Twenty-one days: the maximum incubation period for Ebola Virus Disease. That means if you have come into contact with the virus but have no symptoms by day twenty two, then you are clear.

Forty two days: the incubation period x 2, and the period it takes for a country to be officially considered clear of the disease. If no new suspected cases are reported for 42 days, the outbreak is over.

Today, Wednesday 13th August 2014, is a big day for me ... it has been twenty-one days since I left Liberia, and for the first time I know beyond a doubt that I am Ebola-free. Not everyone is so lucky. In my first 14 days of incubation in the comfort of my Southampton home, the number of cases in Liberia more than doubled from 249 on 23rd July to 554 on 6th August. Of these cases, 294 people had died. The country is in a state of emergency, schools are closed, roads are blocked, communities are quarantined and attempts to bring the disease under control are being crippled by widespread fear.

So for another 21 days I am going to write a blog post every day to raise awareness of the grim challenge confronting Liberians, and to raise funds to support the Red Cross, who I work with collaboratively in my normal life as a PhD social researcher, and who are at the front line fighting the worst known Ebola outbreak in history.

Sunday 31 August 2014

How to spend $490m in six months

It’s reassuring to know that someone has a plan.  A few days ago the WHO released their Ebola Response Roadmap with the goal of stopping Ebola transmission within 6-9 months in affected countries, and preventing international spread.  It’s sobering to see what financial resources, human and organisational capacity is going to be needed, but more so to observe the assumption that the outbreak is going to get quite a lot worse before it gets better, and that already in some areas the number of cases may be 2-4 times the number we know about.

Let’s take a look inside …

Objective 1: “To achieve full geographic coverage with complementary Ebola response activities in countries with widespread and intense transmission.”
Key Milestones: “Reverse the trend in new cases and infected areas within 3 months, stop transmission in capital cities and major ports, and stop all residual transmission within 6-9 months.”

Focusing on Liberia, Sierra Leone and Guinea, this means caring for Ebola patients in purpose-built treatment centres with full infection control measures, laboratory diagnosis facilities, contact tracing and monitoring, supervised burials, and engagement with communities.  Areas with intense transmission will be continuously identified and monitored, and the interventions will be significantly stepped up in these locations.  To limit national spread, where there are ‘containment areas’ (quarantined communities) this means ensuring that basic services such as primary health care, psycho-social support and food are provided.  Public gatherings should also be deferred.  To limit international spread, there will be exit screening at all major land, air or sea borders and no Ebola sufferers will be allowed to travel unless by medical evacuation.  There will also be an effort to cover the gaps in essential services such as health care, education, water and sanitation, food, and protection.  An investment plan to strengthen health services in the longer term will be developed, as well as a fast-track training programme for health workers.

Objective 2: “To ensure emergency and immediate application of comprehensive Ebola response interventions in countries with an initial case(s) or with localised transmission.”
Key Milestone: “Stop all transmission within 8 weeks of index case.”

In countries like Nigeria, and now Senegal, where there has been a first case (known as an ‘index case’) and perhaps some transmission on a relatively small scale, emergency health procedures should be instigated, including the establishment of an emergency operations centre and plans for coordination and communication.  Ebola response protocols must be followed, including isolating patients in a designated treatment centre, accessing diagnostic capacity, contact tracing/monitoring, safe burials and good public communication.  Again, international spread must be prevented by forbidding travel by Ebola-sufferers.

Objective 3: “To strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with an intense transmission area and those with international transportation hubs.”
Key Milestone: “Full Ebola surveillance preparedness and response plan established in areas sharing a land border with an Ebola-infected country and at all major international transportation hubs within one month.”

Neighbouring countries are most at risk of international spread because of porous land borders (that’s how Ebola got to Senegal), and transport hubs (as we have seen in Nigeria) are also vulnerable.  All countries should be prepared – by providing travellers to affected areas with information, ensuring an isolation facility is available along with arrangements for diagnosis and contact tracing, if needed.  Countries with a land border should also provide the population with accurate information about Ebola and how to prevent it, begin active surveillance for any clusters of unexplained deaths (particularly near borders) and put in place means of managing travellers at major land crossings who show signs of fever.  International travel hubs also need to be prepared to manage passengers with unexplained fever.

None of this comes cheap – a budget of $490 million (£295.3m) is projected for a six month period.  Hard to fathom, isn't it?  Money isn't everything though – the plan also identifies the need for 3170 national staff, all in skilled or semi-skilled roles, and 410 international staff, in Liberia alone.  Finding those people will not be straightforward.  I can’t help thinking had this level of coordination been put in place earlier, things might never have got this bad.

Then there are the things that the budget doesn't include – such as the costs of supporting essential services to be provided in the worst-affected countries, and the costs of health systems recovery and strengthening in these areas.  Who, I wonder, is going to take care of that?


For the keenies, the full Roadmap can be found here: http://apps.who.int/iris/bitstream/10665/131596/1/EbolaResponseRoadmap.pdf?ua=1

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