“Given that surveillance and response measures have held this [Ebola] terrifying disease in check for the past decade, why has the situation gotten so far out of hand this time?”

This is the complex question raised by the West African Ebola outbreak in Guinea, Liberia, and Sierra Leone and posed so clearly  by Dick Thompson, a former WHO communications official, in National Geographic News. Several epidemiologists and health officials close to the outbreak have shared their insights in trying to answer this question.

From Control To Crisis in 5 Minutes

“Within five minutes, everything changed.” That’s how Hilde de Clerk, a Doctors Without Borders/Medecins sans Frontieres (MSF) physician, has described the shift in thinking about the Ebola virus outbreak in Guinea. In an interview on the MSF website, de Clerk describes how MSF health officials in taking a small cluster of phone calls went from monitoring only two villages and thinking they were witnessing the end of the outbreak to having to monitor 40 villages with more than 500 potential contacts and realizing they were facing the largest epidemic of Ebola they had ever faced. MSF is now describing the Ebola outbreak in Guinea, Sierra Leone, and Liberia as “out of control”.

Epidemiologist  Speaks Out

According to MSF epidemiologist Michel van Herp who spoke with the Telegraph, “I have covered six previous Ebola outbreaks and this is unprecedented.  It is unique in terms of the number of cases, where they are and how they are spread, the difficulty of putting enough treatment centres where they are needed, and the fact that these people move around so much.”

WHO Update

The July 15 report from WHO covering the period July 8-12 has identified 79 new confirmed, probable, and suspect cases from all three countries with the majority coming from Sierra Leone (30 cases) and Liberia (49 cases).  The cumulative total of cases as of this report is 964 with 603 deaths (63% case fatality rate). WHO has recently established an outbreak coordination center in Conakry Guinea to coordinate technical support and help to mobilize resources from a vantage point closer to the outbreaks.

Communications Expert Speaks Out

According to Thompson, the Ebola outbreak in West Africa is presenting several familiar and many new challenges. His list is daunting and helps to understand more deeply why control is so difficult to achieve. This has not been the experience in other Ebola outbreaks.

1. The disease had almost never been seen before in West Africa. Also, patients presented initially without the characteristic hemorrhaging. These two facts meant that recognition of the disease was delayed and it slowed the initial response.

2. Officials initially gave inaccurate and sometimes contradictory information. Also, they have failed to communicate the true scope of the outbreak.  Trust in government communication messages is low and this is a serious limitation because mobilizing the community is a key ingredient of successful containment.

3. The outbreak is occurring now or has occurred in multiple locations over a vast area. Also, the disease is spreading to urban areas for the first time. An outbreak on this scale exceeds the current capacity of the organizations involved to respond effectively.   MSF has said it can no longer send teams to new outbreak sites.

4.  As Thompson reminds readers so vividly, treatment of patients is dangerous for staff, physically grueling in protective gear from head to toe, and emotionally draining because of the high death rates. It requires enormous physical and emotional stamina as well as courage to be involved in treatment and outbreak control work.

5. Rumors about sinister purposes for isolation wards cause patients to escape and hide and cause the non-ill population to hide from investigators seeking the names of close contacts of patients.

6.  Some populations believe a curse is at work on Ebola patients and families, and they are often stigmatized.   ■

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