CDC Director on Ebola – An Urgent Response is Needed

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The following is an excerpt of the transcript of CDC Director Tom Frieden’s teleconference on the continued efforts to contain the recent Ebola outbreak.

The transcript in its entirety may be found here, with audio here.

TOM FRIEDEN:

dr frieden“Thank you very much for joining us today. I’ve just returned from West Africa yesterday. I visited all three countries where Ebola is spreading. The men, women and children I met and spoke with, the health care workers responding to people from within countries, patients, the survivors and relatives of those who died will always be with me.

The bottom line is that despite tremendous efforts from the U.S.  Government, from CDC, from within countries, the number of cases continues to increase and is now increasing rapidly.

I’m afraid over the next few weeks; those numbers are likely to increase further and significantly.  There is a window of opportunity to tamp this down, but that window is closing. We need action now to scale up the response.

We know how to stop Ebola. The challenge is to scale it up to the massive levels needed to stop this outbreak. This is really the first epidemic of Ebola the world has ever known. By epidemic what we mean is it’s spreading widely through society but not spreading through new ways according to everything we know. It’s spreading from just two roots — people caring for other people in hospitals or homes. And unsafe burial practices where people may come in contact with body fluids of someone who has died from Ebola. That is really the Achilles heel of this virus. We know how it spreads. We know how to stop it from spreading.  The challenge is to do that everywhere that’s needed. In order to do that effectively, speed is key.

The number of cases is increasing so quickly that for every day’s delay, it becomes that much harder to stop it.

There are three key things that we need. The first is more resources.  This is going to take a lot to confront. The second are technical experts in health care and management to help in country. And the third is a global coordinated unified approach because this is not just a program for — this is not just a problem for West Africa, it’s not just a problem for Africa, it’s a problem for the world and the world needs to respond. 

DrFriedenQuoteI’ll start with what’s happening now and some of the things I saw. I met a young woman, I’ll call her Fatima. She is 22. She’s in the fourth year of a four-year program at university. And her sister in law came to visit from Sierra Leone. Her sister-in-law’s young child, daughter, 10 years old was ill. She held the child in her arms and comforted her. That’s how she became infected with the Ebola virus. 

Because other people in her family had also become ill and been diagnosed, she learned early that she had Ebola and she was able to go to the treatment unit and she was able to be saved.  Earlier treatment with the tools that we have at hand saves lives and reduces spread in the community. But while she was in the treatment center, I asked her what was the hardest thing about it? She broke into tears, and she said she was next to her big brother when he died horribly from Ebola. She was horrified by the symptoms he was having. She was horrified that she couldn’t help him. She was terrified that she was next. That’s the kind of reality that people in this region are dealing with every single day. 

I went into the Ebola treatment unit that doctors without borders or MSF has set up.  And there I saw patients surviving; patients recovering, but also tremendous needs.  MSF is working under incredibly difficult circumstances, so difficult it’s even hard for them to keep up with providing basic care for the people there.  But by helping get those people care, they’re saving lives, and they’re preventing spread in the community. 

In some ways, what I saw — in some ways the most upsetting thing I saw — is what I didn’t see.  I didn’t see enough beds for treatment.  So in one facility which had just opened with 35 beds, there were 63 patients, many of them lying on the ground. 

I didn’t see data coming in from large parts of the country where Ebola might be spreading.  I didn’t see the kind of rapid response team that’s needed to stop a single cluster from becoming a large outbreak.  I didn’t see the kind of efficient management systems and support and transport and jeeps that are essential for a rapid and effective response.  That is the situation now.  Everything I’ve seen suggests over the next few weeks it’s likely to get worse.  We’re likely to see significant increases in cases. 

Already we have widespread transmission in Liberia.  In Sierra Leone, we are seeing strong signs that that will happen in the near future.  That’s why I spoke to people at every level of each society, from patients, survivors, families, health care workers, people who run health care facilities, ministers of health and each of the presidents to think about what we can do together to get this under control.  Because it’s not just in the interest of these countries to get it under control. 

For every day that this continues to spread in West Africa, the likelihood of someone getting infected and becoming sick elsewhere increases.  And we expect that there will be more people in countries like Senegal and Nigeria who come in and have the illness.  That means as long as Ebola is spreading anywhere, all of us need to be concerned and make sure we’re identifying people who could have it and taking prompt action so it doesn’t spread. 

There’s also a real risk to the stability and security of societies as governments are increasingly challenged to not only control Ebola but provide basic health services, security services, and keep the government running, the stability of these countries, of their economies, of their neighbors and of others is increasingly at risk.  And there is a theoretical risk that may be very low; we simply don’t know that Ebola could become easier to spread through genetic mutation.  That risk may be very low, but it’s probably not zero.  The longer it spreads, the higher the risk. 

Faced with all of those challenges, it’s certainly possible to feel hopeless, and there are times in my career where challenges have seemed to be overwhelming.  But it’s not hopeless.  We do know how to stop Ebola.  The window of opportunity is not yet closed.  We can turn this around.  Sometimes the problem can seem so large it’s hard to get started.  But we can chip away at the challenges one by one and begin getting the situation under control.  We can work with communities that don’t yet have Ebola in these countries, to have them well prepared so if a single case occurs, it stops there.  We can work in the communities where Ebola is spreading widely to make sure we tamp it down as much as possible and we give care and treatment to those who need it.  The countries are willing. 

