10 Key Pillars to an Effective Ebola Response

As the world focuses on combatting COVID-19, we are reminded once again that dozens of outbreaks of other infection diseases continue to occur. Many of these diseases are endemic like Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) and can reemerge at any given time. In February, there were 2 Ebola outbreaks, one in the DRC and another in Guinea. The outbreak in the DRC was declared over on May 3, and according to the World Health Organization, Guinea began a 42-day countdown to declaring an end to the EVD outbreak in early May.

Both of this article’s authors are part of a special pathogens team tasked with ongoing preparedness and maintaining a state of readiness in health care for Ebola. This team is made up of physicians, nurses, technicians, infection preventionists, emergency management coordinators, administrators, and more.

What follows are their 10 core pillars to an effective Ebola-outbreak response.

1. The 3 Cs: Communication, Coordination, and Collaboration

The need for clear, concise, consistent, transparent, and science-based communication is essential, both for outbreak responders and for the public. For those involved in Ebola response, ongoing communication, coordination, and collaboration must occur at all levels—from local to international. Given the multilevel, multisectoral, and multidisciplinary rapid response teams needed to combat Ebola, from local nongovernmental organizations to international medical assistance institutions, ensuring that all parties have up-to-date information—sharing scientific and medical knowledge as well as data—in a coordinated fashion helps with rapid response.

2. Box in the Virus: Testing, Case Finding, and Contact Tracing

To contain the virus, rapid and ongoing laboratory services to accurately diagnose individuals, identification of cases coupled with isolation, and contact tracing to find and quarantine exposed persons are critical to prevent transmission. The ability to conduct contact tracing relies on trust and cooperation from the public—hence the need for risk communication and community engagement. Previous epidemics of Ebola have been contained through successful contact tracing, isolation, and quarantine, which break the chain of infection.¹

3. Monitoring and Surveillance

A public health surveillance system should be in place to immediately detect and report cases of illness compatible with Ebola. Strong surveillance systems to track all suspected and confirmed cases of disease will allow for detection of new cases and monitoring spread. Upon detection of a possible Ebola event, a rapid-response team should investigate and implement initial mitigation measures, including systematic contact tracing.² Technological advances can supplement traditional surveillance methods to accrue information in real time, offering the possibility of better outbreak management.³

4. Patient Care

All efforts should be made to provide usual standard of care to patients with suspected or confirmed Ebola. While such care should be provided in a safe and logical manner, planning and education should result in avoidance of altered standards of care due to the perceived risk to providers. Lastly, there should be synchrony between the multiple disciplines involved in the care of a patient with EVD, including physicians, nurses, laboratory personnel, environmental services, and infection control.

10 Key Pillars to an Effective Ebola Response

5. Infection Prevention and Control

The core of every Ebola response is basic infection prevention and control. This includes a combination of measures to prevent and minimize the transmission of Ebola, such as administrative controls and safer work practices (eg, protocols, processes for screening, limiting individuals who come in contact with suspected or confirmed persons with Ebola); engineering controls to prevent or minimize exposures (eg, physical barriers or designated rooms for patient care and designated equipment and supplies); and use of personal protective equipment to prevent and minimize exposure. This also includes safe and dignified burial practices and other environment-of-care strategies (eg, cleaning and disinfecting, waste management).

6. Social Mobilization and Community Engagement

Outbreak response starts and ends with the people. For people to change any behaviors (eg, burial rituals) and follow public health guidance, there must be community engagement. This starts with grassroots, boots-on-the-ground messengers who are part of the community and can serve as trusted emissaries. In previous and current Ebola outbreaks, community engagement has served as the backbone of successful responses.³

7. Risk Communication

Risk communication refers to effective communication during an emergency.⁴ Effective risk communication helps the public make informed decisions regarding the event and helps rapid-response teams understand behavior changes to mitigate risks. Risk communication can occur through multiple channels including social media, government briefings, and press releases. Given the misinformation and disinformation that occur during Ebola outbreaks, which can result in mistrust and hostility toward responders,⁵ having experts who are trusted messengers provide ongoing risk communication (with science- and evidence-based information) is essential.

8. Epidemiological and Outbreak Analytics

Effective Ebola response relies on good data and analytics to provide information on current and projected case counts and where the outbreak is headed in terms of trajectory, map current progress and spread, assess populations at risk, and help with early detection and control of viral spread. Epidemiological and outbreak analytics are complex and multifaced and require collecting, analyzing, interpreting, modeling, and reporting of data. Effective data collection and analysis inform the outbreak response and help decision makers determine next steps (eg, mobilization of resources).

9. Logistics Management and Incident Command

All Ebola outbreaks require resources including personnel, treatment centers, equipment and supplies, vaccines and therapeutics, and more. The assistance of an incident management structure can facilitate planning, logistic management (eg, supply chain), and the ability operationalize a response. The complex task of coordinating and dispatching needed supplies, equipment, and human resources and maintaining a safe and hygienic environment is a massive undertaking that often requires all hands on deck.

10. Governance

Leadership and governance can make or break Ebola response. A successful strategy requires responsiveness, accountability, and the ability to galvanize rapid response. Regions with civil unrest and unstable public health and health care systems pose additional challenges, but these hurdles can be overcome by effective leadership with trust between government and citizens.

Syra Madad, DHSc, MSc, is senior director of the System-Wide Special Pathogens Program at NYC Health + Hospitals and core faculty at the National Emerging Special Pathogens Training and Education Center (NETEC) in New York, New York.

Vikram Mukherjee, MD, is an assistant professor NYU Grossman School of Medicine; director of the Medical Intensive Care Unit and Special Pathogens Unit at Bellevue Hospital Center; and coprincipal investigator at NETEC in New York, New York.

References

1. ^{Saurabh S, Prateek S. Role of contact tracing in containing the 2014 Ebola outbreak: a review. Afr Health Sci. 2017;17(1):225-236. doi:10.4314/ahs.v17i1.28}
2. ^{Ebola publications: surveillance, contact tracing, laboratory. (2021). World Health Organization. Accessed May 7, 2021. https://www.who.int/csr/resources/publications/ebola/surveillance/en/}
3. ^{Woolhouse ME, Rambaut A, Kellam P. Lessons from Ebola: improving infectious disease surveillance to inform outbreak management. Sci Transl Med. 2015;7(307):307rv5. doi:10.1126/scitranslmed.aab0191}
4. ^{Crisis & Emergency Risk Communication (CERC). CDC. Updated January 23, 2018. Accessed May 7, 2021. https://emergency.cdc.gov/cerc/}
5. ^{Allgaier J, Svalastog AL. The communication aspects of the Ebola virus disease outbreak in Western Africa--do we need to counter one, two, or many epidemics? Croat Med J. 2015;56(5):496-499. doi:10.3325/cmj.2015.56.496}