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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Ebola: The Beginning of the End or the End of the Beginning?

January 20th, 2016

By Gary Evans, Senior Staff Writer

It’s bad enough that the announcement of the end of the Ebola epidemic was rudely interrupted by the virus’s loyal companion, death. Now we find that after two years of Ebola horror in West Africa this latest patient was treated like an unrecognized index case, with no diagnosis made despite presentation of the classic symptoms and concerns that health care workers did not wear adequate barrier protection.

Some 100 patient contacts are now being followed, forestalling the end of the current epidemic and eroding any confidence of our ability to stop whatever arises next. “Perhaps the most disconcerting aspect of the new case in Sierra Leone was not that it occurred so soon after WHO's proclamation, but that Ebola wasn't diagnosed until after the patient died,” notes Nahid Bhadelia, MD, an infectious disease physician at Boston Medical Center and the director of Infection Control at the National Emerging Infectious Diseases Laboratory.

In a blog post for National Public Radio, Bhadelia reports several disturbing aspects of the case of a young woman who developed symptoms at the beginning of this year after traveling to the Tonkilli area of Sierra Leone that was one of the last to be declared Ebola-free. These include:

• She went a local hospital with clear symptoms of diarrhea and vomiting but was not diagnosed with Ebola. The diagnosis was not made until the patient died.

• The health care worker who drew her blood did not wear the appropriate personal protective equipment and the woman's blood sample may not even have been tested for Ebola.

• She was eventually discharged to die at home rather than being isolated, and dozens of other people have been exposed.

Subsequent cases were certainly expected to occur even as the Jan. 14 WHO announcement was made, but the strange lapses in the case raise disconcerting questions about the response to future emerging epidemics -- let alone ending this one. In that regard, Bhadelia cites a survey by the Skoll Global Threats Fund that found 90% of epidemiologists polled said they expect a large pandemic in their children or grandchildren's lifetime, one that could affect over a billion people and cause global recession.

“Having worked for months in Sierra Leone over the past two years, I can bear witness to the toll this epidemic has taken on affected communities,” she concludes. “Nothing could be more tempting than to put this behind us. … Rather than thinking of beginnings and ends, we need continuous surveillance for threatening infectious diseases that are both known and yet to be discovered. We need to move from a culture of outbreak response to one that focuses on prevention.”