New Management Approach to Ebola May Save Lives
by Lynn Hetzler
Educating people in areas affected by Ebola about how the disease spreads is the most effective approach for stopping the epidemic and saving lives, according to a new study.
Ebola is a virus transmitted principally by direct physical contact with an infected person or their blood or body fluid during the late stages of the disease or after death. Contact with dead individuals or their blood and body fluid is common in West Africa, where family members frequently touch and wash the body of a deceased individual in preparation for burial. These cultural practices in high-incidence areas can expose family members to the Ebola virus and increase transmission rates. Unfortunately, many communities in high-incidence areas had not been accepting of changes to their burial rituals.
Confusion created by multiple prediction models also caused significant uncertainty during the 2014 Ebola outbreak. The research conducted by scientists from Penn State University suggests a new management approach that may save lives by preventing another outbreak of Ebola from turning into an epidemic.
Uncertainty in the 2014 Ebola Outbreak
More than 28,600 people contracted Ebola, according to the World Health Organization (WHO), and more than 11,300 have died from the infectious disease. The worst outbreak to date occurred during 2014. During that outbreak, researchers created and used a number of different intervention models in hopes of determining the best strategy for halting the spread of Ebola.
Confusion was one of the factors driving the 2014 Ebola outbreak, as various models gave conflicting estimates on the number of infections that were likely to occur. Many communities based their Ebola management strategies on these estimates, which often fell drastically short of the actual number of cases because the models did not consider factors that could influence spread of the disease. In the case of the 2014 Ebola epidemic in particular, many prediction models failed to include funeral traditions that drastically increase exposure to the virus, or the implementation of education aimed at reducing transmission rates. In this way, then, differences in prediction models can distract from the ultimate goal of limiting infectious disease outbreaks.
“When a disease outbreak happens, there is a lot of uncertainty regarding how the epidemic is going to spread in the future. However, we can’t afford to wait before implementing control — we need to make rapid decisions in the face of this uncertainty,” said a researcher involved with the study, Dr Michael Tildesley from Warwick’s School of Life Sciences and Mathematics Institute, in a press release. “Our approach allows us to make best use of the information that is available and to manage an outbreak in the most effective way, thus saving lives.”
Saving Lives Through Consistent Projections and Education
The new approach proposed by the researchers identifies consistent patterns in projections. Consistency in projection estimates gives policymakers, researchers and healthcare providers the accurate and reliable information they need to save lives.
In the newest study, the researchers reassessed 37 of these models with the goal of identifying the most consistent approach to managing Ebola outbreaks. The scientists used various methods to simulate several different outbreak scenarios. Methods included increased hospitalization, reducing transmission rates at funerals and community education focusing on disease transmission.
During the evaluation, two management strategies emerged as the most effective: lowering transmission rates in the community and decreasing Ebola transmission rates at funerals. Specific strategies for lowering community transmission rates included decreasing risky behavior, encouraging people who are sick to stay at home, the provision of household sanitation kits and expanding community awareness about the transmission of the disease.
Ensuring safe burials can also help reduce Ebola transmission rates at funerals. During times of high Ebola activity within a community, family members may perform a safe burial by using personal protective equipment, placing the body in a leak- and puncture-resistant plastic body bag, and burying the body in a grave that is 2 meters deep or deeper. Educating the community about the way Ebola spreads is essential, in that patients in West Africa receive a substantial amount of their care at home from family members.
The reassessment of the 2014 models showed some strategies did not effectively contain Ebola outbreaks. Strategies focusing on increased hospitalization rates and reduced Ebola transmission rates at hospitals, for example, did not rank well in the new analysis.
Most of the cases of Ebola — and most of the deaths — occurred in the 2014 outbreak. By March of 2016, there were 28,646 cases and 11,323 deaths. If another Ebola outbreak occurs and the epidemic reaches those same numbers, using the new approach could reduce cases by 3,266 and save 1,633 lives.
“Our approach synthesizes data from many models and provides two important pieces of information. It identifies the best course of action, given what we know now, and highlights the gaps in our knowledge that actually matter to the selection of interventions strategies,” said Shou-Li Li, postdoctoral researcher at Penn State and first author of the study.
“It could guide the management of outbreaks where rapid decision making is critical, including diseases we know a lot about, like influenza, those that we don’t know a lot about, like Zika, and those that we don’t even know exist.
“The difference between the projections and the actual size of the 2014 Ebola outbreak caused intense public debate. But rather than focusing on how big the outbreak would be, our study focused on what to do to keep it small?”
In short, they found that education about how Ebola spreads could reduce infections within the community and at funerals.
Published in the Proceedings of the National Academy of Sciences, the research received funding from the Biotechnology and Biological Sciences Research Council (BBSRC) in the UK, the National Science Foundation and National Institute of Health. The Huck Institutes of the Life Sciences also provided support.