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To: Smokin' Joe; Black Agnes
This is an interesting idea.
Key considerations for the implementation of an Ebola Care Unit at community level

Complementary approach - West Africa Ebola Outbreak

FIRST VERSION – SEPTEMBER 2014 - To be reviewed in October 2014

This document has been developed by WHO with the inputs from CDC, DFID, GOARN, IFRC, IRC, MSN, PHAC, Save the Children, and UNICEF

Introduction

The standard recommended public health actions implemented for stopping the Ebola outbreak include the early identification of cases, isolating and treating all patients in Ebola Treatment Centers (ETCs), rigorous contact tracing, and safe burial practices, supported by strong social mobilization and sound risk communication practices. These actions remain critical for stopping the Ebola outbreak in West Africa and should continue to underpin operational response plans. However, over the past few weeks, the epidemic has evolved rapidly and there has been an exponential rise in the number of Ebola cases reported with half of the approximately 5,000 total cases in this outbreak reported in the last three weeks. Available epidemiological data and modelling suggests that the number of cases will continue to rise in the coming weeks. Even with the current case load, the capacity of the ETC’s have been stretched and the number of beds in available ETC’s are inadequate to treat all reported case patients. In many places, infected patients remain in their family homes, with no other option of care, increasing the risk of infection for their families and contributing to continued transmission of Ebola.

Consequently, WHO, with the support from a variety of UN, NGO and government partners is proposing a complementary strategy to slow down and eventually stop transmission in affected areas. This will be done through the establishment of controlled settings, called Ebola Care Units (ECU), where infected persons can be moved to so that they do not further transmit the virus within their households and communities and where they can receive basic curative and palliative care in an environment supported by members of their family and their respective communities.

Such an approach would complement, and not replace, current disease control efforts including the ETC’s. If properly implemented it will slow down the progression of the epidemic by reducing community contact with infected persons and offering care to Ebola patients close to their homes, thus reducing transportation of infectious patients which, in some instances has led to significant infections among taxi drivers.

Home-based care has been put forward as an option. However, this will likely require an intense medical supervision and unmanageable medical supply chain of personal protective equipment (PPE) to families and significant challenges for dangerous waste management. Unless large-scale decentralised laboratory testing is available, it would leave families guessing as to whether an ill household member should be treated as an Ebola-infected patient at home or has another illness that can perhaps be treated by seeking care outside the house. In addition, this approach may present greater risks to other members of the family as it is unrealistic to expect families, living in a confined environment to adequately protect themselves from infection even if extensive awareness raising and community training of infection control can be rolled out quickly at community level.

By contrast, a well-run ECU may be a realistic option and one that could draw upon community will and support, and at the same time offer a level of basic care above what can be provided at home, including presumptive treatment for malaria and infection prevention and control. Another major advantage of this approach is the fact that ECU could be operated via trained community health workers rather than a reliance on formal health workers thus minimizing the risk of pulling out already health workers, who are already limited in number, from essential functions (e.g., operating ETCs or in primary health care facilities) in order to run the ECUs.

This brief paper provides the guidance and considerations that need to be taken into account when introducing the ECU strategy. The document is not prescriptive in nature but aims to provide the parameters within which these ECUs can successfully operate. While flexibility in the strategy is paramount to allow its adaptation and delivery in a range of different environments and contexts the document hopes to ensure that certain safety standards are maintained.


2,378 posted on 09/23/2014 7:08:58 AM PDT by ElenaM
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To: Smokin' Joe; Black Agnes
I checked the latest WHO "roadmap" report and didn't see any indication of new cases in previously uninfected areas. Have you guys seen anything about this?
USA Today 9/22/14: WHO: 21,000 Ebola cases by November if no changes

(large snip)

Dye and colleagues wrote they expected the numbers of cases and deaths from Ebola to continue rising from hundreds to thousands of cases per week in the coming months — and reach 21,000 by early November. He said it was worrisome that new cases were popping up in areas that hadn't previously reported Ebola, like in parts of Guinea.

"The picture is too unclear at the moment," he said, noting the outbreak is continuing to double in size about every three weeks.


2,379 posted on 09/23/2014 7:34:45 AM PDT by ElenaM
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