CDC declares Ebola epidemic in West Africa

Director’s Ebola Epidemic Assessment Summary: Key Areas and Timelines

Based on a week long intense trip to the area, Dr. Frieden summarized a forward action plan in 5 key areas with 10 key steps to spur international response. For all of these steps to succeed, both adequate funds, and means to rapidly and effectively spend these funds, are also needed.

Incident Management. Effective and empowered incident management/Emergency Operation Center functioning in each of the 3 countries and in each sub-national area (approximately 15 counties in Liberia, 12 in Sierra Leone and 33 prefectures in Guinea).

• National and subnational emergency operations centers led by a technically sound Incident Manager from each affected country.
  • Establish basic functionality within 10 days (including reliable electronic communication with all areas of each country) and high level of functionality within 30 days.
  • Funding and flexible fund flow mechanisms to support hiring and travel of a dedicated cadre of staff for surveillance, contact tracing, and infection control and other essential functions needs to be established within 10 days.
• Transport.  Motorcycles (several thousand needed for the 3 countries), trucks (several hundred 4x4s needed) for transport of patients, bodies, supplies, equipment and staff, and other appropriate vehicles should be provided in ample number within 1-2 weeks.
• Active surveillance for suspected cases and deaths from all health care workers, individuals involved in burials, and community leaders should begin within 30 days and be fully established within 60 days.  By that time there should be an international surveillance/epidemiology expert in every sub-national area in each country.
• Staff and community resources for active case identification and contact tracing should be in place, trained, supervised, paid for their work, and reimbursed for their transport within 30 days.  People who have recovered from Ebola could be employed for this and other purposes to help reduce high levels of stigma in the community.

Treatment.  Emergently expand isolation and treatment capacity.

• Ebola treatment units.  As many treatment unit beds as possible are needed as fast as possible (e.g., at least 800 within 30 days).  
• A system of high quality in-country care or repatriation needs to be established within 30 days for national and foreign health workers who have significant exposure to or acquire Ebola.  To date, foreign medical teams have been reluctant to engage due to understandable concerns about their own care if they become infected.  Treatment facilities for health care workers, potentially with access to new treatments as they become available, are also a priority to build confidence of national and international health care staff.

Burial support.  Immediately and effectively address safe burial.

• Within 30 days, no dead body reported for collection should be left overnight.  Effective, culturally sensitive messaging should be undertaken in every part of each country to increase burial practice safety within 60 days.

Health care system strengthening.  Improve functioning including infection control throughout the entire health care system.

• The general health care system must be protected and confidence restored.  Latex gloves (many millions needed) and facilities for handwashing/hand sanitizing should be present at every facility.  Training on infection control and safe triage of patients should be undertaken.  A new cadre of full-time infection control practitioners, with one present at every facility with inpatient treatment as well as large outpatient facilities, should be established, trained, and supervised within 60 days.
• Bednets (along with soap if possible) should be distributed to every person in the 3-country Mano River area within 30 days to reduce the causes of fever (facilitating Ebola diagnosis), reduce burden on health care facilities, decrease avoidable illness and death, and improve trust and cooperation.

Communications.  Communicate clearly, simply, and frankly at all levels to mobilize communities including businesses and to change behaviors.

• Communications need to be urgently improved with simple, clear messages appropriate to local language and culture disseminated within 2 weeks and adapted based on evaluation within 2 months.

For more information about Ebola and CDC’s response, visit www.cdc.gov/vhf/ebola

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES