Controlling Ebola: next steps.

The Ebola epidemic is paradoxical: it is out of control yet readily controllable. The key to epidemic control is rapid diagnosis, isolation, and treatment of infected individuals. 1 This approach was used in past Ebola outbreaks through contact tracing, in which anyone exposed to a person with Ebola was monitored, tested if they developed symptoms, and, if positive, securely transported to a health facility for treatment. 2 Moreover, while 60–90% of untreated patients with Ebola die, effective medical care could reduce this rate to below 30%. 3 This strategic approach was not taken in time during the present Ebola outbreak in west Africa. According to estimates from the US Centers for Disease Control and Prevention, about 60% of all Ebola infections in west Africa remain undiagnosed in the community with the potential for hundreds of thousands of cases by mid-2015. 4 Infected individuals become contagious when they begin to show symptoms. Without effective isolation, each Ebola patient is estimated to transmit the virus to around 1·8 additional people, leading to the exponential growth of infections with a doubling time of around 20 days. Control strategies based on rapid diagnosis, patient isolation, and treatment, can reduce the transmission to well under one additional person per infected case, thereby rapidly containing the epidemic. 4 No coherent national or international approach has so far been implemented to integrate the intervention chain from case identification to diagnosis, to secure transport, to isolation and treatment. While efforts to create new vaccines, medicines, and diagnostics are underway, we recommend that three measures be adopted in a concerted way. First, individuals with Ebola-like symptoms must be tested early so that cases of Ebola are identified rapidly and moved to isolation and treatment. Without laboratory testing, early diagnosis is difficult, because Ebola causes symptoms seen in many other infections, including malaria, typhoid, and influenza. 5 Distinguishing a case of Ebola requires testing a patient's blood with PCR. In past outbreaks where all infected individuals were known, only contacts, who were exposed to someone with Ebola, were tested if they developed symptoms. In the present epidemic, most Ebola patients—much less their contacts—are unknown. 4 Thus, everyone can be considered a potential contact, and testing is needed for anyone with symptoms to minimise the possibility of transmission to others. International efforts to bolster the capacity of west Africa's fragile and underfunded health systems to respond to Ebola have been woefully …