Daily Briefing Blog

How the world's 26th Ebola outbreak can prepare us for the 27th


Clare Rizer, The Daily Briefing

The Ebola outbreak in West Africa has receded from the headlines in the past couple months, largely thanks to a sharp decline in cases reported at the beginning of the year.

In fact, the World Health Organization (WHO) on Jan. 28 announced that the focus of the official outbreak response has moved from curbing transmission to ending the epidemic. And President Obama has announced plans to withdraw all but 100 of the 3,000 service members responding to the Ebola epidemic in West Africa. In his announcement, Obama said that despite the troop withdrawal, "Our mission is not complete," and the country is moving on to the "next phase": eradication of the disease. "Our mission now is getting to zero," as "every case is an ember that if not contained can light a new fire."

But Ebola experts warn that good news on the frontlines does not mean it's time to pack up and move on.

Speaking at a panel on "Digital Aid: Lessons learned from the Ebola crisis" in Washington, D.C. this month, Emira Woods, global client principal for social impact programs at tech firm Thoughtworks, said,  "There have been 25 other Ebola outbreaks since the 1970s. This was number 26. There will be a 27th and we've got to use the lessons learned from this crisis" to guide us through future epidemics.

The panel also featured U.S. Ebola czar Ron Klain, a physician from the Doctors Without Borders' (MSF) frontlines in Sierra Leone, and a Washington, D.C.-based ED physician and expert on emergency preparedness. They shared several "lessons learned" that could be applied to quickly contain the next outbreak of the deadly virus: 

1. The Power of People

"In the end, the Ebola crisis has been a reminder that the thing that made a difference in West Africa was people, the willingness of people to put themselves at risk and human beings who were willing to help one another," Klain mused when opening the discussion.

Dan Lucey, an adjunct professor of microbiology at Georgetown University Medical Center who spent time combatting the outbreak in Freetown, Sierra Leone, echoed Klain's sentiment with a story from the frontlines.

According to MSF protocol, physicians can only spend 45 minutes during the day and 45 minutes in the evening taking care of sick patients before they risk overheating and dehydration in their personal protective equipment (PPE). As such, physicians' time was very limited. To ensure that all patients received treatment, MSF taught patients who were in pre-survival condition—meaning they were now immune to the virus, but still had to remain in the hospital to keep it from spreading—to take care of the patients who were still experiencing symptoms like vomiting and diahhrea.

Lucey said that by teaching others the skills necessary to care for the sick, doctors were able to spend more time treating patients who were severely ill.

2. Innovation on the frontlines

Another anecdote Lucey shared showed the power of collaboration in a crisis. Because nothing could be taken out of the tent where MSF was treating Ebola patients, paper patient records often became soiled or lost in transit. And although there were electronic scanners in some locations, they only worked a portion of the time.

But having up-to-date patient records was essential for things like medication administration, according to Lucey. To meet the challenge, Lucey and other physicians and nurses worked together to photograph patient records from outside the tent. They placed the records against the tent's plastic window so a clinician on the outside could snap a picture of the records with a cell phone camera.

It's just one example, but Lucey said innovations like this were commonplace on the frontlines. "This was a standard of care never seen or practiced. But you have to start with what the situation is and do whatever you can to make it better," he said.

3. The importance of communication

Klain said the administration approached the outbreak response strategy by focusing on improving communication between Ebola patients, their physicians, and other members of the community. He said, "The two heroes of the Ebola response were radio and cellphones," and "the reason we broke the back of Ebola was because people changed their behavior" as a result of this enhanced communication.

Klain noted that expanded cellphone coverage and connectivity in the region allowed officials to trace the contacts of Ebola patients, while both radio and cellphones were instrumental in disseminating information about the disease and instructions for infected individuals and their families.

During the outbreak in Sierra Leone, some tech firms helped develop the country's first emergency response call center, much like the 9-1-1 system in the U.S., according to Woods. Using the call center and GPS mapping to identify the location of the calls, the center was able to more accurately map cases and model the disease's path.

Klain said this focus on communication was integral to the U.S. response at home. For instance, individuals returning from Ebola-stricken countries were all given a disposable cell phone so officials could check in each day to see if they had developed any symptoms. They were also given a list of local hospitals that had been designated Ebola centers where they could go for treatment. Klain said "capturing and routing people appropriately" was key to containment. 

4. Investments in science must continue

Klain also stressed the "incredible importance" of continuing to invest in basic science. He said the work that federal agencies, researchers, and other scientific organizations put in—years before the epidemic even began—was the reason some treatments became so readily available.

For instance, some vaccines that had been in the pipeline for nearly a decade are now being tested in Phase I. Had such developments not already been in the works, trials would not have been able to begin so soon, Klain said. He noted that the first large-scale trial of an Ebola vaccine is underway in West Africa.

And Klain said other investments in scientific investments have been instrumental in fighting the spread, like point-of-care tests and new PPE.

5. Refocusing on public health

All of the panelists stressed the need for a "recommitment to public health."

Mark Smith—chief innovation officer at MedStar Health and chair of emergency medicine at Georgetown University School of Medicine—said the best way to do so and prepare for future emergencies is to "design for the extreme, use for the routine." By developing systems so they are equipped to face the worst kind of outbreak and then scaling them back for everyday use, "we can learn a huge amount about how to craft our systems based on these conditions," he says.

Or as Lucey said, "We haven't learned lessons until we implement the lessons to prove we've learned them."