Still on Ebola – the role of technology in Global Health

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Below is the text of the speech given at the Exponential Medicine event at Singularity University, San Diego. Here is the video.

It is rather unfortunate that the people of West Africa may soon be dealing with two deadly infectious epidemics, meningitis and Ebola, at the same time. In Africa’s Meningitis Belt, the beginning of the dry season (November to January) signals the start of the annual meningitis epidemic. Many more people may be infected with meningitis than have been killed during the current Ebola epidemic. Thousands may die from meningitis even as Ebola continues to kill. Yet there is little talk or even preparation to mitigate the impact.

A double whammy for West Africa?

Seventeen years ago, I survived meningitis during one of the annual epidemics that kills thousands of children and young adults in West Africa every year. In fact, according to UNICEF, as of March this year, while the 2014 meningitis season was still on, there had been nearly 23,000 cases with about 1,400 deaths. Data from the World Health Organization (WHO) indicates that by June, the number of cases had risen beyond 34,000, with nearly 2,500 deaths.

That I survived meningitis under circumstances marked by limited access to health-related technologies is certainly instructive for us today as we battle Ebola. The public health response to Ebola in West Africa has been good but with technology we can do better. This explains why the United States Agency for International Development (USAID) launched its Ebola Grand Challenge seeking innovative solutions to fight the epidemic. Fortunately, the fight against this deadly infection need not be with low level technology. The high level technology we need is available and, hopefully, the people to deploy them are reading this right now.

What exactly do we need to do?

Understanding Ebola

To be clear, tackling any disease outbreak requires a good understanding of the disease as well as the environmental, cultural and political factors that influence the occurrence, distribution and spread of that disease. This is particularly true now that it appears that we facethe possibility that Ebola will become endemic among the human population of West Africa. To beat this Ebola outbreak and to prevent a recurrence of similar outbreaks there is a need to tackle the disease along with its determinants. The good news is that there are potential technological solutions for every aspect of this Ebola outbreak.

According to the World Health Organization, Ebola virus disease (EVD) is characterized by sudden onset of fever, fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding. Ebola spreads through human-to-human transmission via direct contact with body fluids of infected people and with surfaces and materials such as bedding and clothing contaminated with these fluids. Cultural factors, such as burial ceremonies in which mourners have direct contact with the body of the deceased person, play a role in the transmission of Ebola.

It can be difficult to differentiate Ebola from other infectious diseases such as malaria, typhoid fever and meningitis. Confirmation that symptoms are caused by Ebola virus infection are made by using serological tests, genomic assays, electron microscopy and virus isolation by cell culture. There is as yet no proven treatment available for Ebola and no licensed vaccines are available yet. However, supportive care such as rehydration with oral or intravenous fluids and treatment of specific symptoms, improves survival as have been seenin the United States.

Technological solutions

In talking about specific examples of what technology can do to help the situation, some of these ideas that have been put forward by Epidemiologist Larry Brilliant.

Beginning with screening and diagnosis, reliable rapid diagnostic kits could make the job a lot easier. Remember that the symptoms of Ebola are not specific to disease. Therefore we need kits that can quickly detect Ebola and rule out malaria or typhoid fever. This is even more important for airport screening because some travelers may take medications that mask a fever if there is one. If we ever consider screening all travelers out of the hot zone of West Africa, rapid test kits will be essential. It is also essential that this technology, as well as others, be made affordable for mass deployment.

Wearable devices, such as electronic bracelets, could also be engineered to provide continuous monitoring of the body temperature of Ebola contacts under supervision or quarantine. These devices may even provide real-time updates and enhance active monitoring by public health authorities.

In the Ebola treatment units it would be a good idea to have multifunctional kits that can also evaluate a patient’s general health status with the ability to tests for liver function, renal function and electrolytes status at the same time. This will obviate the need to conduct those tests on separate machines in different buildings thereby limiting the chances of disease spread.

The health care workers in the hot zone also need to be kept cool. Wearing a full cover Tyvek suit in 100*F heat is no mean task. Can we create comfortable protective suits?

Innovative public health practices

With regards to surveillance for new outbreaks and contact tracing, smart phone apps and low cost automated voice or text messaging could be developed. On both platforms, people concerned about a risk for Ebola could key in their concerns and receive feedback that help them seek appropriate care. Data from such system would help epidemiologist detect new outbreaks and trace the contacts of Ebola patients.

How about using technology to ensure that quarantine conditions are made more humane? We still hear of people breaking out of quarantineto find food for themselves. Yet in some cases, the food aid meant for those communities lie in warehouses!

Coordinating the international Ebola response has been a challenge. Information technologists could create a regional disease surveillance and response network to share protocols and information, and as well build trust among agencies working across borders.

Social justice for global health

Yet it will not be enough to target technology at the disease alone. We must also act on the cultural and political factors that have encouraged the occurrence and persistence of infectious disease outbreaks in the developing world. Can we create affordable technologies that will improve literacy and educate the masses? Can we make gadgets that will help pull people out of poverty? Are there systems that can help make governments accountable and elections truly free and fair? The public health systems in West Africa will become strong only when political governance is good.

What I am saying about Ebola is true for all infectious diseases. Indeed, there are many viruses and bacteria out there just waiting to create global disruption. We call them Emerging Infectious Diseases. And so the time to act is now. With the right technology we can combat this outbreak and prevent the occurrence of others.

Remember, infectious diseases do not respect international borders.

This article is based on a speech Dr. Effiong delivered in November 2014 at the Exponential Medicine Conference held in San Diego, California. It was first published by the University of Michigan Risk Science Center.


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