Controlling Ebola: next steps
By Ranu S Dhillon, Devabhaktuni Srikrishna, *Jeffrey Sachs
The Ebola epidemic is paradoxical: it is out of control yet readily controllable. The key to epidemic control is rapid diagnosis, isolation, and treatment of infected individuals.1 This approach was used in past Ebola outbreaks through contact tracing, in which anyone exposed to a person with Ebola was monitored, tested if they developed symptoms, and, if positive, securely transported to a health facility for treatment.2 Moreover, while 60–90% of untreated patients with Ebola die, effective medical care could reduce this rate to below 30%.3 This strategic approach was not taken in time during the present Ebola outbreak in west Africa. According to estimates from the US Centers for Disease Control and Prevention, about 60% of all Ebola infections in west Africa remain undiagnosed in the community with the potential for hundreds of thousands of cases by mid-2015.4 Infected individuals become contagious when they begin to show symptoms. Without effective isolation, each Ebola patient is estimated to transmit the virus to around 1·8 additional people, leading to the exponential growth of infections with a doubling time of around 20 days. Control strategies based on rapid diagnosis, patient isolation, and treatment, can reduce the transmission to well under one additional person per infected case, thereby rapidly containing the epidemic.4