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As health officials
struggle to contain the world's biggest-ever Ebola outbreak, their efforts are
being complicated by another problem: bad data.
Having accurate numbers
about an outbreak is essential not only to provide a realistic picture of the
epidemic, but to determine effective control strategies. Dr. Bruce Aylward, who
is leading the World Health Organization's Ebola response, said it's crucial to
track every single Ebola patient in West Africa to stop the outbreak and that
serious gaps remain in their data.
"As we move into the
stage of hunting down the virus instead of just slowing the exponential growth,
having good data is going to be at the heart of this," Aylward said.
"We are not there yet and this is something we definitely need to
fix."
"Decisions about
prevention and treatment should be data-driven, but we really don't have the
data," agreed Irwin Redlener, director of the National Center for Disaster
Preparedness at Columbia University.
A week ago, the World
Health Organization insisted at a media briefing it had mostly met targets to
isolate 70 percent of Ebola patients and bury 70 percent of victims safely in
Guinea, Liberia and Sierra Leone. But two days later, WHO backtracked and said
that data inconsistencies meant they really didn't know how many patients were
being isolated. Then the U.N. health agency also conceded that many of the safe
burials were of people not actually killed by Ebola.
Aylward said not knowing
exactly how many Ebola patients there are in hotspots like western Sierra Leone
means health officials might miss potential contacts who could unknowingly
cause a surge of cases. Compared to other epidemics like malaria, which is more
seasonal and can fade away without huge control efforts, ending the Ebola
outbreak will require extraordinary attention to detail.
"This outbreak
started with one case and it will end with one case," Aylward said.
"If we can't get 100 percent of the contacts of cases, we will not be on
track to shut it down. Unfortunately at the moment, the data right now is not
enough for us to get to zero."
In West Africa, where
health systems were already broken before Ebola struck, collecting data amid a
raging outbreak has been challenging.
"Suddenly you have
all these different sources of data that have to be compiled" from
different aid agencies, said Ray Ransom, a data expert at the U.S. Centers for
Disease Control and Prevention. "The ability to actually collect information
is a different challenge than responding to the outbreak, and the energy has
been focused on the response."
He said local officials
are good at tracking known or suspected Ebola cases and their contacts but not
as reliable relaying that information to national authorities.
The software built to
track Ebola outbreaks was initially designed by the CDC to have one person
entering data into a computer. That "was perfectly fine since the dawn of
time up until" the outbreak exploded this summer, said Armand Sprecher, a
public health specialist with Doctors Without Borders.
The CDC has redesigned
the software so now multiple people can enter data, although that created new
problems like possible duplication, Sprecher said.
When the epidemic starts
to taper off, health officials should have more time to find every Ebola case
and their contacts. But they may find they have to re-establish trust with the
community to do that.
"If people were
calling in cases for months and no one was coming ... and then suddenly that's
no longer a bottleneck, do people suddenly realize that and say, aha, if I call
in today, it'll work this time?" asked Sprecher. "If you've lost the
community, you don't get anywhere."
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