Elizabeth Cohen says that on paper, we know how to stop Ebola
We have not been able to execute that plan, she says
While in Liberia, Cohen saw indications that we don't know how to end the epidemic
Last month, President Barack Obama declared that the world knows how to fight Ebola. Three days later, on my way into Liberia, I asked: Is he right?
And my answer, after spending a week in Liberia, is no.
On paper, we do know how to fight Ebola. You isolate patients and keep track of the people with whom they had close contact while they were contagious, and if those contacts get sick, isolate them and start the cycle over until the disease burns itself out.
But knowing how to do something intellectually isn’t the same as knowing how to execute that solution. Execution requires management and control over details at a level that I don’t think we have right now.
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Horrifying video from Liberia shows Ebola patients collapsing on the ground outside the Island Clinic because no one was there to escort them in. Isolating the infected is crucial to stopping this epidemic, and the most basic first step toward isolation – getting the patients inside the hospital – failed.
The day after we visited the Island Clinic, I showed the video to Peter Graaff, the World Health Organization’s representative to Liberia, since the WHO and the Liberian government are the clinic’s sponsors. He was horrified and said he’d had no idea this had even happened.
Graaff had been at an elaborate ceremony opening the clinic just hours before these patients fell to the ground. Did he stick around afterward to make sure everything was working properly? Did he go back to the clinic the next morning to see how things were going?
No, he told me. He left after the ceremony and didn’t return. “I didn’t want to get in the way,” he said, of the Ugandan team of doctors the WHO had contracted to run the place.
When I asked Graaff why there was no one to bring in the Ebola patients, he said he didn’t know, but perhaps the clinic was “overwhelmed” as it nearly filled up in its first day.
This answer underscores my point. Why was it overwhelmed? For weeks, everyone knew there were long lines to get into Ebola treatment centers. It was no mystery that patients would be flocking to the new clinic the minute it opened. Why wasn’t it prepared for something as basic as bringing patients inside?
While in Liberia, I saw other indications that we don’t truly know how to end this enormous epidemic. After isolation, the second crucial step in controlling the outbreak is to follow people who were in close contact with Ebola patients to see whether they develop symptoms of the disease.
In Liberia, I met Fatu Kekula, a young woman who by any definition is a supercontact. Without proper protective gear, Kekula single-handedly took care of her Ebola-stricken mother, father, sister and cousin at home. She clearly should have been followed up with by authorities, but she says no one ever contacted her. Other contacts in Liberia told me similar stories.
When I mentioned these problems to international aid workers in Liberia, they lamented that not enough money had been spent early on to get the outbreak under control. That’s certainly true, but perhaps it’s not just about money.
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It’s also about what Dr. Michael Osterholm at the University of Minnesota calls “command and control.” You can put millions upon millions of dollars into containing Ebola, but if the response isn’t well-organized, the outbreak will win in the end.
A U.S. federal official familiar with the situation told me that this spring, the Centers for Disease Control tried to go in and help, but the WHO’s African region resisted, saying they could handle the situation.
It was only when CDC Director Dr. Tom Frieden personally reached out to Dr. Keiji Fukuda, the WHO’s assistant director-general for health security, that things changed, according to the official. Fukuda flew from Geneva to West Africa, saw his agency’s resistance and paved the way for CDC to get involved.
Although we don’t seem to know how to fight this particular Ebola outbreak, there is good news: We can learn. We can learn how to manage. We can learn how to execute. We can develop good command and control.
It’s on you now, Maj. Gen. Darryl Williams. Williams, the U.S. Army-Africa commander, is leading the U.S. military’s response – officially called Operation United Assistance.
Welcome to Liberia.