Lessons from the Ebola Outbreak - The 3 C's

During the 2014 Ebola outbreak in West Africa, I was part of the volunteer effort to fight the disease. I worked alongside many dedicated men and women in the UK and Sierra Leone. This included individuals from the affected countries, the UK government, Public Health England, the United Nations and many other organisations.

Like COVID-19, Ebola is a viral disease but there are differences. Ebola is spread through direct contact with infected bodily fluids or indirect contact with contaminated surfaces. COVD-19 is a respiratory virus, which is more easily spread, for instance through air droplets near an infected person. Ebola has far greater mortality - maybe as much as 100x more deadly than COVID-19.

Despite these differences, many lessons learnt from the fight against Ebola can be applied to the current COVID-19 outbreak.

Like Ebola, COVID-19 can only be controlled through the 3 Cs - Capacity in healthcare, Communication and Compliance.

Capacity

Healthcare capacity includes healthcare personnel, testing facilities, medical supplies, ambulances, isolation units and hospital beds.

During the Ebola outbreak, capacity was severely lacking in West Africa and had to be built, sometimes from scratch. The UK government and military played a massive role in building this capacity, alongside other West African countries, USA, France, China and others. The United Nations and World Health Organisation played a critical role in marshalling resources.

The UK has the capacity to deal with COVID-19 in the current phase, though may be ill equipped at its peak. The government must therefore either contain the spread, so we avoid a peak, or flatten the curve so that infections are spread over time to allow the National Health Service (NHS) to cope.

The NHS is an extraordinary institution and a great asset of the United Kingdom. The ability to control the response to COVID-19 through an established, effective, centralised healthcare infrastructure - like the NHS - is critical. At the core of this infrastructure is an amazing group of healthcare workers that serve tirelessly to care for us.

I came to appreciate the greatness of healthcare workers during the Ebola outbreak. I was part of the effort to recruit UK healthcare workers for the Ebola units in West Africa. I saw many enrol, from young paramedics to active and retired nurses and doctors. They volunteered, knowing that one small error or a defective personal protective equipment (PPE) could mean death. I recall asking them why they volunteered and they all had the same answer - there is a critical need over there and we have the skills to help.

Like the Ebola outbreak, there will be thousands of healthcare professionals in the frontline fighting COVID-19. During the best of times, these are selfless people. However, they rise up to heroic levels during such epidemics, going to work every day knowing the danger they face and putting themselves and their loved ones at incredible risk. They are central to our capacity to deal with COVID-19 and deserve our gratitude and support.

Communication

To stop an epidemic, it is critical for the government to be in control of the message and for the message to control behaviour.

During the Ebola outbreak, the goal was disease eradication. The authorities eventually realised that the super spreaders were those who were very sick and corpses. Once this was established, the governments in West Africa were relentless in their messaging.

Effective communication requires a few fundamentals. Firstly, we must be clear on the strategy - is the goal disease eradication or propagation toward herd-immunity? Secondly, the authorities must frame an unambiguous message as to what each person should do to achieve the goal. Thirdly, communication must be pervasive and relentless - everyone must receive the same message and receive it over and over again. Finally, we must eliminate fake news, hoaxes, false cures, conspiracy theories and other incorrect information. This requires credible and easily identified sources of reliable information which requires coordinated and concerted effort from governments, broadcasters, social media companies and the public.

Compliance

Millions of us must change our behaviour overnight to limit the contagion, with every person knowing that they are a vital link in the chain and their actions can limit or increase the spread. This is difficult but attainable once we realise that we have no other option.

West Africans, during the Ebola outbreak, had to change a fundamental aspect of our culture. We believe in personally looking after the sick. For the poor, it means caring for them at home. For those who can afford hospitals, it means constant hospital visits, participating in their personal care and providing them with home cooked meals. When our loved ones die, the funeral wake at home, with the corpse present, is our final goodbye and a necessary rite of passage to a better world. All of this had to change. We had to call the emergency services when someone got ill, to have them taken away to the Ebola units. Our dead were toted away by HAZMAT suited personnel to be buried in sometimes unmarked graves. This challenged the very essence of who we are as a people, but eventually we yielded. We did so because we had no more time and had no other choice; it was compliance or face apocalypse.

The current COVID-19 outbreak requires a similar change in behaviour. Similar to the Ebola outbreak, people will change behaviour for as long as is necessary - there will be no “behavioural fatigue” when it is a matter of compliance or risk the deaths of many of your citizens.

The UK did a tremendous amount to bring an end to the Ebola outbreak in West Africa. That effort taught us how critical the 3Cs are: Capacity, Communication and Compliance. We should learn from that investment to bring an end to the COVID-19 epidemic, which threatens our way of life - and for some of us our very existence.

BBC Business Daily

Coronavirus: Where's the joined-up thinking?

What can be learned from East Asia's response to Covid-19, and from West Africa's Ebola epidemic? And why hasn't there been a unified global response to the pandemic?

Mykay Kamara, CEO Welbot, was in Sierra Leone during the epidemic and helped recruit medical staff to the region. Reporter, Manuela Saragosa asks what lessons are there from the 2014-16 Ebola outbreak in West Africa for the likely long-term impact of the pandemic?

Stream or Download:

https://www.bbc.co.uk/programmes/w3csy795