In Monrovia, the blue steel gates guarding JFK Medical Center’s Ebola ward separate two worlds, each hopeless. On one side, three Liberians lie huddled on the ground under a UNICEF shelter, waiting to get in. On the other side, a flatbed truck loaded with 10 bodies in white plastic bags waits to drive out.
The truck belongs to one of four burial teams who pluck the dead from treatment wards — or worse, from homes where terrified families huddle around loved ones, desperate for one last touch. For many Liberians, giving a body to the burial team for cremation is unthinkable. Yet those last touches — part of Liberian funeral practices — are the very things that spread Ebola.
I follow the burial team to a home said to hold five bodies, all Ebola victims. As rain falls and a crowd gathers, the team members from the truck put on white suits and masks and set out down a narrow alley to the home. In 10 minutes, they are back. There were only two dead in the home, and the family told them to leave. “It isn’t Ebola,” they said. No time to find out if they were right — there are many more bodies to collect.
The truck heads next to ELWA 2 hospital, a major treatment center. Until just weeks ago, the hospital was run by the mission groups Samaritan’s Purse and SIM; others oversee it now. Then two of their American volunteers became ill. As the burial team pulls up to the walled compound, more people are waiting for treatment, including two suspected Ebola patients in an ambulance. But there are not enough beds for the patients — and not enough health-care workers to provide treatment even if they could fit them in.
This is a big part of the problem. There’s no cure for Ebola, but supportive treatment as simple as supplementary fluids can save lives and slow the spread of the disease. But many treatment centers are unable to provide even rudimentary care. Last week, the World Health Organization and the U.S. Centers for Disease Control and Prevention called for more support for the region. CDC Director Tom Frieden talked about the window of opportunity for the world to respond — a window that is quickly closing.
I don’t think the world is getting the message. The magnitude of the response needed for a deadly outbreak like this in a staggeringly poor country demands both dollars and people.
For four years I led the CDC’s emergency-response activities, including the early response to the H1N1 flu pandemic in 2009. I speak from sad experience: The level of response to the Ebola outbreak is totally inadequate. At the CDC, we learned that a military-style response during a major health crisis saves lives. In a global setting, the CDC usually provides technical support to local ministries of health. This crisis calls for much more.
The United States has the expertise and the personnel to get this outbreak under control. This week there were encouraging signs that the U.S. government was starting to take it more seriously and scale up the response.
The president has started talking more about the outbreak. USAID and the State Department announced that they will transport 100 African medical workers from across the continent to provide support in the Ebola-affected region. They are also providing equipment and resources to outfit an additional 1,000 beds. The administration is asking Congress for funds to provide more CDC technical experts and supplies. However, while supplies and experts will help, they are not enough. It will take much more.
We need to establish large field hospitals staffed by Americans to treat the sick. We need to implement infection-control practices to save the lives of health-care providers. We need to staff burial teams to curb disease transmission at funerals. We need to implement systems to detect new flare-ups that can be quickly extinguished. A few thousand U.S. troops could provide the support that is so desperately needed. There could be casualties, but what military operation is ruled out solely because it is dangerous?
Some may ask why the United States should play this role. Well, no one country is doing enough. We have the expertise and the personnel to tackle this challenge. From a humanitarian and medical perspective, we have a moral obligation to provide care to those who need it, wherever they may live. Nancy Writebol, an American missionary who survived Ebola, said she hoped a silver lining in her brush with death would be increased attention to the plight of her “brothers and sisters in Africa.” She recognizes a sad truth about her own story: Without American victims, Americans might not care.
But go beyond humanitarianism: Epidemics destabilize governments, and many governments in West Africa have a very short history of stability. U.S. aid would improve global security. And consider the issue of “health security.” Microbes don’t respect borders. Now that Ebola is spreading in Nigeria, a global travel hub, cases are sure to appear outside the continent. While one Ebola case in the United States is unlikely to spark an outbreak, things could change if the virus becomes more easily transmittable. We already know it’s mutating.
In my 13 years at the CDC, I never witnessed an outbreak as disturbing as this one. We have the tools to save thousands of lives, but our response has been inadequate. We underestimated this epidemic, and the people of West Africa are paying for it. We know how to control Ebola. It’s time to step up and get the job done.
Richard E. Besser is chief health editor at ABC News.