US cities' Ebola lessons yield readiness checklist

Analyzing the experiences of four US cities that managed or detected confirmed Ebola cases, experts from the Johns Hopkins Center for Health Security and the US Centers for Disease Control and Prevention (CDC) developed a checklist to help local health sectors strengthen their response to similar high-consequence infectious disease (HCID) events.

On the medical literature front, new studies on Ebola shed new light on the impact of safe burials, challenges with field research, and the complexities involved in translating academic information about the virus into clear policy action items.

Range of stakeholders guided checklist

The 56-page report, released Jun 21, bridges local health sector planning gaps that the two groups identified after exploring peer-reviewed reports, media stories, after-action reports, and interviews with people who treated Ebola patients or played other roles in the response in Atlanta, Dallas, New York, and Omaha, Neb., and with the CDC. The authors also held focus groups with health sector members in Dallas and New York and brought together an expert group to discuss the findings and make recommendations.

Eric Toner, MD, senior associate at the Center for Health Security, said in a press release that one of the key findings was that the diversity of people who were involved in the response, many who never expected to. "Therefore, many more stakeholders must participate in planning, and they are eager for firsthand information from others who have experienced a HCID event."

The report details challenges to common and unique problems the cities faced, focusing on the ones they didn't expect. Some of the tough issues they faced included fear-based reactions, quarantine, monitoring, and waste management. Some of the healthcare-related issued include identifying treatment hospitals, triage, limitations on clinical services, and equipment decontamination.

For the checklist, the authors define an HCID as a disease that is moderately to highly lethal, prompting significant public concern, such as smallpox, Middle East respiratory syndrome coronavirus (MERS-CoV), or H5N1 avian influenza. Resilience actions are grouped under seven checklist categories: planning and preparedness, leadership, creative flexibility, command structure, public trust, managing uncertainty, and crisis communication.

The report also includes specific checklists for public health agencies, healthcare organizations, emergency medical services, and elected officials.

Burial impact, field research, media review

In the latest Ebola research developments, groups examined the impact of burial teams in helping curb Ebola transmission in West Africa's outbreak, discussed challenges of launching a clinical trial in Guinea during the outbreak, and compared how academic and lay press covered the epidemic.

  • Red Cross safe and dignified burial (SDB) activities in the three West African outbreak countries prevented from 1,411 to 10,452 secondary Ebola cases, according to an estimate from a Red Cross–led research team, published yesterday in PLoS Neglected Tropical Diseases. They based their findings on interviews with next of kin and community members who were involved with unsafe burials in six districts. They predicted that the SDBs may have reduced the epidemic by 4.9% to 36.5%. They concluded that the infections prevented were significant, but a greater impact could be achieved through early hospitalization of primary case-patients.

  • Fear, mistrust, protocol compliance, and lab problems were among the challenges in preparing and conducting a clinical trial in the field during the Ebola outbreak in Guinea, researchers reported yesterday in PLoS Neglected Tropical Diseases. They described the experiences they had in conducting a phase 2 trial of the antiviral drug favipiravir. They emphasized the importance of collaboration between research teams, humanitarian medical groups, and local researchers, adding that though their observations are context-specific, they might be useful in future international medical emergencies.

  • Academic writers may need to take a more active role in communicating actionable items in their findings, according to researchers who compared Ebola information in the lay press with general review articles in the academic literature. Researchers based at the National Institutes of Health published their findings yesterday in PLoS One. They found that academic review articles could not help clarify or put the uncertainties surrounding Ebola in context, perhaps because of trade-offs between technical accuracy and clarity. Because of the fast pace of the media environment, researchers should keep in mind that no study is outside the public forum and consider taking more responsibility for translating scientific words into public policy actions, they said.

See also:

Jun 21 Johns Hopkins press release

Jun 22 PLoS Negl Trop Dis abstract on burial team impact

Jun 22 PLoS Negl Trop Dis abstract on clinical trial challenges

Jun 22 PLoS One abstract on academic and press coverage

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