While only three cases of Ebola have been diagnosed on U.S soil, errors in communication have already threatened to spread the disease further (see the Ebola-exposed nurse who flew on a plane with permission from the CDC, even though she had a mild fever).
So it’s probably a good thing that President Obama has just designated an Ebola “czar” to coordinate efforts, because proper management and communication of the crisis is key to containing it. These factors are, in some ways, just as important as having enough medical supplies and beds for patients.
Just ask Frank Mahoney, a medical epidemiologist at the CDC who helped with the successful mission to contain Ebola in Nigeria. Before organizing Ebola case-finding efforts in Nigeria, Mahoney was the lead for the Nigeria Polio Response Team. Now that Nigeria’s situation is contained, he’s working on Ebola response in Liberia.
According to Mahoney, a number of techniques learned in polio eradication work were used to contain Nigeria’s 19 Ebola cases. “We did a lot of effort to quickly isolate patients, and put in place a very detailed contact tracing program to follow everyone who had come in contact with Patrick Sawyer [the original patient] and subsequent cases,” says Mahoney. Contact tracing, the practice of finding and monitoring anyone who recently had contact with the patient, is a time-consuming and labor-intensive process–in this case, it involved visiting 26,000 households.
“Initially, it was difficult to get data organized, and there were a lot of federal versus state issues of who’s in charge,” says Mahoney. One initiative that ultimately proved helpful: People who had previously been working on the polio program were brought in to run things in Lagos. They already had experience with a widespread infectious disease in the country.
“You’d track a contact, and all of a sudden they come in with full-blown Ebola. We were then reminded we didn’t have a supervision process in place, and we needed to maintain oversight. You needed to make sure people at the local level were really doing their job,” says Mahoney. “That was a lesson learned in polio–you need strong supervision and accountability in fieldwork.” Everything in Nigeria also became a lot easier once the response team had a functional rhythm–ensuring that people who didn’t need to be at meetings weren’t there, ensuring that meetings had a strong focus, and so on. Of course, it also helped that Nigeria is a comparatively wealthy country that had the resources and the wherewithal to move quickly.
The same principles of adherence that helped Nigeria could also be useful in the U.S. “One thing we were fortunate to have in Nigeria was on-site mentors that helped set up treatment centers. If you haven’t managed an Ebola patient, it’s extremely difficult,” says Mahoney.