Ebola outbreak: Liberia's newest, largest treatment clinic already at capacity

[Pathfinder]

Ebola outbreak: Liberia's newest, largest treatment clinic already at capacity

CBC News was granted access to the Island Clinic in Monrovia

By Adrienne Arsenault, Stephanie Jenzer, CBC NewsPosted: Sep 29, 2014 5:00 AM ET|Last Updated: Sep 29, 2014 11:01 AM ET

The centre, known as Island Clinic, was exactly seven days old when CBC News toured the ?green zone," or safe zone, of the facility on Sunday. It has almost doubled the Ebola treatment capacity in Liberia's capital city of Monrovia, a major urban centre overwhelmed by an exponentially increasing number of cases of the deadly virus.

When it opened, there were 120 beds available. Within hours, the clinic was already stretched ? every space available filled with the city?s most frightened and seriously ill. Somehow, room was made for more patients and currently, by adding beds and sofas where possible, staff estimate the total number is likely closer to 200.
...
WHO spokesperson Pieter Desloovere said the building can?t handle increasing capacity yet again because of the heavy load on the water supply and electricity, but he acknowledges the need.

?It?s a drop of water in an ocean,? he says. ?The demand is so huge.?
...

http://www.cbc.ca/news/health/ebola-outbreak-liberia-s-newest-largest-treatment-clinic-already-at-capacity-1.2780845

[JimO]

Re: Ebola outbreak: Liberia's newest, largest treatment clinic already at capacity

“It’s a drop of water in an ocean,” he says. “The demand is so huge.”
...
http://www.cbc.ca/news/health/ebola-...city-1.2780845

That last quote is disturbing. If 200 is a drop in an ocean, then the 2,000 - 4,000 beds that should be in place in the coming weeks is what by comparison?

[franzpick]

Re: Ebola outbreak: Liberia's newest, largest treatment clinic already at capacity

Liberia's new cases have averaged 75 per day over the past 12 days, which would require 525 new beds per week, and I'm sure their data is incomplete, and the reported numbers understated, and the daily new bed requirement is much higher.

To prevent the sick from being turned away from treatment centers and returning home to infect others, and to infect more at private burials, Liberia needs 100-plus NEW beds per day, 700 per week, far in excess of the announced plans and capabilities of WHO, MSF, China, the national ministries, the u.s. army and all other contributors combined: announcing plans for, or completion of, a 100 new bed facility, is announcing an underwhelming response to less than one day's new EVD case treatment needs.

[Vibrant62]

Re: Ebola outbreak: Liberia's newest, largest treatment clinic already at capacity

How could this problem be solved? How do we get ahead of the curve with the resources now available? Just trying to get us to think outside the box.

With all the international aid and personnel now mobilising, could there be other solutions, either proposed or underway in the outbreak zones?

It seems clear that the gap in treatment beds vs cases isn't going to be overcome anytime soon.

[JJackson]

Re: Ebola outbreak: Liberia's newest, largest treatment clinic already at capacity

The protocol successfully used in all previous outbreaks has been Isolation, Contact tracing & Supportive care. I don't doubt it would work in this case as well if it wasn't for the fact it is so labour intensive the numbers of boots on the ground required would be in the 100s of thousands - and growing.

We need the beds and trained HCWs, as many and as fast as we can manage, but they will not be enough on their own. In parallel we need other ways of reducing the doubling time and this has to be by reducing the community transmission.
The public all need to be aware of exactly what the means of transmission are. They must have free and easy access to anything that would help them - however mundane. Something as stupid as getting people to wear a paper bag on their heads with a couple of holes cut for eyes and mouth might make a big difference as it would make you very conscious each time you had the automatic response to rub your eyes or scratch your nose. Trying to not to touch anyone else in public. Making sure that anyone caring for a patient at home has a bucket, bleach and some washing up gloves. It is hardly state of the art PPE but if it reduced the number of caregivers being infected by 10% it would make an enormous difference in the outbreak overall.

So - Education, Social distancing and very basic PPE are the bolt-ons to the tried and tested system. If we can stop, or greatly reduce, the doubling time then all those beds and HCWs will come into their own and, hopefully, rapidly contract the epidemic to the point that the traditional containment methods can finish the job.

Looking at the maps of infected counties can give a misleading impression of the realities on the ground. If the actual case count is 20,000 in a population of 20 million then 'only' 0.1% of the population are infected at present. Due to the method of transmission this is very unevenly distributed with a much higher percentage infected in small clusters and gaps in between. In the larger population centers these have key-holed into much larger clusters. Where the case numbers are small, and new outbreaks, we will need to employ a disproportionally large number of our precious resource to apply traditional isolation and contact tracing. The epidemic should be treated not as one massive uncontrollable outbreak but as many smaller clusters and we need to pick the battles we can win nibbling around the edges until we can redirect our efforts at a more manageable center.
My 2 cents.

[Shannon Bennett]

Re: Ebola outbreak: Liberia's newest, largest treatment clinic already at capacity

There really is only one solution to stopping the virus, social distancing. All contacts with other people would have to be treated as if the other person was infected. No shaking hands, kissing or even hugging of any other persons. Any surfaces that might have been touched by other people would be suspect. That would mean that everyone should be wearing gloves. Washing hands thoroughly before eating anything. Foods should be washed in a disinfectant, peeled or cooked prior to eating. Those that are infected would then probably have to follow Vibrant62's suggestion of quarantine in a designated Ebola village. A modern day leper colony. I don't like it but I don't see an alternative. However, I can't see the above suggestions actually put into practice for myriad reasons. That list includes poverty, social norms, lack of education and a way to enforce the new modified behaviour.