In an Ebola treatment unit run by doctors without borders (MSF), more than 90 percent of the staff are local.  I saw a unit in the capital of Guinea where there was only one international staff or two international staff working last week.  The Guineans, the Liberians, the Sierra Leoneans are learning how to handle this.  Each president said the same thing to me, tell us what to do, we will do it.  If we can’t do it, help us to do it.  Teach us to care for Ebola patients, to set up a treatment unit, to manage the system more effectively.  If we can’t do it ourselves, help us with those things, whether it’s trucks, personal protective equipment, more medical experts or management experts. 

The countries are engaged, they’re willing to stop it.  They need the world to work with them.  This isn’t just these countries’ problem, it’s a global problem. 

In the Ebola treatment center, I got a sense of what it’s like to work in personal protective equipment.  It’s roasting hot, very difficult to move, a distressing environment to work in because you see the enormous needs and you realize there may be some risk.  Sweat pours down into your goggles and into your eyes, the ability to draw an intravenous line or draw blood is hard with two sets of gloves.  That’s the difficult environment people are working in.  But MSF never has had the slightest problem to get people to work there from within the countries.  They train them.  They support them.  And the people in the countries themselves are willing to do their part. 

I talked to the director of one group that does very important work.  It’s a little gruesome. It’s the burial team. The number of dead bodies is increasing.  It’s hard for the burial team to keep up.  The burial team needs to work in that same, full, personal protective equipment. You need multiple members there’s to make sure they’re removing the bodies safely.  One of the teams was working until 10:00 at night.  When they got home after being — making sure they safely removed their personal protective equipment — their family and community was not letting them sleep in the house, because of stigma. They had to sleep on the ground; they got up the first thing the next morning to begin the same work.  They’re committed to stopping the outbreak.  All of us have to have that same level of commitment.  All of us have to ask what we can do to stop it. 

I went to a call center where 100 volunteers are working 24 hours a day, seven days a week without pay to answer thousands of calls a day and route them to where people can address people’s needs.  Every community has strengths.  One of the challenges is to identify how to enlist those strengths in fighting Ebola. 

For example, there are large businesses in these communities that have taken a role in supporting the efforts.  I went, for example, in Liberia to the Firestone company, which is, as I understand, the largest rubber plantation in the world.  They had Ebola cases.  They realized they were going to have to manage them themselves.  They created an Ebola treatment unit.  They got the floor plan, they did it themselves, they trained their staff, and they admitted everyone who had Ebola.  They got the tests done by the CDC lab there. And they identified 73 contacts.

They placed all of those contacts into rooms, monitored them for 21 days, 11 of those contacts became ill with Ebola.  They immediately put them into the isolation facility and they did not have a single additional case.  Their Ebola outbreak stopped. 

The same thing was done by the military in Sierra Leone.  So, those same tools that are working to stop Ebola in individual communities need to be scaled up widely throughout Liberia and Sierra Leone and Guinea which is in considerably better shape as of today.  Take this as a warning because they also have seen a big increase in the last couple of weeks.  The approach has to be specific to each community. 

In theory it’s not hard to stop Ebola.  We know what to do.  Find patients quickly.  Isolate them effectively and promptly.  Treat them.  Make sure their contacts are traced and tracked for 21 days, if they develop fever, do the same thing and make sure they’re tested and treated.  Make sure health care is safe and that burial practices are safe.  The challenge is not those efforts, it’s doing them consistently at the scale that we need. 

One of the most experienced Ebola experts in the world was there on one of my site visits, his comment to me summed up my visit.  “What has worked to stop every Ebola outbreak until now will work here if we can get it to scale.”  That’s the number one challenge.  That’s why I do have hope.  That’s why the window is not yet closed.  Because we can make progress community by community little by little to turn it around.  We know how it spreads.  We know how to stop it.  There’s a lot that everyone can do. 

If you want to help there are great groups that are helping out there.  Whether it’s MSF, Doctors Without Borders, UNICEF, the CDC foundation or any other group helping on the ground. If you have specialized skills and are willing to work and have worked in this kind of environment before (it’s not something for someone who has not been there before in this kind of environment), not only doctors and nurses, but people who know how to run a health care facility in low-income country and work in environments, contact a group like MSF or the world health organization or save the children or others that are involved and see if you can be of assistance if you can do that. 

For everyone else, it’s really important to recognize that we are all in this together.  Like it or not, we’re in an interconnected world.  And what happens in West Africa has a direct bearing on our own ability to go about our lives.  We can stop worrying about it being here when it’s controlled there.  But the window of opportunity really is closing. I could not possibly overstate the need for an urgent response. 

An urgent response to get more patients into care, more work getting done in the communities, safer burials, all of these things will begin to get this outbreak under control.  While I fear we will see a worsening over the next couple of weeks, I remain confident that we can make a difference here, it’s not too late, and that we can control it if we act now. 

I’d also like to say that I also saw many signs of hope.  I got to hold a 2-year-old kid who’s healthy, kicking, and she’s a survivor.  She had Ebola, her parents have died.  But she’s being raised by family.  She’s strong.  She’s learning.  And she’s a symbol of hope.  We’re seeing an increasing number of people surviving Ebola.  While some of them are experiencing significant stigma in their communities, many of them are a big part of the solution.  Getting the message out that we can beat Ebola, that individuals can survive Ebola.  There’s nothing mysterious about what we need to do.  The only real question is whether we’ll do it fast enough.”

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