Dr. Gabriel Fitzpatrick:

I thank the committee for that wide range of questions. When I was going into very remote regions of Sierra Leone looking for cases, I was being told initially that there were no cases in the village I was going to. When I would turn up in the village, I would find a number of cases. This would happen regularly, day in, day out. One has various models predicting how many cases will occur in the next three months or six months, but we know from basic information of going into villages and finding cases that nobody has told us about previously that there are a lot more cases than are documented.

Ebola is a viral haemorrhagic fever. MSF has been containing ebola outbreaks since the 1970s. If one looks at the literature, one will see that every time an ebola outbreak or a viral haemorrhagic fever outbreak occurred in Africa, it was MSF dealing with it. MSF controlled those outbreaks and performed effectively because the outbreaks were small. The major components were building the treatment centre, going out into the community, educating the community, bringing those sick cases into the ebola treatment centre, following up all the contacts of those cases in the community, and doing that for 21 days. We have been doing that for decades with viral haemorrhagic fever such as ebola, and it works. That is why I stated the world knows what to do. We need to do it.

However, this is a totally different ball game we are dealing with. The scale is unprecedented and we cannot do what we could do previously in terms of building enough treatment centres, enough case finding and enough contact tracing. We cannot do it. From being on the ground, as many will agree, the NGOs cannot deal with this either. That is why we are making this unusual call to get the military from larger countries involved with this outbreak. We need military organisation to set up large numbers of ebola treatment centres across the region. The NGOs there at present cannot do that and that is what we need.

Obviously, Ireland would not be in a position to provide a large-scale military biohazard capacity simply because we are a small nation, but there are larger nations.

We welcome the response from the US, which is sending 3,000 personnel to the area and setting up 17 ebola treatment centres, with possibly 100 beds in each centre. That is the sort of response we need. No response can be too big at this time, because we do not know how big the problem is. We do not have all the information.

A question was asked in regard to the benefit of an ebola treatment centre. Obviously, patients who arrive into an ebola treatment centre earlier have a marginally improved chance of survival, but that is not the main reason for bringing people to these centres. We are bringing patients into the ebola treatment centres to try to stop them spreading the virus among families and friends who visit them. We are asking the patients affected to come with us in our ambulance to our ebola treatment centre to save members of their community. This has worked previously, but the scale of the spread of the virus is much larger this time.

In the Irish context and in regard to staff, while there are many NGOs in the world, very few of them have experience with treating and containing viral haemorrhagic fevers such as ebola. We believe it is a good idea that if countries are sending out staff, they should send them out with organisations that have a track record of dealing with this issue in order that they will know they will be working in a relatively safe environment and with people who have done this previously.

On the issue of ebola in Nigeria versus in Sierra Leone and Liberia, there are five different types of ebola. We can take the fingerprint of each of those types and tell which ebola is which. The ebola in Nigeria and in Sierra Leone has the same fingerprint. It is the same type of ebola, but the response in both countries has been hugely different. Nigeria is a much richer country than Sierra Leone. It has a stronger, though not perfect, public health infrastructure and has been able to respond more swiftly and widely to the cases that arrived in the country than Sierra Leone was.

In regard to diagnosing ebola, we have case definitions we try to disperse within the community in order that people with certain symptoms and signs will respond to our invitation and come to our treatment centre. When they arrive, we will assess them and make a medical judgment as to whether they fit the case definition. If they fit the case definition, we will admit them and perform the ebola test to see whether they are positive or negative. If they are positive, they will be admitted to the confirmed tents and if negative, they will be sent home. Prototype rapid diagnostic tests for ebola are in development and, when developed, these will mean we can take a finger prick of blood, put it on a small card device and see from the lines that develop whether ebola is present. These tests would be similar to the tests available for malaria, but they have yet to be validated.

The question as to how Ireland can respond in this situation has been asked repeatedly. First, it can make funds available to organisations working on the ground and, second, it can funnel experienced staff from within our health care system through agencies we know are safe. It is not ideal to send staff out without the backup of an agency with a track record of working in the area.