Ebola hemorrhagic fever - its name strikes fear in most people, even those who live far from its epicenter in West Africa where the World Health Organization estimates there have been 5,800 cases so far. Ebola often starts with symptoms of fever, fatigue, headache, joint/muscle/abdominal pain, and loss of appetite—symptoms similar to a number of other ailments, including the flu. But Ebola is not the flu—it is much more lethal, killing at least sixty percent of the people it infects. So what does the global community need to know about the threat of Ebola and the public health strategies being taken to control it?
First, the United States and other nations are engaged in an energetically global public health response to Ebola. It is an exemplary and extraordinary effort, showcasing the best of what coordinated public health policy can achieve in the face of a deadly, population-level threat. Along with the Bill Gates Foundation’s $60 million commitment to fight Ebola, America’s response, showcased by President Barack Obama earlier this week—with a promise of 3,000 U.S. troops to assist Liberia with training health care workers and building new facilities—to the Ebola crisis underscores the value of early, targeted strategy to limit the spread of infectious disease organisms. The U.S. response typifies what is best in public health—namely, quantifiable measures to limit or reduce the eventual size of an epidemic.
Second, there are four Level 4 Bio-containment units (BCU) in the United States – Montana, Nebraska, Georgia, and the National Institutes of Health. These units have only about a 20-bed capacity, and they will need to identify other hospitals willing to take Ebola victims. It is important to note, however, that normal bodily fluid precautions are adequate for the treatment of Ebola. We really do not need the highest level of care for most patients. One of the challenges for the Centers for Disease Control and Prevention is the perception of the public that Ebola is easily transmitted because of the first few patients repatriated - with police escorts, moon suits, and BCU’s. That is a hard message to reverse. The public likely expects that kind of care as standard for this disease. Institutions that are identified as Ebola units may have a difficult time maintaining their other admissions due to public fear, if Ebola spreads beyond West Africa to other countries.
Third, although there is a pressing need for clinical care professionals, infrastructure support, and support for patients in West Africa, there is an equally important need to incorporate an understanding of cultural factors that have caused and sustained this epidemic. This likely will require a major push to train a cadre of national community facilitators versus only clinical healthcare workers. Horizontal communicators, opinion leaders within target communities who have exceptional ability to influence the behaviors of these communities, will need to engage people using interventions based on their values and beliefs. This is true community empowerment/engagement and stems from the field of cultural communications. Public Health has been developing these competencies and can be very helpful in this endeavor