Ebola Isolation & Treatment
Bong County, Liberia ETU run by the International Medical Corps, October 9, 2014. Photograph by Morgana Wingard, courtesy of USAID
Case Management: Isolating and Treating Ebola Patients
The international non-governmental organization Médecins Sans Frontières (MSF) was already working in the region when Ebola virus disease was first confirmed in March 2014. In response, MSF converted existing clinics and erected new Ebola Treatment Units (ETUs)—drawing upon its extensive clinical experience in treating the disease. However, the unprecedented spread of Ebola quickly overwhelmed MSF’s capacity, as well as local hospitals, which were poorly resourced and unprepared for the intense demands of treating people with Ebola.
This urgent and dramatic need for additional beds, care centers, and isolation units became a priority of the global response in Fall 2014 because the best chance for survival was early treatment. The United States government played a major role in supporting the establishment of ETUs. In collaboration with USAID’s Office of Foreign Disaster Assistance, World Health Organization, Department of Defense, and multiple other partners, CDC provided technical support and training. CDC was also involved in developing other infection control and treatment strategies, such as community care centers and household protection kits.
Addressing Treatment Challenges
In late August 2014, there were just 500 beds available in Guinea, Liberia and Sierra Leone in eight ETUs—five run by MSF and three run by the Ministries of Health with WHO support, plus a private sector ETU run by Firestone Liberia. The number of ETU beds rose to more than 1,500 in December 2014, and peaked at 2,044 the week of February 8, 2014, with 49 operational ETUs. Building sufficient beds where proper care could be provided was key to encouraging people to come forward for help.
Beyond practical considerations, there were other social and cultural factors that hampered treatment in the early days of the epidemic: fear of ambulances and hospitals, particularly when loved ones disappeared without a trace; treatment by traditional healers uninformed about the disease; early resistance to safe burial practices; and an epidemic of rumors and distrust.
Thus, solutions were multi-faceted: multiple and accessible treatment centers sensitive to the needs of the patients and their families, and widespread community outreach messages about the disease and the importance of personal responsibility to prevent the spread of Ebola.
MSF health worker in protective clothing carries a child suspected of having Ebola in the MSF treatment center on October 5, 2014 in Paynesville, Liberia. Photograph by John Moore, Getty Images
Charles Keimbe
Charles Keimbe, the surveillance pillar lead for the entire Western Area in Sierra Leone, discusses difficulties in isolating patients. Transcript.
UNICEF, USAID and the Paul G. Allen Family Foundation provided 9,000 household protection kits that were distributed across Liberia in fall 2014. Photograph by Morgana Wingard, USAID
Equipping Families: Household Protection Kits
Tragically, at the height of the epidemic, people were turned away from ETUs because there were simply no beds for them. Although the wisdom of providing families with PPE was debated, responders, including MSF and UNICEF, began to distribute household protection kits in 2014 in order to reduce the risk of infections among families. Each kit included biohazard bags, soap, PPE and gloves.