Hygienic funerals, better protection for health workers offer best chance to stop Ebola

Hygienic funeral practices, case isolation, contact tracing with quarantines, and better protection for healthcare workers are the keys to stopping the Ebola epidemic that continues to expand in West Africa, researchers say in a report published online in Science.

Continuing the status quo of intervention efforts would allow further expansion of the epidemic by about 224 new cases daily in Liberia by Dec. 1, and 348 new daily cases by Dec. 30, the scientists report. However, they say, broad implementation “with utmost urgency” of more aggressive approaches could by mid-March lead to its control in Liberia, the focal point of the epidemic.

Researchers from Yale University, Oregon State University, and Liberia conclude that funerals, as they have been customarily practiced in this region, have been “super-spreader events” that have had a disproportionate impact on the early transmission of the virus.

“The cultural body preparation and funeral practices that are common in West Africa have driven the initial spread of this disease,” says study co-author Jan Medlock, PhD.”These funeral practices often include washing, touching, and kissing of bodies that were still capable of spreading the Ebola virus. “It is imperative that funeral transmission be stopped, and also that we take other aggressive steps to isolate cases and better protect healthcare workers.”

The findings were made with complex mathematical models that consider many variables in how the disease is spreading, what steps are being taken to slow its progression, and how effective those steps are. The research sought to identify not only what would theoretically work, but what was most practical and achievable.

The goal, the researchers say, should be to shift the current Ebola epidemic from one that is expanding to one that is slowly declining—to change what scientists call the “basic reproductive number” to less than 1, so the epidemic is on the road to ultimate extinction. They estimate that in Liberia the Ebola reproductive number is currently 1.63, meaning that two infected people would infect, on average, about three more people, and the epidemic continues to expand. Getting that number below 1 will require adequate and proper use of personal protective equipment, more complete case isolations, contact precautions, quarantines, and particularly improved funeral practices. Read the study.