Tuesday, September 02, 2014

Simple minded thoughts about Ebola

Ebola is apparently a disease in some African animal population or populations. Rarely a human contacts the disease from an animal. In the case of the current epidemic, the animal that passed the disease to the first person who started the epidemic may have been a bat.

Once a human has the disease, he/she can spread it to others when he/she is sick (or indeed after death, as others handle the dead body). The disease is not spread through the air nor by mosquitoes or other insects; it is spread when an uninfected person comes in contact with blood or other material from a sick person that caries the Ebola virus.

Thus those coming in contact with someone infected with Ebola should wear protective clothing and should be trained to in how to protect him/herself from the disease. The chance of a protected and trained person getting the disease from a patient is relatively low, but doctors and nurses dealing with large numbers of Ebola patients do sometimes get the disease.

It is important for public health officials to learn as soon as possible when Ebola has entered a community. Ideally it would be helpful to know when the first infected animals arrived, and what they were. So too, it would be helpful to know when the first person was infected, and how he/she was infected. Thus, in an ideal world, people would inform public health officials of sick animals and of the first cases of human Ebola and the public health officials would follow up to verify the causes and if Ebola were confirmed begin the broader public health response. The earlier an epidemic is iidentified, the fewer people will have been infected, and the easier and faster it will be to contain. If, as is the case now, thousands of people in a number of  countries have been infected, including hundreds of scarce health service providers, the epidemic will be very difficult to contain.

Early treatment of someone infected with Ebola by trained medical practitioners improves the patients chances of survival. Still, many Ebola patients die. Their bodies can be managed by trained public health officials to avoid infecting others.

On the other hand, a person sick with Ebola who is treated at home by unprotected and untrained family, friends and/or neighbors is likely to infect several of them. If the patient dies, when the body is washed and prepared for burial  it is likely to infect others.

A major problem in the spread of the epidemic is when a person infected with Ebola moves from one place to another. There is a delay from the time of infection until symptoms occur, and in this period people sometimes move from rural to urban areas, from one town to another, or even from one country to another. The early symptoms of the disease can be mistaken for common, less serious diseases, allowing the symptomatic patient to travel, perhaps infecting other travelers.

One key element for the control of Ebola epidemics is knowledge. People should know when an epidemic is present in their vicinity. They should know how to recognize the signs and symptoms of the disease. They should know that people with Ebola should be hospitalized as quickly as possible, and that others should avoid contact with Ebola patients. And they should know that Ebola patients should not travel (other than to the nearest appropriate hospital) to avoid spreading the epidemic.

Fortunately, the communications infrastructure has improved greatly in Africa in recent decades. It  is possible to reach out to communities by radio and even television; cell phones are widely available and can be used to call for ambulances and specific guidance.

However, trust is also needed. People may get the messages, but if they don't believe them they will not accept them. Telling someone to go to a hospital for care will not work if that person does not believe that the hospital is equipped to help him/her, or worse that it will turn him/her away. Telling someone not to travel to another place after exposure will not work if the person believes the message is not truthful, and that the threat of serious illness and death such travel would pose to many other people is real.

Thus the health system must be prepared to help all the people who come to it for help with Ebola. Indeed, if the health system has failed with regards to many other diseases, it will be hard to get peole to trust that it will deal adequately with Ebola.

Coercive measures to force people to behave so as to reduce spread of the disease may also cause angry reactions of those people and undermine trust.

A government which is not seen to be concerned with the welfare of its citizens and which is thought to regularly lie to them via speeches, radio, television and newspapers will find it difficult to get people to believe it about Ebola.

Ultimately, I believe that it is people who will end the Ebola epidemic -- healthy people who will avoid contact with the infected, infected people who will act to avoid infecting others and especially to avoid carrying the epidemic to new areas, health care providers who will risk their lives to care for Ebola patients and patients suspected of having the disease, people in the knowledge system who will disseminate good information and advice, and people in government and other management positions who will help to get the resources to where they are needed to fight the epidemic.

In the long run, development should reduce the threat of Ebola epidemics getting out of hand. The Health service industries in developed countries are likely to deal with any introduced Ebola cases before they create epidemics. The better educated people in these rich countries have better sources from which to gain knowledge of how to deal with Ebola, and are more likely to trust the advice they get from government and health officials. So too, African nations should develop the capital (physical, institutional and social) to deal better with Ebola in the future.

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