An Ebola veteran shares lessons for COVID-19

WASHINGTON — Gyude Moore has more experience with social distancing and disease response than many in his current hometown of Washington, D.C. During the Ebola response, he served as a senior adviser to then-President Ellen Johnson Sirleaf of Liberia and stopped interacting with people far earlier than most.

He’d seen firsthand how important behavior change is in ending a pandemic, saying he knew it would spread if people didn’t alter their behavior.

“What has been frustrating for me about the U.S. response is that, during the West Africa outbreak, people came from the U.S. to help us respond and people here know what needs to be done, but what’s been missing is central guidance. It doesn’t make any sense,” he told Devex.

Moore said he has seen parallels with the Ebola crisis, which had political leadership hoping that numbers wouldn’t go up. The first case in Liberia was a woman who had gone to Guinea for a funeral. Though a “frantic search for her” took place and there were efforts to trace all of her contacts, there was then a roughly monthlong hiatus in which people continued going about their normal lives — until there was an “explosion in cases.”

There was an assumption that the health system in West Africa was overwhelmed as a result of poverty and overall weakness, but that’s not quite right, Moore said. The weak system “only accounted for how quickly the system was overwhelmed, not that the system was overwhelmed.”

It has been hard to convince people in advanced, wealthy countries that their hospital systems could also be overwhelmed, Moore said.

“What we learned is you have to overprepare so you don’t have to overreact,” he said.

For example, if it seems that 300 beds might be needed, prepare 1,000. “At the end of the day, you want to be criticized for wasting resources and overpreparing. That’s praise in preparedness,” Moore said.

There were three key actions that helped bring the Ebola response under control: behavior change or social distancing; testing and isolating people who were infected, including from their families, to prevent new clusters and bring down infection rates; and separating incident response from regular health care. In Liberia, a number of tent hospitals, known as Ebola treatment centers, were built where those with symptoms were advised to go, leaving regular hospitals to treat patients with other issues so that they wouldn’t be overstretched.

While it seems as though there is currently a low number of cases in Africa, that may be a reflection of testing capacity rather than the virus not being present, Moore said. Most African countries struggle with testing, but if newer tests providing rapid results become available, that would help in the response, he said.

Countries that have dealt with previous epidemics, including Ebola, have certain infrastructure that can help in this response, especially the expertise and systems to do contact tracing. But most countries don’t have that experience and “so will be relearning lessons their West African counterparts learned,” he said.

Many African countries have had vaccination campaigns that reached remote areas, and those systems can be used in the response, Moore said. But not all countries have incident management teams, and they need plans for how to handle hard-to-reach areas with limited health resources, he said.

In most African countries, a significant amount of the health budget goes to diseases such as malaria and typhoid, and it is often heavily reliant on donors for basic health services. The result is that they don’t have the “ability to withstand external shocks.” The inherent weakness in those systems, even those that have experience, means countries will struggle to respond, Moore said.

The unique difficulty with COVID-19 is that the disease is global, whereas with localized outbreaks, African countries could expect assistance from European nations, the U.S., China, and Japan. But with those countries all fighting the new coronavirus at home, it’s “not clear if external assistance is forthcoming, and if it is, if it’s coming at the volume that’s needed if Africa is only lagging behind,” he said.

There are nearly 300 confirmed cases of COVID-19 in sub-Saharan Africa, according to the World Health Organization, and it’s unclear how quickly or severely the virus will spread. While Africa has a younger population than some of the hardest-hit countries, people struggle with nutrition and food security, which can weaken their immune systems. A particular challenge with COVID-19 is that severe cases require more sophisticated health interventions, such as ventilator use, which creates complexity in countries where people struggle to provide basic health, Moore said.