23 Nov 2015
A lack of knowledge and disjointed efforts enable the Great Plague to kill 100,000 Londoners in the 17th century. With recent reports criticising the global effort to combat Ebola, how have modern reactions to epidemics changed in the last 350 years?
Dr Vicky Simms, from the London School of Hygiene and Tropical Medicine, was on the ground fighting Ebola. She tells us how they tried to control the outbreak and get the world to respond.
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Understanding Ebola
In the 17th century the causes of infectious disease were completely unknown, but some key principles for managing an outbreak were already visible: record the death rate, quarantine contacts, educate the public, protect health workers. We used the same principles to combat the recent Ebola outbreak in West Africa.
Epidemiologists working on the ground spoke to every patient they could find, worked out when, where and how the person was infected, and traced their contacts who might also have become infected with the virus. Mathematical modellers pooled all the incoming information and ran computer simulations to predict how the outbreak might develop. Terrifying scenarios started to emerge that showed how many people might die if the outbreak was not contained, which shocked the world into responding.
Fighting Ebola in Sierra Leone
I helped set up the health information system for the Ebola Treatment Centre in Kerry Town, Sierra Leone. Every day I reported the number of admissions, discharges, transfers and deaths. I connected information between the wards, pharmacy, lab, nutrition team and family liaison to make sure all patients received the right care.
The family liaison team were very important. Our patients often felt alone and frightened, and some of them were very young children. It made a lot of difference for them to be able to see their families, although it had to be at a distance separated by fencing to prevent infection. We also put mobile phones in the wards so patients could call home.
The largest group of workers at Kerry Town were not doctors and nurses, they were water, sanitation and hygiene (WASH) staff. Everything had to be disinfected almost constantly.
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The WASH team wore heavy duty personal protective equipment to protect themselves from Ebola and from the concentrated bleach they used. How often do you ignore a sign telling you to wash your hands? Any mistake or short-cut in hygiene procedures could have given Ebola the opening to rip through the treatment centre. There was continuous training to keep standards high and bring new staff up to speed.
Treating victims of Ebola
The first priority for the health team was to stop people dying of dehydration caused by diarrhoea and vomiting. Every patient able to drink was given oral rehydration solution, an isotonic mix of salt and sugar in water which hydrates far more effectively than water alone. Nobody knew enough about Ebola to treat it properly, so we did some research. I helped analyse lab tests from 118 patients to investigate how Ebola affected a person’s organs and biochemistry. We expected to see kidney damage from dehydration, but we discovered that many patients without vomiting and diarrhoea had acute kidney failure too, and they were the ones most likely to die. We shared our findings at a clinical meeting in Freetown and warned the other treatment centres to look out for kidney failure in patients who didn’t show the normal symptoms. In a disease outbreak, sharing data and information between organisations is crucial, as the situation can change and develop quickly, and everyone is constantly learning and adapting their response.
Looking to the future
The Ebola outbreak in West Africa is officially over when six weeks have passed without a single case, but the effects of Ebola will last much longer. The knowledge and action of health workers, policy makers, and the communities affected in the region have helped to bring the epidemic under control, but the health systems of the affected countries have been decimated, and we are only beginning to understand the long term consequences of Ebola infection for survivors.
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For more information of the Great Plague of the 1660s visit Samuel Pepys: Plague, Fire, Revolution