Pandemics, Public Health, and A Physician’s Perspective
Applying public health principles from the Ebola outbreak to the COVID-19 pandemic
Written by Colbey Ricklefs
“When we first had the outbreak, the response was inadequate,” shared Dr. Ifeolu David, a Fulbright Fellow and Ph.D. student in Health and Rehabilitation Sciences at the University of Missouri. But Dr. David is not referring to the current COVID-19 pandemic; instead, he reflects on the outbreak of Ebola from 2014–2016.
Dr. David is a general practice physician from Sierra Leone, where he had only been working as a clinician for a year after medical school when the Ebola outbreak struck parts of western Africa. “We lost a few health workers in the hospital,” he said. “The health system wasn’t ready; it was post-Civil War, and the health system needed a lot of things. We only had one treatment facility and one ambulance per hospital, and sometimes these weren’t even working. Test results took three days. We had shortages of things like gloves.”
Dr. David had grown up in Freetown, Sierra Leone, during the ten-year Civil War and had to flee from his home several times to avoid the conflict. “We kept losing things, which made life difficult,” he remembers. “We had to take shelter in new communities, and one of the common themes I saw was the health challenges of those communities.”
These health challenges encouraged him to attend medical school, where he became involved with several projects to improve the health of the community. “I was involved with polio eradication campaigns and cholera responses,” he said. “ I voluntarily took part in them because they were community projects. Working with communities is something I had always been interested in.”
Motivated by and equipped with some of the community health campaigns he had led before, Dr. David employed some of these strategies to combat the Ebola outbreak. “We started an infection prevention and control strategy to reduce exposure, which worked out well and helped to reduce exposure overall,” he said. He was recruited to lead Ebola clinical training for healthcare workers, including both local and international responders.
He led five-day long clinical trainings for a total of three months, and then was recruited by the World Health Organization for a surveillance team. “They wanted doctors to fill those positions,” he explained. “We were working with communities as well as quarantined homes, and doing contact-tracing.”
Due to international collaboration, the outbreak was controlled within ten to eleven months. “It was easy to see how basic public health measures really influenced the outbreak,” he stated. I saw the impacts we had when public health measures were upgraded and I took an interest in public health measures from there. It seemed like a more efficient way to influence health in communities.”
“It was easy to see how basic public health measures really influenced the outbreak.”
“The patients were frightened,” Dr. David remembers of the early days of the Ebola outbreak. “They didn’t trust the health system because of the way things were being handled. There were communication gaps also: some patients died in treatment units and their relatives didn’t know. It led to the outbreak getting worse. Patients didn’t want to come to the hospital because they didn’t think they would be treated well. Eventually, we got help from international communities. Health workers were better equipped and quarantine services were improved. The trust improved, and once this improved patients felt more comfortable seeking healthcare services. Overall, the chances for survival improved.”
Soon after his success with the Ebola outbreak, he was selected as a Fulbright scholar. “Fulbright placed me at Mizzou. I wanted a public health program that had policy and promotion because these were the two things that were missing during the outbreak setting in Sierra Leone,” he mentioned.
However, little did he know that while he was studying thousands of miles from home, another major outbreak would take the world by storm. “We have had 86 cases of COVID-19 in two weeks in Sierra Leone,” Dr. David mentioned. “It’s not a perfect response, but it’s been much better than the response we had with the Ebola outbreak. Ebola taught us lessons that prepared us for COVID-19; we learned a great deal.”
“Ebola taught us lessons that prepared us for COVID-19; we learned a great deal.”
Yet he cannot help but draw comparisons between the two public health crises. “Fear has been a common theme: the fear of getting infected, of loved ones getting infected, fear of daily life activities being affected,” he described. “People lose trust in the system and believe that their challenges have been overlooked. Individuals are affected differently, hard to get everyone to understand that this is what’s going on. It’s entirely similar. It has to do with trusting the system.”
In both outbreaks, protecting healthcare workers has been an area of special concern. “With COVID, having enough resources is still an issue,” he believes. “The demand is much higher, so much so that the resources are not enough. Having no treatment and no vaccine, it makes it difficult.”
“With Ebola, the fear was especially justified among healthcare workers because the disease was deadly and survival was low, and disease was highly transmissible,” he remembered. However, because only the ill can transmit Ebola, it was easier to prevent transmission. “With COVID, it’s less deadly but it spreads faster. Not all sick individuals show severe symptoms, so it’s easy to transmit as you go about your daily activities. And because chances of survival are on the high side among the younger population, people start to prioritize economic challenges over the health challenges.”
It is precisely in those moments of fear and doubt that partnership between communities and the healthcare system is most crucial. “For the two outbreaks, community collaboration with the health system is essential for success. Without community collaboration, the health system cannot work by itself. When we involved the community in our public health efforts, that is when we started seeing success.”
“Community collaboration with the health system is essential for success.”
He has not stopped his community involvement with Sierra Leone since the COVID-19 pandemic began. “I’ve been in collaboration with teams from Sierra Leone involved with lobbying and making recommendations,” he said. “I’m working with philanthropists to set up health education programs; we’ve been working on that for a while, and we’re now on the implementation stage.”
He is also applying his lessons learned in a graduate-level public health course being taught at the University of Missouri this summer, entitled Interdisciplinary Perspectives in Global Health. “The course will explore issues, problems, and controversies in global health with an interdisciplinary perspective,” he said. “The world is becoming a global village, so this comes with many health challenges: being a global village, any problem somewhere affects you elsewhere, and that’s what we’re seeing with COVID.”
He hopes the course will encourage students to understand global health challenges as well as engage in prevention and intervention strategies, in addition to drawing linkages between global and local health issues. Finally, the course will examine case scenarios, taken from real-life events such as the COVID-19 pandemic and Ebola outbreak, and apply these principles to future global health concerns.
In the meantime, Dr. David reminds the public that everyone has a role in the pandemic. “Just following public health recommendations is a huge contribution to the outbreak,” he recommended. “It feels like doing nothing, but it’s not. Staying home and social distancing are a huge part of the response; just doing that alone helps a lot.”
Dr. Ifeolu David, MBChB, MPH, is a general practice physician from Freetown, Sierra Leone. He served in the World Health Organization as a surveillance officer during the Ebola outbreak and was involved in an Ebola vaccine trial research before traveling to the USA. He is a current Fulbright Fellow with the University of Missouri School of Health Professions where he is pursuing his Ph.D. in Health and Rehabilitation Sciences. He also received his MPH in health promotion and policy and a graduate certificate in epidemiology from the School of Health Professions.