Where and How the Current Epidemic Began
In March 2014, public health services and MSF in Guinea reported clusters of patients with fever, severe diarrhea, vomiting, and a low rate of survival. This paper describes the ensuing virological and epidemiological investigation that led to confirmation of an Ebola disease outbreak.
Describing Ebola Disease Progression; Understanding Patient Prognosis and Outcomes
Before 2014, Ebola outbreaks were few and the total number of patients in all outbreaks added together was low—significantly less than the number over the past year. The current outbreak therefore began not only without any specific anti-Ebola treatment but with little understanding of which patients were at most risk (i.e., which characteristics or symptoms are associated with good versus poor prognosis), of Ebola pathology, and of what critical/supportive care treatment interventions might help improve survival rates. The articles listed below exemplify efforts by Doctors Without Borders/Médecins Sans Frontières (MSF) clinicians, collaborating with staff from host countries, the World Health Organization, and other responders, to begin tackling these questions.
Ebola and Communities
Evidence for a Decrease in Transmission of Ebola Virus—Lofa County, Liberia, June 8–November 1, 2014
A successful response? The story of Lofa County, Liberia and its community-based interventions
Ebola and Pregnancy
Pregnant women infected with Ebola have very poor chances of survival, as do their babies, and there is almost nothing in the medical literature on their clinical outcomes or management. And health care facilities are often unable or unwilling to accept them, since without stringent infection control, miscarriage or delivery involve highly infectious fluids that put health care workers at significant risk.
This paper describes the cases and care of two pregnant women with Ebola who survived, although their babies did not, illustrating the significant clinical challenges in managing these patients.
Personal Stories from Clinicians on the Front Line
A nurse working in Sierra Leone early in the epidemic describes the overwhelming nature of the outbreak, the despair of being unable to save desperately ill patients, and the inadequacy of the world’s early response to the epidemic.
Perspectives from a clinician who worked on the front lines of Ebola in Guinea, then found himself embroiled in a firestorm back in the USA when he became ill with Ebola and the politics of fear overtook evidence-based public health policy.