I appreciate the thought and debate on this issue. Progress? Two matters:
1. Dr Fall’s statement is welcome but does it address the sorrow, anger, and worry of people who have lost loved ones in DRC? Suppose, for example, a school district had a fleet of school buses picking up and returning children every day. Suppose bus drivers regularly ran over and killed 2-4 children per month. Suppose school managers refused to admit buses had killed students, refused to talk with parents. We would expect parents to be angry. Maybe they would attack school buses. Maybe they would walk their children to school or keep them home. By the same token, health programs should be reporting day-by-day X ebola cases in Y community, of which Z are likely from unsafe healthcare. Not admitting nosocomial ebola to people who know the pain is like telling people the sun rises in the west. That’s not a good way for health managers to build public trust.
2. Where is any evidence that trying to treat all ebola cases in health facilities reduces outbreak duration or severity? In Liberia, for example, a shift by health agencies to accommodate home-based care in August 2014 coincided with the change from an exploding to an imploding outbreak. Here’s what MSF reports (pp 10-11 in https://reliefweb.int/sites/reliefweb.int/files/resources/ebola_accounta...): MSF’s facility in Monrovia “was unable to keep pace with the overwhelming demand during the peak in August and September. Tragically, MSF teams had to turn people away, many of whom were clearly ill, because there were simply not enough beds. Those who were unable to be admitted were provided with a home protection kit to reduce the risk of infecting their families.
The vastly insufficient bed numbers across Monrovia led MSF to distribute tens of thousands of family and home disinfection kits to provide some protection for household contacts of Ebola patients. In Grand Bassa county MSF provided home-based care for suspected patients while establishing an EMC in the town of Quewein [my emphasis]. The number of Ebola cases declined almost asrapidly as they had increased, and by December Liberia was reporting the lowest incidence of the three main affected countries [my emphasis].”
HIFA Profile: David Gisselquist is an independent consultant in the United States and has a professional interest in nosocomial risks and transmission of HIV in Africa, agricultural development and agricultural inputs regulation, environment.
Email address: david_gisselquist AT yahoo.com