Ebola Then and Now

http://www.nejm.org/doi/full/10.1056/NEJMp1410540?query=TOC

Recommendations from professionals on the ground:

breman_1410540_thumb111x111 Overall, we found that coordination of partners, transparency, and clear designation of authority and responsibilities were essential. We assuaged fear by working closely with national and local leaders, explaining what we knew and didn’t know, and promising to remain in the area, treat patients, visit villages, and give evidence-based guidance. Reopening YMH addressed the community’s daily needs, and our field IFA system permitted rapid diagnosis. Assuring international and Zairean health and support workers that they would be treated equally if they became ill helped us keep dedicated workers in the field. One dilemma was whether to care for sick team members locally or to evacuate them, which could delay treatment and expose many other people to the disease. The recent cases of two U.S. aid workers who were treated with an experimental therapy and then flown to Atlanta underscore such ethical questions.

In the current Ebola epidemic, we believe that the main priorities should be adequate staff for rigorous identification, surveillance, and care of patients and primary contacts; strict isolation of patients; good clinical care; and rapid, culturally sensitive disposal of infectious cadavers. Timely control will require convincing community leaders and health staff that isolation and rapid burial practices are mandatory; that patients can be cared for safely in improved local conditions; and that only trained, qualified, and properly equipped health staff should have patient contact.

These steps from the first Ebola outbreak may help bring the current epidemic under control. We also await key virologic, clinical, epidemiologic, and anthropologic descriptions of the epidemic — which will permit comparison with the other Ebola outbreaks that have occurred since 1976 and help us prepare for future outbreaks.

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