In an editorial published online today in the International Journal of Epidemiology, experts from the Departments of Psychiatry and Epidemiology at Columbia University, New York, are calling for survivors of the Ebola epidemic to be mobilised in a bid to hasten containment of the disease.
We already know that the current Ebola outbreak is unique in its magnitude and for its dispersion in dense, mobile populations. Physicians and nurses face high mortality, and foreign aid in the form of medical supplies and staff continues to be unequal to the scope of the problem. With a case recovery rate of around 30% at the present time in West Africa, survivors already number in the thousands. In their editorial, Dr Zena Stein of the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Joseph Mailman School of Public Health at Columbia University, and her colleagues, who are based at the HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, lay out four major reasons why Ebola survivors may be critical to controlling the epidemic:
The recovered have developed immunity to the current strain of Ebola and therefore are able to care for the sick with little to no risk of re-infection
Dr Stein says, 'In a sense survivors are the only people in the world who are "vaccinated" against further Ebola infection with the strain in circulation. This uniquely positions them to mediate between the infected and uninfected and between local people and foreign responders.'
Survivors can donate blood as their antibodies might be protective and help those infected survive the deadly virus.
While this has not yet proven to be effective, passive immunotherapy with survivors' blood could be an effective treatment for the tens of thousands of people predicted to battle Ebola.
Unlike many foreign responders, survivors speak local languages, understand cultural dynamics, and may be viewed more favourably than outsiders during this time of intense fear and community mistrust
This means they could care for the sick in both medical and home-based settings. Employing trained Ebola survivors as caregivers would also give them a source of income in a context of increased poverty and stigmatisation.
Ebola survivors may play a role in generating an effective, community-based response in exposed localities.
The researchers state, 'Community-initiated actions in epidemics are recognised as important to public health, and have already been proven successful in an African context. For instance, the Treatment Action Campaign in South Africa has generated an effective, nationwide social movement among those HIV-positive, stigmatised and deprived of treatment. A movement among Ebola survivors could establish their effectiveness as advocates and educators, countering stigma and building community trust.'
The editorial recommends that adult survivors be identified through medical records and community leaders, as well as recruited through public messages, and their immunity established via blood tests. Interested survivors could then be trained in essential care-giving roles, allowing non-immune staff to move to positions that minimise their exposure to Ebola.
Dr Stein comments, 'Slowing and then stopping the spread of Ebola in West Africa is not only crucial to the region, but also to public health around the world, as demonstrated by the recent spread of the virus to Spain and the United States. But overcoming the crisis wrought by Ebola will require sustained action, cultural insight, and cooperation among affected communities and international responders.'