Ebola expert explains public health side of outbreak

Why is this Ebola outbreak so big? One of the world’s top experts – a UNMC dean – tells why.

Why is this Ebola outbreak so big – by far the biggest yet?

A sell-out crowd of more than 200 people learned the answer at UNMC’s Science Café on Nov. 4.

And they learned the answer from one of the world’s experts on Ebola – Ali S. Khan, M.D., M.P.H., dean of UNMC’s College of Public Health.

“There was no public health system to help these people,” Dr. Khan told the crowd at a downtown Omaha pub called the Slowdown. “It spread like wildfire, unfortunately, in these communities.”

It’s a large epidemic for a lot of reasons, he said, and those reasons highlight the importance of public health.

Among the reasons:

The disease was newly recognized in western Africa. Previous outbreaks had occurred in central and eastern Africa, where people and health care workers had learned what to do. But that wasn’t the case in western Africa – mainly Liberia, Guinea and Sierra Leone – where people weren’t prepared and where infection-control practices were bad.

Burial practices in the region contributed to the spread. Hundreds of people often show up for the final washing of a body, and that can cause 40 to 60 cases of Ebola.

Ebola spread in the densely populated capital cities and across the porous borders. That was new to this outbreak. In eastern Africa, previous outbreaks ended before reaching major cities.

These western African countries had no public health systems because they were recovering from civil war, he said, either in their own country or on their border.

The response from the rest of the world was delayed, partially because it had been so well-handled in the past in eastern Africa.

Dr. Khan, a former assistant surgeon general, spent the first decade of his career studying Ebola and other exotic diseases around the world. He’s led and responded to many high-profile public health emergencies, including SARS, anthrax and Ebola.

He came to UNMC this past July. Before that, he’d served for 23 years at the Centers for Disease Control and Prevention, retiring as the director of the Office of Public Health Preparedness and Response where he led the $1.5 billion public health security program and was responsible for all of the CDC’s public health preparedness and response activities.

“It’s kind of funny,” he said. “Three months into my stay here in Nebraska as the dean of your college of public health, and we are seeing Ebola cases here. Some people are calling me a ‘black cloud.’ I think it is more fortuitous.”

Outbreaks of diseases occur all the time, he said. This outbreak has taught people that “an infectious disease threat anywhere is an infectious disease threat everywhere.”

Nowadays, he said, you can be anywhere you want to be in the world in just 25 to 36 hours. That may make you think about screening our borders. But for every one person you find that way, you’re probably missing 50 to 100 who have the disease (depending on the incubation period and the number of people who show symptoms).

The secret, he said, is to stop the disease where it occurs.

“Until you stop it there, people will always be at risk of importation of the disease. It’s a good reason to improve public health practice not just here in the United States but worldwide.

“You protect us by protecting everybody at the same time,” he said as he discussed the reasons why UNMC as a leading academic medical center was chosen to provide care to Ebola patients medically evacuated from the outbreak epicenter.

The steps he shared:

Step 1: Make sure you protect the health care workers and everyone in the hospital and the community.

Step 2: Provide extraordinary care to your patient.

Step 3: Share what you’ve learned with the world.

And that’s why Nebraska is now seen as a global resource against infection disease threats.

UNMC had the foresight about a decade ago, he said, to establish a biocontainment unit to take care of patients with a highly contagious disease transmitted person to person. The fear, he said, was that U.S. troops would be at risk in the event of a global small pox outbreak.

In the past few months, Nebraska Medicine and UNMC have used the biocontainment unit to treat three Ebola patients. Two of them lived. The third patient, who arrived at the medical center in critical condition, died.

The care here, he said, has been extraordinary.

UNMC also has created two free online Ebola educational courses and established itself as a role model for other centers.

The two courses, “The Nebraska Ebola Method for Clinicians” and “The Nebraska Ebola Method for General Public,” provide instruction and information through videos and printable documents.

“This is a great lesson – a lesson that has played out in the newspapers,” Dr. Khan said. “So you can hand somebody a bunch of guidelines and say, ‘Take care of a patient,’ and what happens is – Texas happens. You have to do more than hand people guidelines. The guidelines have to be correct, and the initial ones were not. And, second, you have to add the training exercises and drills.

“This is what the biocontainment unit has done at UNMC to ensure extraordinary care – not just for people in Nebraska, but also for people worldwide.”

If you would like to help UNMC’s College of Public Health continue to make a difference across the state and the world, please consider giving to the College of Public Health Student Assistance Fund, which helps recruit students from Nebraska and worldwide to tackle public health problems, or to the College of Public Health Research Support Fund, which develops UNMC’s program on emerging infectious diseases.

For more information, contact the foundation’s Karen Levin at 800-432-3216.

Dr. Khan’s presentation is available alongside two free online Ebola education courses and other downloadable materials on the UNMC website.

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