As of Oct. 15, 2014, no one can accurately predict the potential magnitude of the Ebola epidemic either domestically or worldwide. What we do know is that there is potential for a global catastrophe. It is imperative that we utilize, strategically, the immense resources available in the United States to take the lead in systematically tackling this major health concern of the 21st century. I think that there are six essential components that will comprise a systematic approach to controlling Ebola.
Creation of a National Ebola Council
The Centers for Disease Control and Prevention in conjunction with the state's and federal Department of Health and Human Service as well as the World Health Organization must convene a National Ebola Council. Utilizing a multi-disciplinary approach, the council would consist of global and national experts to include epidemiologist, virologist, pharmacologists, statisticians, pubic health experts, physicians, nurses, academic and community hospital administrators, ethicists, veterinarians, pharmaceutical industry members and also engineers, IT experts, members of the military and law enforcement, economists, mathematicians and demographers, who would work together to solve the multiple complex aspects of Ebola. Additionally, weekly national training broadcasts and information updates by council members to all hospitals, health clinics and physicians throughout the nation should be instituted.
Utilizing this multidisciplinary approach and employing the world's best minds, I have no doubt that Ebola can be controlled.
Development of rapid, early diagnostic test
Taking a person's temperature to identify a fever as a screening test for Ebola has very little value diagnostically. It may allow the general public think that something is being done to control the spread of disease. However, since hundreds of diseases, infectious and noninfectious, may produce a fever, using temperature as a screening tool has extremely low sensitivity and specificity. Instead, researchers need to harness our nation's resources to develop a rapid test that can diagnose Ebola shortly after infection. We must aim for a test with high sensitivity and specificity.
Development of a one-piece "spacesuit" for protection of health care workers
Current protective gear for health care workers is proving inadequate primarily because of the complicated procedure required to remove the gear to avoid contamination. The current protective gear is actually composed of several components that are put together in a piecemeal fashion. The development of a one- or two-piece, easy to remove and put on "spacesuit" for health care workers is needed. Ideally, the suit would be able to be decontaminated with a disinfectant spray and hence be reusable.
Development of new or identification of appropriate existing medications for treatment and prophylaxis of Ebola.
ZMapp is felt to be an effective agent to treat Ebola. A few precious lifesaving doses were available before the supply was totally exhausted. Highest priority and resources must be given to the development of medications that not only treat Ebola but also used as post-exposure prophylaxis. Much like antiretroviral medications are given as soon as possible after exposure to HIV, similarly, Ebola post-exposure prophylaxis must be developed to be administered to close contacts of Ebola patients including health care workers after exposure to bodily fluids.
Another important area for exploration is the identification and use of existing medications that may prove effective for the treatment or prophylaxis of Ebola. In our quest to identify something new, we must not overlook currently existing anti-viral and other medications that would not have to jump the hurdles required of experimental medications and the side effect profile would be largely known. An example is reflected in a New York Times op-ed by David S. Fedson and Steven M. Opal, who suggest the use of an existing class of medications called statins to help treat some of he devastating effects of Ebola.
Vaccine development for the prevention of Ebola
The development of an effective vaccine will be a game-changer for the entire world particularly for those as the epicenter of the epidemic in Africa. Vaccines are an effective way to slow the spread of disease and at the same time, protect vulnerable health care workers. In general, new vaccine development has slowed in recent years in the United States because of economic considerations. It is time to once again ramp up vaccine research and development.
Support during quarantine
Quarantine is an effective method to prevent the transmission of Ebola. Voluntary compliance is often necessary for success of this program. However, once a person or family is quarantined, important questions include: Who will provide and pay for the essentials required for survival including food, medications, supplies and housing, and how can the individual or family continue to collect their salary and maintain their job? A state and local plan must be in place to provide for the needs of these individuals and families. Without this support, individuals may likely violate the quarantine. Once out of quarantine, how do we prevent these individuals from being discriminated against and shunned from society?
Instituting these six essential elements for eradicating Ebola are by no means easy, but neither was putting a man in space, irradiating diseases like smallpox or curing certain types of cancer. America, I am hopeful that we can do this.