The World Health Organization (WHO)'s Foreign Medical Team Coordinator posted Sunday that the organization is being forced to rely heavily on community volunteer centers to fight the outbreak of the deadly hemorrhagic fever Ebola, even as they know many of the people they send to staff the centers will die.
In a blog post written for the Columbia University Program on Health and Forced Migration from on the ground in Sierra Leone entitled "Brutal Triage," WHO's Les Roberts warned that the "prediction landscape is looking bad."
While official reports currently say that around 8,900 people have been infected with Ebola, Roberts cautioned that those are lab-verified results. Because the results take 7 to 10 days to process, he said, and because samples and results are frequently lost and mixed up, those numbers more accurately reflect the situation as of two weeks ago.
"We thought the doubling time of the outbreak was 30 days," he said, meaning he amount of time the virus needs to double the number of infected people. However, he wrote, "it seems to be less than that here."
The number of beds for Ebola patients in all of Sierra Leone, he said, is around 200. That's in a country where he estimates there are already more than 900 cases.
"As Foreign Medical Team Coordinator, helping to get these beds up and supported is one of my primary tasks," said Roberts. "If there are really 3000 cases this month, and 6000 next month...with all going perfectly on the treatment bed establishment side, we will have 30% of the beds we need next month, slightly worse than the situation now."
WHO's strategy is to establish numerous Ebola Community Care Units (ECUs). Each will have "tents with eight beds...maybe two tents, a wet tent (vomit and diarrhea) and a dry tent and a big buffer zone around with a couple latrines and a burning pit and a water supply," Roberts said. They will be staffed by health care workers and community volunteers.
"The idea is that at the first sign of symptoms, the family brings the feverish loved one in," he said. "Everyone will be treated with an antimalarial and an antibiotic. If they can be tested for Ebola, they will be. If not, they get monitored and if they develop 3 of the key symptoms they get referred to a proper hospital bed...which will be in short supply...or otherwise they move to the wet tent."
Some people, he explained, will be given Oral Rehydration Salts (ORS) and fed. Many will die, he conceded.
"This is very close to no treatment," he said. "But the goal is to get them out of their houses to where they will be less likely to infect others."
Many clinic workers will become infected, he said, but WHO believes that this is the best way to try to contain the epidemic. If the disease continues to spread at its current explosive rate, the region could be seeing 10,000 new cases per week by December.
The U.S. Centers for Disease Control and Prevention (CDC) has suggested that health workers in the stricken regions distribute kits designed to promote "safe home care" for infected patients.
The kits, Roberts wrote, contain "ORS (a lot...like 20 sachets) and gloves and masks and chlorine and an ORS mixing bottle." The kits' main contents, however, will be instructions to the family.
"Again, like the ECU’s this is not about treating the ill as much as it is about minimizing infections," he said.
"If you think about it a few steps removed from West Africa, this is freakin’ wild," he said, approaching Ebola from a strictly containment standpoint rather than trying to treat the ill and suffering is virtually unheard-of.
"We are about to assist thousands and thousands of people to die an excruciating death at home without even the most mild of pain relief," he lamented.
Furthermore, "We are going to set up treatment facilities in hundreds of villages for one of the most deadly of diseases to be largely run by volunteers who will be lucky to get 3 days of training. Dozens, perhaps hundreds of them will die."
"And the most surreal aspect of this triage for me is that I completely think that this is the right thing to do given where we are and the limited ability to respond," he said. "As I think about you students reading this I struggle with the degree to which my endorsement of this multi-pronged approach is pragmatism or wisdom or loss of idealism."
