How to Fight Ebola

Dr. John Redd, a captain in the U.S. Public Health Service, was sent in September by the Centers for Disease Control and Prevention (CDC) to Sierra Leone, one of the three West African countries most devastated by the Ebola epidemic. The 52-year-old was assigned to Makeni, the capital of the northern district of Bombali (pop. 434,000). After six weeks battling the deadly disease, Redd returned to his home in Santa Fe, N.M., where he described his experience to Time Inc. senior editorial adviser Richard B. Stolley.

WHAT WAS THE ULTIMATE GOAL OF YOUR WORK?

To slow down the spread and reduce transmission, because that’s what really controls an outbreak like Ebola. It’s the public-health measures that will end the outbreak, not treatment, as important as treatment is.

HOW DID YOU PROCEED?

First is case identification, or case finding. That means helping local authorities find people in the community as early as possible who have the disease or may have it, moving them into holding centers removed from their community while their labs are pending, then sending patients who are positive to an Ebola treatment unit (ETU).

WHAT WAS THE EBOLA SITUATION WHILE YOU WERE THERE?

We investigated more than 800 patients with suspected Ebola, and more than half were confirmed with the disease. There were over 100 deaths, but that is probably an underestimate. There’s a delay in reporting deaths from ETUs, and some deaths in rural areas are not reported. By the time I left, the numbers in our district had begun to decrease. But in areas around Freetown–the capital of Sierra Leone–cases are still on the rise.

WHAT WAS YOUR FIRST CONTACT WITH EBOLA?

I saw my first patient the day after I arrived, through a window in a holding center in Makeni. We could not go inside. We had three holding centers with a total of 140 beds, with a physical gradation according to patient risk. In the middle of each center were confirmed patients awaiting transit to an ETU in another district. They were vomiting, had diarrhea, were very weak. Anyone who treated those patients, mostly nurses from Sierra Leone, needed to be in full protective gear in spite of the heat–near 100ºF–and high humidity. Those nurses were incredibly heroic. There was another section for patients waiting for blood-test results. And a third for patients being observed for 21 days after their tests turned out negative. This separation of patients, and the nursing procedures, were all designed to minimize the risk that someone who was negative could get the disease there.

WHEN DID YOU WITNESS YOUR FIRST EBOLA DEATH?

It was the same morning. As many as eight people were dying some days.

HOW DID THE SURVEILLANCE PROCESS WORK?

We had about 100 college and public-health students, mostly men, some women, whose classes had been canceled because of Ebola. They were the team’s disease detectives. Every morning they would ride their motorbikes out to respond to alerts that a household member was ill or had died. They would call an ambulance to remove the body or take the patient to a holding center. We had only four ambulances, so sometimes we would have to ask patients to walk to the holding center. We had to be very practical about it. Then the surveillance officer would talk to the family about who might have come in contact with the patient. These contacts would be followed for 21 days.

HOW DID FAMILIES REACT WHEN THIS HAPPENED?

It could be tragic. In some cases, it was the last time they ever saw their loved one. They would say goodbye in the house, and because they were contacts, they would have to remain there and be monitored for Ebola. Getting information on that patient in the holding center could be very difficult, though the surveillance officers tried. If the person turned out to be positive, he or she would be taken away to a distant treatment unit, where sometimes they died. Those were some very touching situations.

ONCE IN THE HOLDING CENTER, WHAT HAPPENED?

They would receive medications for malaria and typhoid fever, and intravenous liquids and oral rehydration with water, sugar and salt for possible Ebola. And the blood draw would go as quickly as possible. That had to be done in full protective equipment. It’s quite a heroic job for someone to draw blood on Ebola patients all day long. Their dedication is hard to imagine.

HOW WERE THE BLOOD SAMPLES TESTED?

They had to be driven four to five hours to a CDC-run lab in a town called Bo, which would email or telephone me the results. We had more than 800 samples while I was there.

THEN WHAT?

There were many days when I would go to the holding centers to deliver blood-test results to the nurses and help with the disposition of patients. If positive, we would get that person to a treatment center as quickly as possible, but it was three to four hours away. We, the lab and the treatment center were all in different locations. One way to conceptualize this is to imagine someone is suspected of Ebola in Dallas, has to be taken to Fort Worth to draw blood, then the blood is driven to Wichita, Kans., and if positive, the patient is transported to Little Rock, Ark., for treatment. That is based on the actual drive times in Bombali.

WHAT WAS THE CDC PRESENCE IN YOUR DISTRICT?

About 60 CDC personnel were sent to Sierra Leone at any one time, and we had seven staying in Makeni and working in Bombali and an adjacent district. Six were doctors or epidemiologists, and one was a communications specialist, because a vast part of outbreak control is educating people. We all stayed in the same hotel and often ate breakfast and dinner together. Lunch was a PowerBar at our desks. Most everybody worked until midnight or 1 a.m., but one evening we all got together to relax and watch a movie I had on my laptop–Die Hard. It was a nice diversion.

HOW DID YOU PROTECT YOURSELF FROM EBOLA?

The most important was no touching. No shaking hands, no hugging. It was a massive societal change. I’d never been to Sierra Leone before, but I’d heard that the people were affectionate and physical. It was really something to live in that reality where you never touch another person–except a couple of times when I inadvertently bumped into someone at a meeting while eating.

WHAT WERE BURIALS LIKE?

Every person who died, no matter what the circumstances were, was supposed to be tested for Ebola with a cheek swab and then buried safely. The body was quickly placed in a body bag, which was sprayed with chlorine by a protected burial team. Then it was taken to a new and separate communal cemetery especially set aside for this purpose. To the burial teams’ great credit, they were extremely respectful. Families could not say goodbye at a funeral and could not be at the burial but could wait nearby. And after the ground was sprayed with disinfectant, loved ones could leave small memorials and markers there. Seeing that cemetery was one of the most moving experiences of my entire life.

THESE WERE HIGHLY EMOTIONAL MOMENTS. DID YOU EVER FIND YOURSELF IN TEARS?

I did cry a couple of times, but only in the evenings at the hotel, not in public. I think most of the CDC workers cried at one time or another. All of the CDC people supported one another a great deal because it was so stressful.

DID YOU FINALLY GET ACCUSTOMED TO THE DANGER?

I never felt personally threatened, but of course my risk was not zero. To keep it at zero, I would have had to stay home. We were all accepting some level of risk. But it was more the constant psychological cost of having to worry about it, of never touching people, maintaining distance, having to stay disconnected from potential patients. It was like a blanket over all our activities.

WHAT DID YOU LEARN IN SIERRA LEONE?

As a physician, I learned how quickly someone can get terribly sick from Ebola and die. As a medical epidemiologist, I saw that the public-health efforts to which CDC is contributing are going to be what eventually ends this outbreak. As a human being, I learned how hardworking and brave my Sierra Leonean colleagues are. Ultimately, what I really learned about Ebola is that it is controllable.

WOULD YOU GO BACK?

Without question.