The NPR website has an extensive interview with Dr. Daniel Bausch, who is an expert in hemorrhagic fevers. He’s been here…ok, not here Liberia, but in Guinea and Sierra Leone, and recently. He is an associate professor at the Tulane School of Public Health and Tropical Medicine. In short, he knows his stuff, and has experienced the current epidemic.
The interview, here, is well worth a read. Some of the highlights include his discussion about contact tracing (finding everyone who has been in contact with an Ebola patient and watching them for 21 days to see if they develop symptoms) and why we’re beyond that point in Liberia, as well as his stories about working in a treatment unit in Sierra Leone. Probably most important is his discussion about how the virus is spread and some of the factors that have caused this outbreak to get out of control.
I take his point that, in Liberia, with over 3000 cases, contact tracing is probably of limited utility, at least to try and stop the spread. There are just too many transmission lines and not enough people to track them all. On the other hand, if part of what is keeping the fatality rate relatively low is early treatment, then we owe it to the population to try and trace contacts. Beyond possibly saving lives this go around, Liberia will need contact tracing experience for when we hit the downswing (to quickly find and isolate new cases to prevent further transmission) and for when Ebola crops up again. Liberia has hundreds, if not thousands, of civil society organizations who want to get involved. That’s a small army of contact tracers already pre-positioned in the leeward (that is, upcountry) so that you don’t need to try and send someone from Monrovia along the washed-out and non-existent roads. They also know the people in the region, so you have lower risk of non-cooperation or violence.