Transcript Module 7: Carol Devine

By Create | Self
Ebola Virus Disease EVD
• Reveals basic health inequalities, now is time
to respond, build
October 4, 2014
“Our people are dying, children are being orphaned, most of the dead
are women. Over 2/3 of those infected belong to the economically
active age of 15 to 50. Children do not go to school; farmers are being
felled in the food production and commercial crop centers of the land;
doctors and nurses are dying, non-Ebola illnesses are adding to the toll
of death and suffering due to further strains and weakening of the
healthcare delivery system in the country.
The existence of my country is at stake; the future of our region is in
peril. By the time I get home from this meeting, there would be over
50 new cases of my people contracting the disease, and based on case
fatality rates, more than half of them may die. “
-Statement by his excellency Dr Ernest Bai Kormoa, President of Sierra
Leone, October 2014
October 4, 2014
Sierra Leone urgently needs the support of
people to combat this virus; without you we
cannot succeed, without your quick response, a
tragedy unforeseen in modern times would
threaten the wellbeing and compromise the
security of people everywhere.
1976 What is Ebola
Ebola is one of the world’s most deadly diseases.
It is a highly infectious virus that can kill up to
90 per cent of the people who catch it,
causing terror among affected communities.
“Now I fear an unimaginable tragedy.” Dr. Peter
Piot who first identified it in the DRC in 1976.
This outbreak March 2014
• MSF was in Guinea when the outbreak began.
A Swiss team doing malaria control near the
borders with Liberia and Sierra Leone, got a
letter from Guinea’s Ministry of Health on
March 12 detailing an illness that struck eight
people, including a doctor who died after
caring for a patient from Gueckedou.
How is it transmitted
• In some areas of Africa, infection has been
connected to handling infected animals such
as chimpanzees, fruit bats, monkeys, forest
antelope found dead or ill in the rainforest.
• It is not an airborne disease.
• Human-to-human transmission occurs
through close contact with blood, secretions
or other bodily fluids from an Ebola-infected
person.
Transmission
• Direct contact with dead bodies is main way Ebola
is transmitted. Funerals are a significant practice in
communities affected by this outbreak. In last
hours before death, the virus becomes extremely
infectious and the risk of transmission from the
dead body is much higher. Ensuring safe burials
crucial for managing an outbreak
• Healthcare workers have been infected while
treating patients through close contact with them
while not using gloves, masks or protective
goggles.
nurse Lucie Peradel checks her goggles, and essential part of
the protective gear, Guinea 2014, MSF
Symptoms
• In the early stages of infection, symptoms are nonspecific, making Ebola difficult to diagnose. The disease
is often characterized by the sudden onset of fever,
weakness, muscle pain, headaches and a sore throat.
Can be followed by vomiting, diarrhea, rashes,
impaired kidney and liver function, and hemorrhagic
symptoms such as nosebleeds, bloody vomit, bloody
diarrhea, internal bleeding and conjunctivitis.
• hemorrhagic symptoms seen in less than 50 % of cases.
How treat? Supportive care
• no specific treatment or vaccine available is proven
effective in humans and is registered for use in patients.
Experimental drugs and vaccines are being considered for
use in accelerated clinical trials.
• Standard treatment is supportive therapy: hydrating
patient, maintaining oxygen status and blood pressure, high
quality nutrition, treating with antibiotics for complicating
infections. Supportive treatment helps a patient survive
longer, extra time may be what patient’s own immune
system needs to start fighting the virus.
• Once a patient recovers from Ebola, he or she is immune
to the strain of the virus contracted.
beyond humanitarian
• MSF calls for help June 23, 2014
“The epidemic is out of control. We have
reached our limits.”
• MSF at Security Council requests military Sept
16, 2014 calls UN members to dispatch (civil
and military) disaster response teams, backed
by the full weight of logistical capabilities.
“The response remains totally, and lethally,
inadequate,” Dr. Joanne Liu
October 4, 2014 Peter Piot
• This isn't just an epidemic any more. This is a
humanitarian catastrophe. We don't just need
care personnel, but also logistics experts,
trucks, jeeps and foodstuffs. Such an epidemic
can destabilise entire regions.
Peter Piot on why did WHO react late?
