Ebola response needs preparedness, not panic
By Dr Poonam Khetrapal Singh, WHO Regional Director for South- East Asia
Ebola Virus Disease outbreak in three West African countries continues unabated and the number of cases and deaths increase exponentially, sending alarm bells ringing across the world. The actions by national governments of Guinea, Liberia and Sierra Leone supported by the international community have yet to yield desired results. Greater efforts and more resources are being mobilized to reverse the escalating epidemic of this dreadful disease. So far no case of Ebola virus disease is reported in the WHO’s South-East Asia Region. Now is the time to step up our preparedness, and to test our plans to ensure effective implementation should it become necessary.
Strong and comprehensive national preparedness is a prerequisite to prevent and to deal with Ebola cases in unaffected countries,. The development of preparedness plans should be coordinated by high level national, multisectoral and empowered Coordination Committees. WHO has provided a comprehensive checklist of core principles, standards, capacities and practices, for all countries to use. The checklist can be used by countries to assess their level of preparedness, guide their efforts to strengthen their capacities and to request for assistance. Items on the checklist include infection prevention control, contact tracing, case management, surveillance, laboratory capacity, safe burial, public awareness and community engagement and national legislation and regulation to support country readiness.
WHO recommended exit screening is being implemented in affected countries to prevent the spread of infection,. In unaffected countries, national public health authorities have already initiated screening of passengers coming from Ebola affected countries. Apart from public health officials, the airlines staff and immigration officials too have been oriented to spot potentially infected persons at ports-of-entry.
However, given the nature of this disease, the likelihood of missing infected patients during point-of-care screenings must be considered and planned for. Detection of such cases – and their contacts and their quick isolation warrants intensive and sustained surveillance which can be undertaken by rapid response teams. Many countries have these teams in place to investigate and manage outbreaks. It is essential that these response teams are trained well and provided appropriate equipment and tools necessary to fight this disease.
It is also vital that sufficient numbers of well-equipped health care facilities required to isolate and manage suspected Ebola patients are put in place. And these facilities must be managed by properly trained staffs that are knowledgeable and skilled in in the proper use of Personal Protective Equipment (PPE). Health care workers must be trained to apply recommended infection control practices. We must recognize that health care staff - our frontline workers- are the most at risk and, therefore, require the highest level of skills and protective equipment to efficiently look after patients, contain the disease and, at the same time, protect themselves, their families and their communities. Guidelines for appropriate infection control practices in different settings have also been developed by WHO and they need to be used vigorously and scrupulously.
The communities too have to play a critical role in this public health emergency of international concern. Many outbreaks of infectious diseases in the past have led to panic amongst people. This invariably creates obstacles in surmounting the challenge of outbreaks. Fear is our greatest enemy. We need to empower communities with information about the mode of transmission of Ebola and the actions they can take to protect themselves and their communities. Only informed and empowered communities can complement public health efforts to fight this disease.
There are two things that everyone must know about Ebola virus disease. First, it is extremely dangerous to take care of a patient of Ebola at home. It not only spreads infection to family members and those who visit these homes but is also detrimental to the recovery of the patient. Ebola patients require intensive treatment in health facilities by skilled health professionals who are trained in managing these high-risk patients. Data clearly indicates greater mortality in West Africa in patients who were provided domiciliary care as compared to those who were immediately rushed to health care institutions.
Secondly, avoiding contact with body fluids of a patient with suspected Ebola and applying simple infection control practices at home are important. Bodies of those who succumb to Ebola virus disease must be handled by people who have been trained to perform these tasks. In day to day routine, hand washing is the most basic and extremely useful infection control practice that everybody should scrupulously practice. It protects against a large number of infections.
Global efforts are underway to develop effective vaccines and medicines against Ebola. Recently, Canada has developed one such vaccine and shared 800 vials with WHO for use in the high risk populations in Ebola affected countries; but this is still in early experimental stage. The widespread availability of such drugs will take more time. Till then, awareness and preparedness for early detection, rapid isolation, proper management, meticulous application of infection control practices and, enabling cooperation from communities are the keys in combating Ebola virus disease. WHO stands ready to assist national governments as needed.
One of the most important development since the SARS outbreak has been the implementation of International Health Regulations (2005). Augmenting IHR (2005) core capacities especially pertaining to preparedness, human resource, laboratories, risk communication, response, and surveillance are now benefiting countries in their fight against Ebola. WHO continues to work closely with all countries in augmenting their IHR (2005) core capacities.
Global response to Ebola virus disease is possible through sustained and strong leadership, national commitment and comprehensive preparedness. Recent success in Senegal and Nigeria in rapidly containing the spread of Ebola virus disease not only raises optimism but also demonstrates the need and impact of effective preparedness by countries and an efficient health systems that can manage competently a case of Ebola.