THE WORLD’S tardy response to the Ebola virus outbreak in West Africa, which has killed 8,810 people, demands that lessons be learned. Toward that end, a fresh batch of scientific reports has emerged in recent days to guide future responses. The World Health Organization, which stumbled in the initial period, seems to be recognizing its mistakes and looking for ways to correct them.
Ebola spreads through bodily fluids, but transmission can be interrupted if those infected are identified and treated as soon as possible and contacts with others traced. In Conakry, the capital of Guinea, one of three West African nations affected, epidemiologists have reconstructed the chains of transmission of the virus. Their research, published in the Lancet Infectious Diseases journal, shows that after the first wave in the city, in the spring of 2014, the outbreak was somewhat well contained, but “an uncooperative family” still harbored the virus and unleashed a second epidemic wave. A third wave came from neighboring Sierra Leone. This demonstrates that it is vital to keep medical interventions in place for long periods — and a big mistake to declare victory too early. The research also shows that most transmission of Ebola occurred in families. Eighty-two percent of transmissions in the Lancet study happened in the community and 72 percent between family members. Neither hospitals nor funerals played a major role in transmission after countermeasures were taken in both.
In fact, hospitals and treatment centers played a significant role in battling the disease. A study just published by the Centers for Disease Control and Prevention estimates that Ebola treatment centers and community care centers in Liberia saved thousands of lives. While there is no known effective cure for Ebola, the centers isolated patients from the healthy and thus prevented more infections. A lesson here is that, in parts of the world where health-care infrastructure is weak, it is of huge benefit to isolate the infected even in rudimentary facilities, and that an airlift of temporary centers can make a real difference.
In the end, fighting an outbreak is not only battling a virus but also dealing effectively with people, modifying their behavior and taming their fears. Another new study from the CDC shows that, in Sierra Leone, an effective way to find and trace infected patients was demonstrated in a pilot project using village monitors who were given cellphones and trained to detect “trigger” events that the virus was afoot. The method helped locate the sick earlier; it also had a high degree of acceptance by key community leaders.
The WHO’s response to the Ebola crisis was so lethargic that some experts have suggested establishing a new rapid-response organization. In a Jan. 25 meeting in Geneva, the WHO’s 34-member executive board agreed to create a special fund for use in emergencies and to undertake an overhaul to make it more responsive next time. The jury is still out on whether this will succeed, but the spirit was right. Next time, the world cannot be late to the scene of the fire.