The effort, which is expected to begin in the next few weeks, is an intermediate step, officials said. The goal is to reduce the chances that Ebola patients will infect their own families and others while ensuring that they receive basic care — such as food, water and pain medicine — at a time when many hospitals and treatment centers are closed.
The initiative also is a tacit acknowledgment that it could be weeks, even months, before new treatment facilities promised by the United States and others are operational. Continued reliance on home-based care doesn’t do much good, officials said, in taming a devastating epidemic in a country where large groups of people live in crowded, urban settings.
The proposed community care centers, as they are dubbed by officials, would have between 15 to 30 beds. Ultimately, as many 70 centers could be set up across Liberia, if the strategy proves successful. Such a program has never been tried on such a large scale.
A similar effort is being discussed for Sierra Leone.
The
10 Ebola treatment centers in West Africa are based on a design of
three wards, which help separate patients suspected of having the
disease from patients with a certain diagnosis. Ebola care units would
have two wards (one each for both suspected and confirmed cases), with a
few beds per ward and a triage zone.
The total number
of cases of Ebola in West Africa is doubling every three weeks, with
each person with the virus infecting as many as two other people, health
officials say. That high rate of transmission is making it impossible
to contain the worst Ebola outbreak on record.
The new treatment beds promised by Washington and others “are not coming fast enough,” Peter Graaf, the WHO’s country representative in Liberia said Monday. “We have to get to the point where every Ebola patient infects less than one [other person]. You have to get out of your house.”
The community care centers are supposed to complement the recently announced U.S. military effort to build facilities for 1,700 Ebola patients across Liberia, as well as ongoing efforts by other groups to provide several hundred beds. There are now slightly more than 380 beds in Monrovia, which has a population of 1.5 million people.
One of the main organizations involved in fighting the outbreak, Doctors Without Borders, is dubious about the new effort and has decided not to take part. Brice de le Vigne, the group’s director of operations, warned that the proposed community care centers could worsen the situation.
“This is not going to work,” he said. “To move people in an epidemic is a big responsibility, and it requires huge logistical capabilities” that the affected countries simply don’t have.
To be effective, he said, these care centers need to have strict infection control, adequate supplies, trained staff, regular supervision, the ability to diagnose and refer patients, and proper burial methods. Otherwise, they could turn into “contamination centers,” he said.
De le Vigne said the top priority should be deploying more trained staff to run the higher-level treatment centers in hospitals and clinics.
Nearly 6,000 people in West Africa have been infected with the virus, and 2,833 have died, the WHO says. Liberia, the hardest-hit nation, has had more than 3,000 infections and 1,578 deaths, according to the latest WHO data.
But this laboratory-confirmed case count is well below the actual number of people infected, according to the WHO and global health experts. Doctors Without Borders, for example, has said that number represents only 20 percent of the current caseload, meaning the true number of cases could be in the tens of thousands.
“I think the message is that this outbreak isn’t going to turn around until we get people out of their homes and into safe places,” said Frank Mahoney, who is leading the team from the U.S. Centers for Disease Control and Prevention here.
No one would be relocated to the community care centers against his or her will. A draft report by the WHO stresses the need to work cooperatively with communities that want to isolate individuals who are infected or suspected of being infected. The project is aimed at people who are showing symptoms of the disease but are not in the later stages of the illness. Patients would get food, water, sanitation, analgesics and other necessities.
The care centers would be located in former health clinics or other medical facilities, many of which have closed, according to the WHO’s Graaf.
In contrast to the basic-care community centers, the medical facilities that provide special Ebola treatment — including the ones the United States and others will be setting up — provide a higher level of care and a better-trained staff.
Because many people with Ebola are being cared for at home, efforts are underway to distribute as much chlorine and as many rubber gloves, buckets and other hygiene items as possible. But officials say such steps don’t go far enough.
In a few locations here, residents already have started a version of the community-care program on their own, moving infected people into, for example, a shuttered school and attempting to feed and care for them without becoming infected themselves.
As envisioned, the new plan would be a somewhat more sophisticated alternative to that, including testing to determine whether a person has Ebola, anti-malarial drugs, infection control and body removal and cremation or burial. Each person moved into the center would be accompanied by a family member or friend charged with taking care of him or her; that relative would be supplied with protective gowns and gloves and taught their proper use.
Graaf said setting up the facilities, supervising them and getting the word out will be labor-intensive. He declined to say how much the plan would cost, saying those figures have not been finalized.
De le Vigne of Doctors Without Borders said the hardest-hit countries don’t have the infrastructure to put in place the logistics, discipline and clear chain of command needed for the community centers to work properly, especially when patients become sicker and need the higher level of medical care available at treatment centers.
“Once you start to vomit blood or have bloody diarrhea, you need to have properly trained medical staff and sanitation to be able to handle these super-infected cases,” he said... http://www.washingtonpost.com/national/health-science/new-effort-to-fight-ebola-in-liberia-would-move-infected-patients-out-of-their-homes/2014/09/22/f869dc08-4281-11e4-b47c-f5889e061e5f_story.html
