Upon his return from 6 weeks volunteering with the King’s Sierra Leone Partnership at a number of Ebola isolation facilities in Freetown, Tom Boyles considers the endgame of the Ebola epidemic.
There are encouraging signs of an overall reduction in confirmed cases of Ebola in west Africa. The graphs below show the epidemic curves for Sierra Leone, Liberia and Guinea as of 14 January 2015 and current data can be found here. Clearly there has been a dramatic reduction in cases in the first 2 countries although in Guinea the epidemic seems to be grumbling on at a lower level. These graphs may signal the beginning of the endgame but one of the important questions at this point is “How will the Ebola epidemic end?” and no-one is quite sure. Having recently worked on the Ebola response in Sierra Leone my suspicion is that when the end finally approaches we will have a significant ‘last mile problem’; what some others have described as a long and bumpy tail to the epidemic. We will need to ensure that the very last patient either dies or survives without infecting anyone else and this will be easier said than done.
From the beginning it has been vital to avoid losing focus on other interventions such as childhood vaccination programme so that the Ebola crisis is not followed by a measles epidemic, for example. In order to keep healthcare facilities open the model in Freetown has been to put screening services and small isolation units at each one. The over-riding aim is to protect the facility staff from Ebola so they can continue with their everyday work. Patients who screen positive are isolated and tested for Ebola; positive cases are then transferred to dedicated treatment centres and negative cases either discharged home or to the healthcare facility if they need ongoing care. This model has been largely successful in protecting staff at facilities and allowing some normal services to continue.