Ebola: controlling the nightmare.

The unprecedented outbreak of Ebola virus disease (EVD) in West Africa is a true global public health emergency, requiring extraordinary measures and global cooperation. Throughout 2014 the world has observed a global health crisis unfold in a way that has never been seen before (Box 1). Multiple outbreaks of EVD have overwhelmed healthcare and humanitarian services in many areas, restricting the ability to perform contact tracing and efforts to limit onward transmission. Existing treatment centres struggle under the strain of large numbers of patients and the rapid and unchecked growth of cases witnessed in some areas means that new facilities reach their capacities almost as soon as they have opened. Tragically, scores of healthcare workers have died and affected countries are being stripped of their already limited medical workforce. Growing numbers of international workers who have helped to fill gaps are now being evacuated from affected countries, at the same time as calls are being made for more workers on the ground. Médecins Sans Frontières (MSF), an organisation with a deep understanding of this epidemic and previous filovirus outbreaks, has told the UN that military support is required and in response the military has begun to deliver support. Other interventions, viewed by some as last resort measures, include the introduction of ‘cordons sanitaires’ and countrywide lock-downs. These are clear warning signs of an impending humanitarian catastrophe. In response, WHO, the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) and their partners are assisting with specific measures, but a concerted global effort is required if we are to win this battle. Fadela Chaib (WHO) recently said that beds are required for 50 Ebola Treatment Units across Guinea, Liberia and Sierra Leone. There is currently 1126 beds, which is only 25% of what is needed. This level of demand for clinical care is unprecedented in the context of viral haemorrhagic fever outbreaks. The previously held view of Ebola—as a deadly infection that affects remote villages and burns out before dissemination occurs—is now obsolete. We have no choice but to change the way we attempt to control outbreaks of EVD and treat infected patients. Armand Sprecher of MSF Belgium articulates this well, We [MSF] are being stretched thin by the multiplication of outbreak sites. Now it is a challenge of local scale. Monrovia will dwarf all our past experiences and require rethinking of what we do. For instance, we opened in Monrovia with insufficient medical staff before we were ready because patients were dying in the street and in cars outside our compound. We opened just to give them a bed to die in. Ordinarily, we would expect to bring up the level of care as our staffing levels increased. (A. Sprecher, personal communication, 2014).