Responding to Ebola: The role of medical journals during global public health emergencies

As a researcher in global public health and a clinician in a high-income, well-resourced health system, I have had the opportunity to work across a spectrum of health services, ranging from the treatment of neglected tropical diseases to providing care for routine surgical pathologies. Regrettably, the focus of the global health care architecture that predominates the research and development agendas around the world has adopted a focus that is frequently out of line with the needs of the poor, resulting in too little attention and innovation being devoted to pressing global health problems (1). On occasion, however, an emerging health concern propels tropical diseases to the forefront of medical practice in Canada or elsewhere, prompting us to reconsider our vulnerabilities within an increasingly globalized world.

Dr Jason Nickerson

Presently, health systems around the world are preparing for the potential of arrival of patients who may have been exposed to the Ebola virus disease by way of an outbreak that began in Guinea in December 2013, but was only declared in March, and has since spread to Liberia, Sierra Leone and Nigeria (2). At press time, the case fatality rate of the outbreak was 54.9%, with a cumulative total of 2240 cases and 1229 deaths, and no indications of a resolution to this epidemic (3).

Control of the virus is proving to be difficult for several reasons (4). The geographical spread of cases in and between the countries affected presents a major logistical challenge in identifying and tracing individuals who may have been exposed to the virus. While much attention has been given to the development of new drugs for the treatment of Ebola, less attention has been devoted to the role of strong health systems in identifying, controlling and responding to the epidemic. Regrettably, the health systems of the affected countries face major longstanding challenges, including severe shortages of health workers. In resource-constrained settings, access to even basic primary care is poor and often hampered by systemic problems such as access to essential medicines, effective health information systems for monitoring disease trends and patterns, and the application of evidence-based treatments, making the effective detection, control and treatment of a complex disease, such as Ebola, extremely challenging.

In Canada, the Ebola outbreak continues to be at the forefront of public discussion and of concern to health workers across the country, perhaps, in part, prompted by the infection of several American and European aid workers. In the current issue of the Journal, for example, we present a brief review (pages 87–90) on one hospital’s infection control procedures that are in place for precisely a situation such as this. The commentary highlights the challenges imposed on Canadian health facilities to identify best practices for high-risk, low-probability scenarios, and to ensure that we can continue to provide treatment in a manner that is effective and vigilant.

Despite this heightened awareness and preparations, several experts have noted that the risk of an Ebola epidemic in Canada is likely low. Unsurprisingly, the justification of this reasoned call is not because Canada harbours an effective drug for Ebola, but rather because Canada’s health care system is well-equipped to effectively deal with a disease outbreak such as this. Case definitions have been established, infection control protocols are in place and our public health surveillance system is strong. Rather than being a call for complacency, the statement that our risk of an epidemic is low is, in fact, a call to arms to ensure that all health professionals are aware of how to safely care for a patient with a highly communicable disease such as Ebola, and that necessary equipment, policies and protocols are in place to be immediately put into action.

Beyond the challenges of clinical care, disease epidemics, such as Ebola, severe acute respiratory syndrome or H1N1, present major intellectual challenges for health professionals who must care for patients for whom there is a small or no evidence base to guide treatments. Ebola has rarely been treated outside of a handful of resource-poor countries where access to critical care medicine is poor; it is, therefore, conceivable that with stronger resources, greater reductions in mortality could be achieved. At the same time, this also means that clinicians are largely starting anew to build the evidence base on which future treatment guidelines and protocols ought to be based. This is where academic medicine, including clinician-investigators and authors, as well as peer-reviewed journals such as ours, must play a strong role in advancing the science of global health. As clinicians with access to resources to provide comprehensive interventions to patients with rare or neglected diseases, and the ability to report on our successes and failures in doing so, we have a responsibility to share these experiences so that others may build on them.

Respiratory therapists play a leading role in the frontline care of critically ill patients, including making important decisions concerning the processes and systems that ought to be in place to ensure that Canadian health care facilities can safely care for patients with diseases such as Ebola. By sharing these experiences in forums that are accessible to other clinicians in low- and middle-income countries, and providing those clinicians with an opportunity to share their experiences with us, this is a direct opportunity to influence the organization and delivery of care globally, and is an opportunity that we all must embrace.