In a future epidemic, more effective strategies must be put in place to stop the spread.
Prof. Tom Koch, of the University of British Columbia, asks how it could be that many of the best minds in infectious disease, epidemiology and disaster medicine missed the early spread of the Ebola disease so that it became a regional epidemic.
While insisting that all parties involved "labored heroically, often at great personal risk, to restrict the original outbreak and treat those affected by it," Prof. Koch believes there are lessons to learn about containing future disease outbreaks in rural areas with minimal resources.
In his review, he focuses on the potential of mapping as a tool to help deal with future disasters.
Prof. Koch points out that limits on data relating to patient location and travel mapping made it harder to contain the Ebola crisis.
At the same time, regional disease protocols were not implemented soon enough, as nobody anticipated such an expansive epidemic.
Records now show that the 2014 epidemic probably began in 2013, when a 2-year-old boy in the village of Meliandou in Guinea's Gue ́ckédo Prefecture first became infected.
Infections need to be appropriately mapped
However, local, national and international health officials assumed that, as in previous cases, this outbreak would be a static, and thus controllable, localized disease event.
Prof. Kock explains that infectious diseases have a spatial structure and that their spread depends on individual features that either promote or hinder their progress. Based on this, he argues that various forms of mapping could help to contain such diseases.
In the case of the Ebola epidemic, having no maps or census data for the region where the outbreak occurred made it difficult to apply aggressive quarantine programs, which could have isolated the villages where Ebola was active and protected those at risk from villagers who did not display symptoms.
Prof. Koch discusses the need to involve the community in mapping and education.
"Employing community members in the mapping also serves anthropologically, involving community members in the disease response, teaching them about an expanding viral event and its local effects. In areas where there is distrust of foreign or official health workers, this can be critical."
Prof. Koch gives the example of the Nepal earthquake in 2015, where resources of Humanitarian Open Street Map and Digital Globe satellite data enabled 39 volunteers to create Quakemap.org, a crowd-sourced mapping program that enabled correlation of reports of earthquakes in individual villages to help ensure that supplies were directed where they were needed.
In connection with the Ebola crisis, he focuses on a strategy called diffusion mapping. In this approach, smaller scale maps are used in patient interviews to identify travel patterns of patients before they become symptomatic. This could be helpful in anticipating the number of patients likely to present with symptoms in time.
He describes the approach as "a potentially invaluable, if so far untested, approach that would rapidly characterize local travel patterns and thus the potential for regional disease expansion."
Prof. Koch hopes that the review will help shape ideas about how mapping could help significantly in future outbreaks by contributing toward a prompt response.
Medical News Today recently reported on trials into the effectiveness and safety of using convalescent plasma to treat Ebola patients.