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Facts not Fear: How do we get the Ebola outbreak under control?

29 Oct, 2014

 

B0009934 Ebola virus structure, illustration

In the second of our “Facts not Fear” posts we ask the experts at the Wellcome Trust about the way the current Ebola outbreak is affecting people and explore some of the options for getting the epidemic under control.

What effect is the Ebola outbreak having on West Africa?

It is having a devastating impact on the whole of the region, and it’s not limited to those infected with Ebola. Malaria will be worse this year, childbirth facilities and schools are closed, and vaccinations of children are not happening in West Africa as well as they would normally. Economies just starting to recover have been dealt a cruel blow with long term consequences and trust will have been eroded between communities and authorities.

These issues are concerning, but we have to have a calm, sensible approach and not panic. We can deal with these issues as long as we retain a sense of proportion and work together. Outside of Liberia, Guinea and Sierra Leone, the spread of Ebola has so far been contained. But we must act now. We have been too slow. The longer we allow this epidemic to continue the harder it will be to eventually control, more lives will be lost, more children left as orphans, the costs will grow and we run the risk of the disease becoming endemic or spreading beyond the region.

What steps have been taken to keep the neighbouring countries safe? Are they prepared to deal with isolated incidents?

They have been preparing for this now for some time. Nigeria was able to control it very efficiently, and Ebola is not present in Nigeria today. The same in Senegal, but all the countries in the region have fragile health systems, and all remain at risk until we bring the epidemic to a complete end.

Preparation across the whole of West Africa is critical, but the best way of protecting it is to focus on the three countries affected, and bring the epidemic to an end in those countries. That will help them, the region and the rest of the world.

Is closing borders an effective way of stopping the spread of Ebola?

Closing borders is not a practical way to control the epidemic. In today’s modern world transport and movement of people and goods occurs at an ever-increasing rate. Few countries are self-sufficient or could manage with closed borders for even a few weeks.

Travel bans are not necessary from an epidemiological perspective and could make matters worse, they will lead to food shortages and block critical aid reaching the affected people, will instill even greater fear that could lead to uncontrolled migration and further spread of the disease.

What about screening at airports? Is that an efficient way to stop Ebola and other infectious diseases spreading?

Every infection is different and for some infections fevers are a good marker of whether someone might be infectious, but for many infectious diseases you can pass it on to someone else before you have a temperature.  With Ebola you are very unlikely to be able to pass the infection on before you have symptoms.

Screening at airports upon entry to a country is not very efficient. It may identify a small number of people and it will increase awareness – making people think twice before they fly if they have a fever – and allow information to be passed on to people (for instance access to clinical care, what to do if they develop a fever, etc) but it won’t solve the problem in itself.

Most people with a fever will not have Ebola and most fevers are minor and cause absolutely no problems. Introducing routine blanket screening for fevers across all airports in the world will increase the level of public fear while only identifying a very small number of cases if any. Screening for a fever at departure from the region and advising home monitoring for fever over the next three weeks does make sense.

What’s the mortality rate for Ebola in this outbreak?

In the current outbreak it is estimated that 70% of those infected by Ebola will die. That is 7 in every 10 people.

Would access to better healthcare reduce the death rate from Ebola in West Africa?

There is no doubt that the current death rate could be lower if the level of healthcare that we are lucky enough to have in developed countries was available.

The death rate in the UK would be significantly lower than it is in West Africa, but Ebola is an incredibly nasty infection and even in London or New York or Geneva, the death rate would still be high just because of how terrible the infection can be. We don’t have a specific treatment for it at the moment, but research is being done to develop one.  Although we don’t have a ‘drug for Ebola’ very good clinical care will reduce the death rate.

In the UK we are lucky to live in a country where healthcare is available and provided free through the NHS. If you compare our situation to the events in West Africa, the fragile nature of their health systems is one of the major contributing reasons for the epidemic.

How close are we to an effective pharmaceutical tool to fight Ebola?

We’re getting much closer, but we don’t know in fact whether ZMAPP works or how effective it might be, although initial reports look encouraging. Convalescent serum (using antibodies from the blood of people who’ve survived Ebola) might offer the best potential treatment for Ebola in the short term that could be scaled up if proven effective.

We need to collaborate, share all information and move quickly on this and other potential treatments, do research to make sure they’re safe, and we need to learn which ones are really effective.

