From 2014 to 2016, the Ebola virus spread in Guinea, Sierra Leone and Liberia. A total of 28,646 people were infected, and 11,323 died of the disease. Treating 5,226 confirmed Ebola-patients, Médecins sans Frontières (MSF) also invested in researching how the virus spread, how well possible treatments worked, and what the consequences on local health systems were.
In their article entitled Operational Research during the Ebola Emergency, members of MSF’s Operational Research unit in Luxembourg and Brussels assemble the key findings and insights.
Six Pillars to Fight Ebola
Fighting the Ebola outbreak required a complex and well-coordinated response. In close collaboration with partners, MSF followed an established approach: confirmed Ebola-patients first had to be isolated and treated in dedicated Ebola Treatment Centers. Anybody with prior contact to patients needed to be retraced immediately. In affected communities, raising awareness for the disease and infection risks was important. Setting-up a surveillance and alert system then helped ensure infection control in communities and treatment centers. Finally, regular health-care for non-Ebola patients had to be maintained.
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Kailahun, Sierra Leone. MSF Ebola Treatment Centre. Two medical staff are bringing a weak patient who has been in contact with people infected with Ebola to the admission. © Sylvain Cherkaoui/Cosmos pour MSF
Across these six pillars of the Ebola response, operational research questions helped improve MSF’s operations during the epidemic. The findings now offer a unique perspective on how humanitarian actors can better respond to future outbreaks.
Important Viral Loads, Alternative Blood Tests and Trial Drugs
For an early assessment of suspected Ebola-cases, clinical symptoms such as fever, muscle pain or diarrhea helped doctors and health workers assess and quickly identify infected patients. Research suggests that the viral load – the level of the virus in a patient’s blood – then helps reliably predict a patient’s chance of survival and to tailor the right medical care.
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Un assistant amène des échantillons de sang de cas suspects. Le laboratoire sur place déterminera en quelques heures si les échantillons contiennent ou non le virus Ebola. © Sylvain Cherkaoui/Cosmos pour MSF
Medical professionals need to wear bulky protective gear when working in Ebola Treatment Centers, making it more difficult to look after patients and perform medical tests. While blood samples are generally taken from patients’ arm veins (venipuncture), data from Guinea shows that the more practical and less invasive finger stick test was able to detect 87% of Ebola cases. For very young children or in environments where venipuncture is not possible or deemed unsafe, finger stick blood tests thus offer a real alternative.
MSF together with the Institute of Tropical Medicine in Antwerp also launched a clinical trial testing convalescent-phase plasma – a serum gained from recovered Ebola-patients – but found it not to help newly infected patients. The trial drug Favipiravir, on the other hand, showed good effects on patients with a low Ebola viral load.
Counselling Patients and Working with Communities
Surviving Ebola can leave deep marks on the mental health of patients. In Sierra Leone, one out of five survivors of the Ebola virus disease was found to be at high risk of developing posttraumatic stress disorder, and psychologic counselling teams were employed throughout the outbreak.
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Bentu Sandy, un survivant d'Ebola qui travaille maintenant avec MSF à Bo en tant que conseiller en santé mentale, célèbre la sortie d'Agustine. Agustine est une pharmacienne qui a attrapé Ebola alors qu'elle travaillait. © Anna Surinyach
In communities affected by Ebola-infections or strict quarantine measures, MSF anthropologists looked at the social consequences of the epidemic. Enforced quarantine zones designed to stop the spreading of Ebola and to save lives often caused a feeling of condemnation and lead to stigmatization. Health promotion messaging was adjusted accordingly, and different means of communication remain to be explored to counter a climate of rumour and suspicion in affected communities.
Maintaining Health Care during the Ebola-Outbreak
The fight against Ebola required vast human and medical resources and overwhelmed local health systems. MSF, the World Health Organization (WHO), the Special Programme for Research and Training in Tropical Diseases, Ministries of Health and other organisations therefore organised two Structured Research Training Initiatives focusing on the effects of the Ebola outbreak on health system performance.
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Un infirmier offre une leçon sur le paludisme aux mères d'enfants recevant des soins dans le service général de pédiatrie de l'hôpital MSF de Monrovia, au Liberia. 28 septembre 2016. © Diana Zeyneb Alhindawi
As the resulting sixteen different studies show, medical service delivery outside the Ebola response suffered drastically during the crisis. Negative effects were observed in crucial programmes treating HIV/AIDS, tuberculosis, malaria and malnutrition, in vaccination campaigns, and in mother and child health care.
In some cases, health workers managed to adapt medical procedures during the Ebola outbreak. In the Kenema District in Sierra Leone, community health workers stopped using rapid malaria diagnostic tests to respect the “no touch” policy in place due to Ebola, and treated clients based on symptoms instead.
Inspired by the pressing issues and experiences of staff in the field, operational research findings overall helped strengthen MSF’s emergency response and further analysis of collected data is ongoing.
The Article on Operational Research during the Ebola Emergency was published in “Emerging Infectious Diseases”, the sixteen studies on health programme performance during the Ebola Outbreak in “Public Health Action” in June 2017.
A comprehensive report on MSF’s operational research on Ebola is also available, and all related articles are published at http://fieldresearch.msf.org/.
* Main picture: Dressing area of Kailahun Ebola management centre in Sierra Leone. Two hygienist are getting ready to enter the high-risk zone. December 2014. © Anna Surinyach
