Reporter's Notebook: Why we haven't stopped Ebola記者手記:我們為什麼就沒有停止過埃博拉病毒

By Elizabeth Cohen, Senior Medical Correspondent
October 10, 2014 -- Updated 1435 GMT (2235 HKT)
A woman crawls toward the body of her sister as a burial team takes her away for cremation Friday, October 10, in Monrovia, Liberia. The woman had died from Ebola earlier in the morning while trying to walk to a treatment center, according to her relatives. Health officials say the Ebola outbreak in West Africa is the deadliest ever. More than 4,000 people have died, according to the World Health Organization.A woman crawls toward the body of her sister as a burial team takes her away for cremation Friday, October 10, in Monrovia, Liberia. The woman had died from Ebola earlier in the morning while trying to walk to a treatment center, according to her relatives. Health officials say the Ebola outbreak in West Africa is the deadliest ever. More than 4,000 people have died, according to the World Health Organization.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Ebola outbreak in West Africa
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STORY HIGHLIGHTS
  • Elizabeth Cohen says that on paper, we know how to stop Ebola
  • We have not been able to execute that plan, she says
  • While in Liberia, Cohen saw indications that we don't know how to end the epidemic
 

(CNN) -- Last month, President Barack Obama declared that the world knows how to fight Ebola. Three days later, on my way into Liberia, I asked: Is he right?

And my answer, after spending a week in Liberia, is no.

On paper, we do know how to fight Ebola. You isolate patients and keep track of the people with whom they had close contact while they were contagious, and if those contacts get sick, isolate them and start the cycle over until the disease burns itself out.

But knowing how to do something intellectually isn't the same as knowing how to execute that solution. Execution requires management and control over details at a level that I don't think we have right now.

Precautions, preparations for Ebola in the U.S.

Horrifying video from Liberia shows Ebola patients collapsing on the ground outside the Island Clinic because no one was there to escort them in. Isolating the infected is crucial to stopping this epidemic, and the most basic first step toward isolation -- getting the patients inside the hospital -- failed.

The day after we visited the Island Clinic, I showed the video to Peter Graaff, the World Health Organization's representative to Liberia, since the WHO and the Liberian government are the clinic's sponsors. He was horrified and said he'd had no idea this had even happened.

Graaff had been at an elaborate ceremony opening the clinic just hours before these patients fell to the ground. Did he stick around afterward to make sure everything was working properly? Did he go back to the clinic the next morning to see how things were going?

No, he told me. He left after the ceremony and didn't return. "I didn't want to get in the way," he said, of the Ugandan team of doctors the WHO had contracted to run the place.

When I asked Graaff why there was no one to bring in the Ebola patients, he said he didn't know, but perhaps the clinic was "overwhelmed" as it nearly filled up in its first day.

This answer underscores my point. Why was it overwhelmed? For weeks, everyone knew there were long lines to get into Ebola treatment centers. It was no mystery that patients would be flocking to the new clinic the minute it opened. Why wasn't it prepared for something as basic as bringing patients inside?

While in Liberia, I saw other indications that we don't truly know how to end this enormous epidemic. After isolation, the second crucial step in controlling the outbreak is to follow people who were in close contact with Ebola patients to see whether they develop symptoms of the disease.

In Liberia, I met Fatu Kekula, a young woman who by any definition is a supercontact. Without proper protective gear, Kekula single-handedly took care of her Ebola-stricken mother, father, sister and cousin at home. She clearly should have been followed up with by authorities, but she says no one ever contacted her. Other contacts in Liberia told me similar stories.

When I mentioned these problems to international aid workers in Liberia, they lamented that not enough money had been spent early on to get the outbreak under control. That's certainly true, but perhaps it's not just about money.

Opinion: Get proactive about screening for Ebola

It's also about what Dr. Michael Osterholm at the University of Minnesota calls "command and control." You can put millions upon millions of dollars into containing Ebola, but if the response isn't well-organized, the outbreak will win in the end.

A U.S. federal official familiar with the situation told me that this spring, the Centers for Disease Control tried to go in and help, but the WHO's African region resisted, saying they could handle the situation.

It was only when CDC Director Dr. Tom Frieden personally reached out to Dr. Keiji Fukuda, the WHO's assistant director-general for health security, that things changed, according to the official. Fukuda flew from Geneva to West Africa, saw his agency's resistance and paved the way for CDC to get involved.

Although we don't seem to know how to fight this particular Ebola outbreak, there is good news: We can learn. We can learn how to manage. We can learn how to execute. We can develop good command and control.

It's on you now, Maj. Gen. Darryl Williams. Williams, the U.S. Army-Africa commander, is leading the U.S. military's response -- officially called Operation United Assistance.

Welcome to Liberia.

