In some of the bleaker flu pandemic scenarios that floated around during the middle of the last decade – with 30% (or more) of the population expected to fall ill with a comparable-to-1918 flu – at some point hospitals would be overrun, healthcare worker infections (and defections) would degrade their ability to provide services, and 90% of those infected would end up being treated in their homes by family and friends (see Alabama Pandemic Drill & Home Alone).
This graphic is from the State of Florida Pandemic plan
With roughly 50,000 hospital beds in the State of Florida – 80%-90% of which are occupied at any given time - finding a way to treat an additional 640,000 cases during a pandemic would be an extreme challenge. But at least in the United States, with more than 1 million hospital beds, there is a fair amount of surge capacity.
In Sierra Leone, where healthcare facilities and community resilience were already badly degraded before the epidemic began, that tipping point appears to have already been reached as the official (albeit, likely badly underestimated ) case count nears 3,000 (see WHO Situation report - 10 October 2014).
Yesterday, in what has been described as an admission of `defeat’ (see NYTs Officials Admit a ‘Defeat’ by Ebola in Sierra Leone), health officials there have approved plans to assist families in treating patients at home.
While work is still being done to increase the number of hospital beds and treatment centers in Sierra Leone – until that can be done – there is little else that health providers can do at this point. Hundreds of people have already been turned away from over crowded treatment facilities, and their option of last resort – treatment at home by family and friends – is already a reality for many.
After months of extolling the advantages of seeking early, professional treatment – in part to save lives, and in part to isolate infectious patients and lower the community transmission rate – the number of people seeking treatment has completely overwhelmed their limited ability to deliver care.
The plan now is to distribute gloves, rehydrating solution, and pain killers to hundreds of Ebola stricken households, and hope that additional aid will arrive in time to prevent a massive spike in deaths, and new cases in the community.
For more details, we turn to Adam Nossiter’s report from the NYTs.
FREETOWN, Sierra Leone — Acknowledging a major “defeat” in the fight against Ebola, international health officials battling the epidemic in Sierra Leone approved plans on Friday to help families tend to patients at home, recognizing that they are overwhelmed and have little chance of getting enough treatment beds in place quickly to meet the surging need.
As the collapse of the healthcare systems in Liberia, Sierra Leone, and Guinea proceed, getting routine or emergency medical care for non-Ebola conditions is becoming all but impossible. Collateral damage – from hunger, violence, and numerous untreated non-Ebola health concerns – threaten to claim nearly as many lives in the region as the disease itself.
A genuine concern is, as this epidemic spirals out of control, that Sierra Leone’s capitulation will be repeated in Liberia and Guinea. And if the virus were to spread substantially beyond these three countries, that other healthcare dominos could fall.
While we seem to be overly focused on few errant, scattered, cases showing up in Texas, or Madrid . . . the real battleground against this virus lies in West Africa, and that is where the most focus must remain.
For now – while it may not be perfect, or pretty – I’m confident that the public health response in most developed nations can prevent large outbreaks of the disease. That said, I fully expect to see ongoing introductions of the virus from infected travelers, and the possibility of seeing small clusters of locally acquired disease cannot be ruled out.
But should the world fail to stop this virus in West Africa – and relatively soon – that dynamic could easily change, with difficult to predict, but potentially dire consequences for other regions of the world.