“I have no idea what’s awaiting me, or what will happen when this all ends. For the moment I know this: there are sick people and they need curing.”
― Albert Camus, The Plague
What shall we do? The Rubicon is crossed! The die is cast and Ebola has declared a war on us. We have to fight, as in all human endeavours, and win if we have to prove our ingenuity and snatch our generation from extinction.
I write this as a pharmacist and a researcher in drug development and, hence, from a perspective which may add to what virologists and public health experts may advise.
There will have to be a long term strategy which should converge at finding a vaccine and/or some form of treatment for this virus. On all accounts, development of a vaccine or treatment is a difficult one. Due to infrastructure and financial limitations, this is presently out of the reach of healthcare stakeholders on the continent. The research and development required for a drug useful in this area will probably have to be funded by the benevolence of development partners outside the continent. My experience with the drug development industry makes it difficult to believe we might have a drug for Ebola for the next several decades. Having first emerged nearly 40 years ago, the sporadic occurrence and the numbers involved have not warranted a rigorous attempt to find a drug for the infection yet. Moreover, as typical with many viral infections, the scientific challenges greatly impede the progress of finding an effective drug intervention if there ever will be. So with these on the table, I am more concerned about what can be done in the short to middle term is to effectively contain this outbreak in the absence of any drug treatment.
Fortunately, a number of factors give hope that this menace can be effectively contained if all get involved with determination. There are different types or strains of viruses that could be responsible for Ebola. A strain, usually in biology and related subjects is a subtype or a specific variant among a family of organisms. As far as we know, the strain that has struck the sub-region presently is not air-borne. This implies that the modes of transmission are well within our control if we strategize effectively.
There are several precedents that can inform a strategy to be adopted to deal with this outbreak. One that comes to mind vividly is how the UK dealt with a troublesome bug that struck hospitals some years back – Methicillin-resistant Staphylococcus aureus(MRSA). As the name suggests, it was resistant to the most effective antibiotic known to eliminate this infection. There has not been any new drug developed for MRSA till date. However, an adherence to a set of rigorous protocols of screening programmes, surface sanitisation, hand washing, effective disposal of used hospital equipment and isolation alongside an effective public education and awareness campaign proved valuable in the fight against MRSA. Nearly a decade into this practice, MRSA is no longer the threat it used to be. A similar model could be adopted in the case of the fight against Ebola. Systems and structures devoid of unnecessary political interference should be marshalled immediately if we are to contain this menace in the best possible way.
Our first line of defence should be an effective public health structure. This is a wakeup call for us that public health is not all about useless and outmoded workshops and so-called experts sampling hotels with fine dining around Geneva and Addis Ababa. It must be practically useful, effective and flexible enough to be quickly reorganised to respond to health threats without valuable time being lost. We will have to reform public health concepts to fit well in our unique context, not forgetting resource limitations. Politicians must give room and deploy the needed financial resources to technical personnel to operate to the best of their knowledge. It would also be helpful if politicians and their sympathisers are moral and sensitive enough to know that making political capital in the midst of threats as severe as the outbreak of an infection, which can reach a mortality of 90% among its victims, is never acceptable and most inappropriate.
Experts claim an efficient rehydration and fever management with readily available medicines like infusions and paracetamol at the onset of the infection are crucial to the survival of victims. It is, therefore, expected that trained and dedicated personnel are knowledgeable and equipped to pick up early signals in patients for immediate treatment. An effective public health system should not be overwhelmed with the logistics and distribution of essential equipment and medicines nationwide. Short supply of these essentials could be a major limiting factor in efforts to contain this outbreak.
Being a highly contagious infection, a scheme to keep cross-contamination minimal is crucial. Herd immunity, a concept in vaccination which defines protection of a population by the number of people immune to a particular disease, could be useful here. Simply, the fewer the people affected by this infection, the better the protection for the rest of the population. This will call for strict adherence to quarantine protocols and in case of victim’s death, some traditional practices and ceremonies must give way for preparation for burial in a manner that allows very minimal contact with bodies; of course whilst ensuring the highest standards of hygiene.
An approach to keep cross-contamination minimal would benefit from a well coordinated scheme defined by personal hygiene, sanitation and personal protective equipment. The fact that most viruses are fragile once outside their host tissue means most of the disinfection procedures would be effective, halting contamination, especially when the right quality and quantities of chemicals and environmental conditions such as temperature are applied and enforced. The real concern here will be an adequate provision of personal protection equipment for frontline healthcare staff dealing with Ebola cases. While financial constraints may impede acquisition of sophisticated protection equipment to go round the country, it is not beyond us to fill the gaps with improvised ones that combine sound bio-safety principles and innovation to offer the much-needed protection for frontline personnel. Total coverage ensuring complete isolation of staff attending to patients must be a mandatory requirement. Disposal of clinic waste, especially where Ebola cases are being treated, must be handled in most professional manner and in strict adherence to a well-defined operating procedure.
It will be remarkably helpful that leadership of public and healthcare institutions involved in community health give utmost attention to the points discussed so far as well as many others that experts have advised. It is worthy of repeating for emphasis that as far as we know, this strain of Ebola is not airborne and hence well within our scope to deal with the outbreak to ensure minimal loss and damage. The biggest beneficiary or otherwise in this, whether successful or failing in containing this menace, is the population at large. It is on record, as at the last count, that this present outbreak is more than twice as large as the previous outbreak and this is worrying. Nonetheless, by official statistics and definitions, we are still at a point where complying with adequate measures could see an end to this outbreak. Critical changes in attitudes, traditional beliefs and health-seeking behaviour among the entire populace are the keys in bringing this terror under control. This shift is worth elaborating further.
The speed with which this infection ran its course towards the death of its victims means the most effective way of managing the symptoms to buy back some of patients’ immunity to contain this virus cannot be downplayed. A comprehensive public awareness and education must be rolled out in all accessible forms for wide and effective reach. Media houses by way of public service can offer their platforms for dissemination of vital information to empower us all in identifying and handling potential cases in our communities; not forgetting the need for ensuring quick access to medical facilities for help.
Furthermore, this viral infection does not mark time while we hamper effective and comprehensive treatment regimen with unnecessary superstitions from religious and traditional beliefs. It is definitely not enough to blame witchcraft and evil forces without seeking immediate medical attention and hence a change in attitude to this effect will be helpful. It will be naïve to assume that this outbreak will change a whole subculture of persistently confusing issues requiring common sense approach with needless mystery. However, if people insist on the need for sending people suffering haemorrhagic fever to already crowded prayer camps and similar places for ‘healing’ then in the interest of public safety, law enforcement agencies may find it useful to redefine the extent of people ‘freedom of worship’.
As a mentor, also a prolific writer and commentator on national issues, Nana Awere Damoah has casually stated, our public health approach as a nation has always been the ‘God’s grace’ strategy! This observation cannot be further from the truth. But as good students of the Bible might have found, the scriptures is replete with specific instructions to uphold hygiene, sanitation and good health at all cost. We must find empowerment in God’s grace to act out these specific instructions, otherwise like the lazy servant in the Parable of Talents, the good Master will as a matter of principle take back our privilege and throw us into the fire… and here, the fire is Ebola!
Since writing this article, CNN has reported that antibodies generated from mice infected with Ebola virus are seen to prevent the virus from infecting new cells. This is a positive development. However, we must be cautiously excited as several steps, trials and clearances will have to be successful for this to be available for public use. As typical with every drug development project, we could still be several years away from having a drug for Ebola and that is if all requirements are met.
By: Francis Asamoah Brako
Pharmacist and researcher, London School of Pharmacy (UCL)