http://currents.plos.org/outbreaks/article/projected-treatment-capacity-needs-in-sierra-leone/
White RA, MacDonald E, de Blasio BF, Nygård K, Vold L, Røttingen J. Projected Treatment Capacity Needs in Sierra Leone. PLOS Currents Outbreaks. 2015 Jan 30 . Edition 1. doi: 10.1371/currents.outbreaks.3c3477556808e44cf41d2511b21dc29f.
Richard A White
- Norwegian Institute of Public Health, Oslo, Norway
Emily MacDonald
- Norwegian Institute of Public Health, Oslo, Norway
Birgitte Freiesleben de Blasio
- Norwegian Institute of Public Health, Oslo, Norway
Karin Nygård
- Norwegian Institute of Public Health, Oslo, Norway
Line Vold
- Norwegian Institute of Public Health, Oslo, Norway
John-Arne Røttingen
- Norwegian Institute of Public Health, Oslo, Norway
The ongoing outbreak of Ebola Virus Disease in West Africa requires immediate and sustained input from the international community in order to curb transmission. The CDC has produced a model that indicates that to end the outbreak by pushing the reproductive number below one, 25% of the patients must be placed in an Ebola Treatment Unit (ETC) and 45% must be isolated in community settings in which risk of disease transmission is reduced and safe burials are provided. In order to provide firmer targets for the international response in Sierra Leone, we estimated the national and international personnel and treatment capacity that may be required to reach these percentages.
We developed a compartmental SEIR model that was fitted to WHO data and local data allowing the reproductive number to change every 8 weeks to forecast the progression of the EVD epidemic in Sierra Leone. We used the previously estimated 2.5x correction factor estimated by the CDC to correct for underreporting. Number of personnel required to provide treatment for the predicted number of cases was estimated using UNMEER and UN OCHA requests for resources required to meet the CDC target of 70% isolation.
As of today (2014-12-04), we estimate that there are 810 (95% CI=646 to 973) EVD active cases in treatment, with an additional 3751 (95% CI=2778 to 4723) EVD cases unreported and untreated. To reach the CDC targets today, we need 1140 (95% CI=894 to 1387) cases in ETCs and 2052 (95% CI=1608 to 2496) at home or in a community setting with a reduced risk for disease transmission. In 28 days (2015-01-01), we will need 1309 (95% CI=804 to 1814) EVD cases in ETCs and 2356 (95% CI=1447 to 3266) EVD cases at reduced risk of transmission. If the current transmission rate is not reduced, up to 3183 personnel in total will be required in 56 days (2015-01-29) to operate ETCs according to our model.
The current outbreak will require massive input from the international community in order to curb the transmission through traditional containment mechanisms by breaking the chains of transmission in Sierra Leone. If sufficient treatment facilities, healthcare workers and support personnel are not rapidly deployed, the increasing number of cases will be overwhelming.In addition to supporting isolation and treatment mechanisms, other viable control options, such as the development of an effective vaccine, should be supported.