Dr. Gabriel Fitzpatrick:

With the permission of the ministry of health in each country, MSF collects data on each patient in its treatment centres. We collect epidemiological and outcome data. When collecting the data we look for risk factors that we find recurring for patients who contract ebola. Two major risk factors stand out and will be published in scientific journals by MSF in the near future. One of these risk factors is close family contacts when family members of patients clean away vomit and diarrhoea without gloves or aprons. This is the primary type of intimate contact we are seeing. The second is in health care facilities where doctors are physically examining patients without gloves or appropriate protective equipment when the patients are actively having gastrointestinal symptoms such as vomiting and diarrhoea. Ebola loves compassion and people's need to help close family members. We particularly see it with children, and 25% of admissions to our facility are aged under 18. When we see children come in, we know older family members will be following closely, because when children are ill, their parents and older siblings will help them and clean away those bodily fluids they are, unfortunately, producing.

Although there is no treatment for ebola, there is a reduction in mortality if people arrive early. There are different results for different areas for a large number of reasons. In the centre where I worked, there was a 10% to 20% reduction in the chance of mortality among those who came in early. That is because we give people anti-malarial treatment, a broad-spectrum antibiotic such as cephalosporin, oral rehydration and, if required, intravenous rehydration. These are not treatments but they can help some patients over the edge from becoming somebody who may die to becoming somebody who can be a survivor. It is a gentle move along the way to helping them, not a treatment. There are treatments in the pipeline. There is hyperimmune serum for people who have recovered, various types of monoclonal antibodies and trial vaccines.

What worries me about this is that people may think there are treatments coming down the line and that we do not have to worry about the outbreak. They may believe that if we focus on treatments, they will come on stream and that the outbreak will be dealt with. The problem is that, even if these treatments work - I hope they will - it will be months at a minimum before they are available on the front lines of the outbreak. That is why we keep going back to the basics of outbreak control, which are finding cases in the community, bringing those affected to the ebola treatment centres, following up on contacts and educating the community. Unfortunately, as I said before, this task is now too big for any NGO. We need to be bigger in terms of our intervention such as involving the US military and its dedication of more than 3,000 personnel. We hope this will be followed up by other organisations.