Bioethical debates about whether to administer an experimental drug for Ebola victims are interesting and necessary. But only a handful of doses are available anyway and hundreds of people are dying in Guinea, Sierra Leone and Liberia. According to the latest update from the World Health Organisation, 2,127 cases and 1,145 deaths have been reported. But it has also declared that “the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak”.
“Extraordinary measures,” are needed, it says, “on a massive scale, to contain the outbreak in settings characterized by extreme poverty, dysfunctional health systems, a severe shortage of doctors, and rampant fear.”
In view of the emergency, the three worst affected countries have taken the most drastic step possible – drawing a “cordon sanitaire” around the areas where the outbreak is most virulent. The perimeter is guarded by soldiers and no one is allowed in or out until the plague runs its course. It is a primitive method but in mediaeval times it was the only way to keep infection from multiplying.
This method was used to control an outbreak of Kitwit, in Zaire (now Democratic Republic of the Congo), a city of half a million in 1995. According to Laurie Garrett, writing in The New Republic, it was “brutally successful, as all trade to the Kikwit region ground to a halt, the desperately poor people were fully isolated to war with Ebola on their own”. She received a Pulitzer Prize for her reporting on the epidemic and the lesson she drew from her experience is tough and utilitarian:
“Despite all the brouhaha here in the United States and Canada about application of experimental drugs and vaccines never clinically tested for safety or effectiveness to the African crisis, this siege will end not with magic bullets, but smart, heroic strategies that find infected people swiftly, place them behind cordoned quarantine barriers, and bury the dead rapidly after their demise without families’ contact or viewing. Yes, it is heartless and can seem cruel, but strategic isolations, coupled with vast urban campaigns of capture of the infected constitute the only hopes for ending the state of siege.”
However, other observers contend that tough love has to supplement tough measures. “It might work,” Dr Martin S. Cetron, of the Centers for Control and Prevention. “But it has a lot of potential to go poorly if it’s not done with an ethical approach. Just letting the disease burn out and considering that the price of controlling it — we don’t live in that era anymore. And as soon as cases are under control, one should dial back the restrictions.”
More probably depends on organisation than vaccines at this stage. “The bottom line with Ebola is we know how to stop it: traditional public health,” says Tom Frieden, Director of the CDC. “Find patients, isolate and care for them; find their contacts; educate people; and strictly follow infection control in hospitals. Do those things with meticulous care and Ebola goes away.”
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