記者手記:我們為什麼就沒有停止過埃博拉病毒
由伊麗莎白·科恩,資深醫藥記者
2014年10月10日 - 更新1435 GMT(2235 HKT)
一個女人爬往她妹妹的身體埋葬隊把她帶走火化年10月10日在蒙羅維亞,利比里亞。 該名女子已經從早期的埃博拉病毒死亡,早上試圖步行到治療中心,據她的親戚。 衛生官員說埃博拉疫情在西非是有史以來最致命的。 超過4000人死亡,根據世界衛生組織。 一個女人爬往她妹妹的身體埋葬隊把她帶走火化年10月10日在蒙羅維亞,利比里亞。該名女子已經從早期的埃博拉病毒死亡,早上試圖步行到治療中心,據她的親戚。衛生官員說埃博拉疫情在西非是有史以來最致命的。超過4000人死亡,根據世界衛生組織。
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埃博拉疫情在西非
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新聞提要
伊麗莎白·科恩說,在紙面上,我們知道如何停止的埃博拉病毒
我們一直沒能執行該計劃,她說:
而在利比里亞,科恩看到跡象表明,我們不知道如何收場疫情
(CNN) -上個月,美國總統奧巴馬宣稱,世界上都知道怎麼打埃博拉病毒。三天後,我進入利比里亞,我問:他是正確的?
而我的答案,一個星期在利比里亞消費後,是沒有的。
在本文中,我們知道怎麼打埃博拉病毒。您隔離病人和追踪與他們有過密切接觸,而他們是會傳染的人,如果這些接觸生病,孤立他們,並開始循環一遍,直到病情燃燒盡。
但我們知道如何做智力是不一樣知道如何執行該方案。執行需要管理和控制細節的水平,我不認為我們現在所擁有的。
在美國的注意事項,準備埃博拉病毒
駭人聽聞的視頻利比里亞顯示埃博拉患者倒塌島上診所外的地上,因為沒有人在那裡護送他們在隔離受感染的關鍵是要阻止這種流行病,並朝著隔離最基本的第一步-讓裡面的病人醫院-失敗。
我們參觀了島上診所後的一天,我發現了視頻彼得·格拉夫,世界衛生組織的代表,利比里亞,由於世界衛生組織和利比里亞政府是診所的贊助商。他被嚇壞了,並說他不​​知道這甚至發生了。
格拉夫曾經在一個精心製作的開幕儀式診所幾個小時前,這些病人倒在了地上。他有沒有留下來之後,以確保一切工作正常?難道他回到診所,第二天早上,看看事情了?
不,他對我說。他離開了儀式後,並沒有返回。“我不希望得到的方式,”他說,醫生在世衛組織已簽約的地方跑的烏干達隊。
當我問格拉夫為什麼沒有人把在埃博拉病毒的病人,他說他不知道,但也許是診所被“淹沒”,因為它幾乎填補了它的第一天。
這個回答強調了我的觀點。為什麼會不堪重負?幾個星期以來,大家都知道有排長隊進入埃博拉病毒治療中心。這是沒有什麼神秘,患者會蜂擁到新診所開業分鐘。為什麼不是它的東西基本為內給病人準備了嗎?
而在利比里亞,我看到其他跡象表明,我們並不真正知道如何結束這場巨大的流行病。分離後,在控制疫情的第二個關鍵步驟,是按照人誰是與埃博拉病毒的病人密切接觸,看他們是否患這種疾病的症狀。
在利比里亞,我遇到了Fatu Kekula,一名年輕女子誰被任何定義是supercontact。如果沒有適當的防護裝備,Kekula一手照顧她的埃博拉欲絕的母親,父親,姐姐和表姐家裡。她顯然應該已經跟進了當局,但她說從來沒有人聯繫過她。在利比里亞的其他聯繫人告訴我類似的故事。
當我在利比里亞提到的這些問題,國際援助人員,他們感嘆,沒有足夠的錢已經花了早期得到控制的爆發。這是千真萬確的,但也許這不只是錢的問題。
意見:獲取主動約篩查埃博拉
這也是什麼邁克爾·奧斯特霍爾姆博士在明尼蘇達大學所稱的“指揮和控制”。你可以把億萬美元到含有埃博拉病毒,但如果反應不是井井有條,爆發將贏在終端。
美國聯邦官員熟悉情況告訴我,這個春天,疾病控制中心試圖去幫忙,但世衛組織非洲區域的抵制,說他們可以處理這種情況。
只有當疾病預防控制中心主任湯姆·弗里登博士親自伸手福田敬二博士在世衛組織助理總幹事的衛生安全,事情改變了,根據官方的。福田從日內瓦飛往西非,只見他的機構的阻力,鋪平了道路疾控中心參與進來。
雖然我們似乎不知道怎麼打這個特殊的埃博拉疫情,有一個好消息:我們可以學習。我們可以學習如何管理。我們可以學習如何執行。我們能養成良好的指揮和控制。
這是你現在,少將達里爾·威廉姆斯。威廉姆斯,美軍非洲司令,是導致美軍的反應 - 官方稱為操作United援助。
歡迎來到利比里亞。

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