Does the military have a role to play in stemming this outbreak of Ebola – or will their presence just create more fear about it?

It’s a very delicate balance, but when you start to plan logistics, particularly the organisation of getting large amounts of supplies to an area quickly, building hospitals and clinics, delivering aid or vaccines to remote areas when roads are washed away by the rainy season, there comes a point when the essential logistical support needed can only be provided by the military.

What we mustn’t have is military-style responses in terms of guns on the streets. Violence and coercion are not the way to deliver healthcare, but the military could be incredibly helpful in this epidemic to support the critical work done by organisations like MSF, Oxfam, Save the Children and the very brave healthcare workers who are on the front line.

Can we get this outbreak under control?

Yes. If the global community comes together and implements all of the various things we have all committed to; e.g. massive increase in clinical facilities, public health, diagnostics, drugs and vaccines, then this epidemic can be brought under control.

However we do need to bring all of that together in a coordinated way with clear leadership, and for the international community to live up to the promises that have been made. And we need to do that quickly. If we don’t do that, then the epidemic will continue to increase, it could become endemic, and it could spread beyond the three countries currently affected.

What are the key priorities for getting this Ebola outbreak under control?

The international community needs to work together. We need to call upon our governments to work in partnership with the affected countries and mobilise as many resources as possible to provide support. This could include support for public health workers to take leave and volunteer in the affected areas.

Infrastructure is needed on the ground in the affected countries – from beds and protective equipment to soap, chlorine, clean water, and electric generators. Increasing public health infection control measures is key to bringing the outbreak under control, but given the scale of the current outbreak, developing effective vaccines and drugs may also now be essential. Developing a treatment option for those who do get infected will hopefully save lives and will also help increase public trust and may encourage people to seek medical help earlier. This would have a major impact on the epidemic. There will inevitably be future Ebola epidemics and we need to be better prepared for those events.

Is there anything that individuals can do to help?

Yes, there is a huge amount of things we can all do, for example supporting what MSF, Oxfam, Save the Children and others are doing in West Africa, all of that is an enormous help and it’s a fantastic thing to do. The Disasters Emergency Committee launched an Ebola crisis appeal today to raise money to help get this outbreak under control. The UK Government will match the first £5 million donated.

But there are also other ways the situation can be helped – for example encouraging politicians and your MPs to appreciate how serious the situation is. We should also all be responsible about the way we discuss Ebola as a society. For example, there is no need for schools to ban students who have been in a completely different and unaffected part of Africa.

You can read our previous “Facts not Fear” post to find out why this outbreak has been so hard to control. Visit the Wellcome Trust news pages to find out what the Trust has been doing to help fund Ebola research.

Image: Ebola virus structure, illustration Credit: Maurizio De Angelis, Wellcome Images

One Comment leave one →
  1. 5 Nov, 2014 12:09 pm

    In the absence of readily accessible and effective healthcare systems, friends and families of people with a range of illnesses are often required to manage the situation themselves. Coming into direct contact with a sick friend or relative is almost inevitable given the basic human desire to offer compassion, warmth and soothing physical gestures in the face of declining health. But compassion carries significant risks in terms of ebola, depending on how long will people wait until they release their ill friends and relatives into a health care system they may know little about, may have limited access to, or may mistrust. We know that (in terms of e.g. malaria), if costs are involved, guardians may put off that trip to the clinic until symptoms worsen.

    The NHS is not free. It is ‘free at the point of care’ to allow people to walk in and not sign a financial contract to receive treatment. There are always associated costs. People within walking distance or travelling by ambulance don’t pay to get to an NHS facility, otherwise they pay to either travel by public transport or pay to park (and pay for petrol). They may pay in terms of taking time off work and taxpayers pay through taxation.

    So how can we ensure that health sufficiently robust systems are made available in the affected countries at zero actual cost to the patients and their guardians and which work to mitigate the risks associated with cultural aspects of helping the sick or dealing with the recently deceased? Scaling up the delivery of infrastructure will help, but there is no guarantee that if a hospital is built that the people will come. Especially if there is no equivalent of a 999 ambulance service for all affected people, effective triage that people have complete confidence in to separate confirmed cases from malaria and other infections. And of course the system needs to process those cases of malaria and other diseases detected at triage completely separately from the ebola cases.

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