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Opinion

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Commentary

Ebola's spread can be stopped using well-known methods

LONDON — The coverage of the Ebola epidemic to date has focused on treatment, or the lack of it: the fact that Ebola has no cure; the heroic efforts to keep patients alive; the use of a new drug never before tested on humans.

All have received considerable attention. So, too, has the terrifying pace of the epidemic in some of the poorest communities in Africa.

Treatment is certainly a critical component of the response to Ebola. But the single-minded focus on treatment is obscuring the most important fact about this current Ebola epidemic. It can be contained and stopped, within months, with tools already at hand, and at a reasonable cost.

This is a life-saving message that must be pushed out, both in the news media and in the communities affected by Ebola where, sadly, myths and suspicion are impeding the work of organizations like the International Rescue Committee.

The recipe for success is well known to public health specialists. It includes tracking and isolating of all that have been in contact with patients, and training health workers to screen suspected Ebola patients.

Unfortunately, the decision by the government of Sierra Leone to, in effect, “lock down” the country is not a sound strategy. It is unlikely to accomplish even its stated mission of identifying Ebola cases, since many people who are infected will not yet have symptoms during that period.

It will perpetuate an atmosphere of fear and suspicion that has helped fuel the epidemic. It may even push tense communities to violence. A ”lock down,” moreover, will disrupt measures that are working, such as contact tracing.

Almost all health worker infections are outside the isolation unit, because clinicians did not suspect the patient of originally having Ebola, and therefore did not take precautions. Basic infection-control measures must be implemented. Gloves and other protective equipment must be used in health facilities. People living in affected areas must be informed about what is happening, and what they can do to help.

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These steps are labor-intensive, tedious and must be performed well to be effective. They have been successfully executed in the past in countries affected by other diseases. If containing this terrifying outbreak is so straightforward, why aren’t we taking these actions?

The scale and complexity of the epidemic has exposed the underlying weakness of fragile states just rebuilding from war, and of a World Health Organization decimated by budget cuts. As a result, the most effective components of a response, such as tracking people who have been exposed, haven’t received enough attention or resources.

No one institution within each country has the capacity to lead the response of this magnitude, identify priorities, allocate the necessary resources and ensure critical supplies reach front-line responders.

The second issue is that governments, NGOs and United Nations agencies, have not been working as a team.

Governments have been suspicious of sharing data and delegating authority, in part because of fear of being criticized rather than supported. In some cases, UN agencies have not taken full advantage of partners equipped to contribute.

Finally, all the players involved have failed to recognize the different kinds of expertise needed to contain and curtail the epidemic.

Everyone recognizes the need to set up isolation and treatment wards. Far less attention has been given to other critical forms of expertise: anthropologists to understand why people are panicking; communication specialists to develop and test messages that get through, and community health workers to set up tracking systems for people exposed to the virus.

Successfully tracking and isolating one Ebola-exposed contact has the potential to save many more lives than treatment, but doing so for thousands of people requires organizations and individuals that have experience with large-scale community tracking.

The remedy — strong leadership and a team approach — is not easy, but it is feasible. An “Ebola Response General” must be appointed within each affected country, overseeing a unified operational plan. This leader needs to be surrounded by a multidisciplinary team, coming from various partners, including governments, the UN, and NGOs, but operating as a cohesive unit.

All of these steps must be implemented alongside treatment. When patients are being treated, they also generate information on where the disease is spreading, which guides prevention efforts.

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This is not a quick fix. But the public health community has used a well-coordinated, well-led, multi-disciplinary approach to successfully fight other scourges such as malaria, measles and cholera.

The alternative — thousands more deaths, economic devastation, and potential spread to other regions — is unthinkable.

Dr. Emmanuel D’Harcourt is senior health director of the International Rescue Committee.


This article originally appeared on GlobalPost.

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