Towards a better epidemicBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2419 (Published 07 May 2015) Cite this as: BMJ 2015;350:h2419
All rapid responses
As a consultant working as EVD technical advisor for one UN agency and one International NGO in Guinea from September 14 to March 15, I'd strongly disagree with the statement "The consensus seems to be that no one had a particularly good Ebola epidemic, with the exception of the charity Médecins Sans Frontières (MSF)".
Where does this consensus come from? Perhaps media – based? propaganda-based? Who actually evaluated MSF’s ETCs?
Ebola Treatment Centers I visited were, for the most part, and at least in Guinea, designed in a way that was at best technically unsound, and at worst ethically unacceptable in the way they gathered suspects within one same tent for testing, keeping symptomatic patients of unknown Ebola status together for hours but most often days in places where health staffs wore PPE.
Suspects were tested inside tents where beds were only separated by a distance of one meter in between beds (calculated from center of bed to center of bed) - no physical separation existent between beds (we had to wait for the Centre de Traitement des Soignants built by the French military to finally have decent physical separations between suspects in ETCs - they proposed disposable tents for each suspect, cost of the tent around 200 euros/disposable tent).
The justification given by MSF was that they separated “wet” and “dry” suspects and that the level of probability of being a case was taken into account in separating groups of suspects in 2 or 3 tents.
I am afraid this is not good enough for a highly contagious disease in an epidemic setting with such poor outcome of treatment in ETCs for a while during the epidemic.
Infection between suspects could not be excluded yet negative cases coming out of ETCs were not followed up as contacts (again, the Centre de Traitement des Soignants built by the French military would have this follow-up included in its protocol).
Lethality rates in ETCs in Guinea remained unacceptably high for at least until December 14. It took Paul Farmer's questioning to finally get some attention to the unacceptable rehydration protocol proposed in MSF run ETCs.
MSF did its best (only 2 ETCs existed in Guinea up until October 14, both of them run by MSF) but MSF is an NGO and needs, as any other NGO, evaluation of its standards of care by competent international and national agencies.
Competing interests: No competing interests