On the one hand, it was because their African
regional office isn't staffed with the most capable
people but with political appointees. And the
headquarters in Geneva suffered large budget cuts
that had been agreed to by member states. The
department for haemorrhagic fever and the one
responsible for the management of epidemic
emergencies were hit hard. But since August WHO
has regained a leadership role. (Guardian)
Washington Post Oct 4, 2014
September 2014 Critical gaps
• MSF teams in West Africa note critical gaps in
all aspects of the response, including medical
care, training of health staff, infection control,
contact tracing, epidemiological surveillance,
alert and referral systems, community
education and mobilization.
Mamadee, 11, was admitted to MSF's Ebola management centre in
Foya, Liberia on 15 August 2014. He tested positive for Ebola, but
recovered, and was discharged on 4 September 2014.
workers spray disinfectant inside a taxi after a man arrived at the
treatment facility in the back seat on Sept. 13 in Monrovia. The man
showed symptoms of Ebola.
House-to-house leafleting, messages on local radio stations,
enlisting “Nollywood” stars to deliver messages.
Doing the Ebola no-hands-greeting with well known Nollywood leading
romantic lead and hero Jide Kosoko, who was visiting the EbolaAlert team
Required international response:
• EARLY ACCESS TO TREATMENT SAVES LIVES.
The response model implemented in Guinea
proved early treatment can decrease mortality
from 90% to 40% (Nigeria 30%). Partners
implemented successful ETC care in locations
since the epidemic onset and continue to
scale-up in West Africa. (WHO)
When is it an outbreak over?
• An Ebola outbreak is officially considered at an end
once 42 days elapse without any new confirmed
cases.
Nigeria October 23, 2014 4 lessons how to stop Ebola
• Trace isolate treat
• Detect early, before lots of people can be exposed
• Strong leadership
• Public part of solution (National Geo)
Needs
• Donors matching needs
• Training
• Materials, Ebola clinical standards and
protocols
• Logistics
• Sanitation, infection control
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Psychological support
Community educators, liaison
People of influence, elders, chiefs
Medical and non-medical personnel
Logisticians, administration
Contingency, management, reporting
Innovation, science, data
• Epidemiological support including contract
tracing, safe burials and analysis of
epidemiological statistics reported by clinics
• Fuel, water, waste
• Restocking medical supplies
• Laboratory diagnostics (24 hour turnaround)
Serious concerns
• Fear, misinformation, discrimination of
victims, families, survivors, health care
workers, response workers, racism
• Slow, inadequate, underfunded response
compared to need
• Risk: continually ignoring ‘neglected’ diseases
October 24, 2014 Clinical Trials vaccine
• “The message we heard from WHO that the
people fighting the epidemic will be among
the first to test Ebola vaccines and treatments
is exactly the one we needed to hear,” Dr.
Bertrand Draguez, Medical Director for MSF
Dr Paul Farmer
• Africa’s Ebola problem is now America’s Ebola problem.
• The best way for the US to free itself of the terror of this virus is
to ensure that it is wiped out at the source, where the epidemic
is currently out of control. That will happen only through a
coordinated effort to provide the kind of basic, front-line health
care that we take for granted in the developed world but which
is tragically scarce in impoverished countries.
UN Ebola Coordinator
Sept 17, 2014
• $500 million not enough David Navarro
• World Bank pledged $200 M to help contain,
improve health systems, help with economic
impact throughout West Africa
• More needed to help with poverty, food
insecurity, protection
• Capacity can be legacy of outbreak e.g. training,
distribution, logistics, case management
Investment and incentives to develop
treatments essential
• investment in front-running vaccines, drugs and
diagnostics vital, and sufficient resources for
clinical trials and post-trial access need to be
mobilized by donors now.
• scientific data generated for each product under
clinical trials should be published in real time.
• The lack of approved Ebola products highlights a
key issue that must be urgently addressed: the
lack of sufficient investment and incentives to
develop them.
• UN emergency Ebola mission says 19,000
nurses doctors & paramedics needed by Dec 1
• “MSF understands and shares the concerns about Ebola
in this country[US], but anyone who is concerned about
the spread of Ebola, anywhere, to anyone, should have
been, and should now be, advocating for a more robust,
comprehensive, and active operational response to the
outbreak where it began and where it has done the most
damage, in West Africa.” Oct 29 2014
stories
USAID September 26 Grand Challenge Call for Ideas
What innovation, collaborations can do:
access to medicines
How does Ebola impact you & your
work?
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Awareness, risk in perspective, fact, science
Education
Advocacy
Disaspora outreach
Innovation
Future planning