlier this year from the Centers for Disease Control and Prevention. “We’re just driving in the fog because we don’t have good data.”

Every single previous Ebola outbreak was stopped using the same techniques: find the cases and isolate them so they cannot infect more people. Figure out with whom they’ve had contact and monitor those people daily. If any of them become ill, isolate them and find their contacts. Bury the dead safely, so that funeral rituals don’t end up infecting more people...

“I think there is very likely a large pool of unrecognized transmission out there and unidentified patients,” said Dowell, who worked for decades for the CDC and has worked a number of Ebola responses. “And it’s uncertain just how big that pool is. And also uncertain to me about whether the current response can get on top of it, which is really worrisome.”...

The delays in getting test results are also discouraging people from coming forward to be tested, said Dr. Axelle Ronsse, an emergency coordinator for the Belgian branch of Doctors Without Borders. Test results can sometimes take two or three days...

ETCs, as they are called, have become a place of stigma, associated with death. In fact, people who seek care in treatment centers quickly after the onset of symptoms have a higher chance of survival than those who eschew the centers — but that reality has not been recognized in the affected communities.

Doctors Without Borders has proposed that some hospitals in the outbreak zone be trained to treat Ebola patients safely — without posing a risk to their other patients — because the reality is that many people with Ebola symptoms turn to clinics or hospitals rather than ETCs.

Likewise, the group has urged the health ministry to consider allowing for some home care of Ebola patients, even suggesting that experimental Ebola drugs might be administered by a team of visiting health workers to some patients being cared for at home.

Ronsse said ETCs should remain the primary sites for care of Ebola patients. But with so many patients refusing to go for to them, finding ways to minimize the risk these patients present to the health workers who care for them in hospitals or family members in households could help reduce transmission...

Likewise, Ronsse said home care — which would involve training family members to take precautions and giving them protective equipment and cleaning materials — is not something that could be done on a large scale. “It’s really for the people who would not accept to come to the center,” she said.

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Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org