Ebola, a 21st century ‘Great Plague’?

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Ebola, a 21st century ‘Great Plague’?

In the seventeenth century the ‘Great Plague’ swept through London killing nearly a quarter of the population. At the time the cause was unknown and despite attempts to halt its advance little could be done for those infected. As of September 2015, according to WHO, the total number of Ebola infection cases reached 28,073. Is this the 21st century’s ‘Dreadful Visitation’ and what can modern medicine do to combat its spread? We hear from Dr Vicky Simms, an Epidemiologist at the London School of Hygiene & Tropical Medicine.

Dressed for work during an Ebola outbreak

Vicky dressed for work in the green zone

In the 17th century the causes of infectious disease were completely unknown, but some key principles for managing an outbreak were already visible: record the death rate, quarantine contacts, educate the public, protect health workers. We used the same principles to combat the recent Ebola outbreak in West Africa.

Bills of Mortality August 15 - 22 1665

Great Plague Bills of Mortality August 15 – 22 1665
Credit: Wellcome Library, London.

Epidemiologists working on the ground spoke to every patient they could find, worked out when, where and how the person was infected, and traced their contacts who might also have become infected with the virus. Mathematical modellers pooled all the incoming information and ran computer simulations to predict how the outbreak might develop. Terrifying scenarios started to emerge that showed how many people might die if the outbreak was not contained, which shocked the world into responding.

Burying the dead during the dreadful plague in 1665_PR15286.jpg

The ‘Great Plague’ killed a quarter of London’s population. One Ebola prediction, based on infection rates in Monrovia, showed it had potential to infect the majority of Liberia.
Image Credit: Royal College of Physicians

I helped set up the health information system for the Ebola Treatment Centre in Kerry Town, Sierra Leone. Every day I reported the number of admissions, discharges, transfers and deaths. I connected information between the wards, pharmacy, lab, nutrition team and family liaison to make sure all patients received the right care.

The family liaison team were very important. Our patients often felt alone and frightened, and some of them were very young children. It made a lot of difference for them to be able to see their families, although it had to be at a distance separated by fencing to prevent infection. We also put mobile phones in the wards so patients could call home.

The largest group of workers at Kerry Town were not doctors and nurses, they were water, sanitation and hygiene (WASH) staff. Everything had to be disinfected almost constantly. The WASH team wore heavy duty personal protective equipment to protect themselves from Ebola and from the concentrated bleach they used.

Plague Doctor

During the Great Plague some doctors wore a beak-like mask which was filled with aromatic items. They thought this would protect them from putrid air, believed to spread disease.
Image Credit: Royal College of Physicians

How often do you ignore a sign telling you to you wash your hands? Any mistake or short-cut in hygiene procedures could have given Ebola the opening to rip through the treatment centre. There was continuous training to keep standards high and bring new staff up to speed.

Washpoint outside a hotel in Freetown for people to wash their hands

Washpoint outside a hotel in Freetown

The first priority for the health team was to stop people dying of dehydration caused by diarrhoea and vomiting. Every patient able to drink was given oral rehydration solution, an isotonic mix of salt and sugar in water which hydrates far more effectively than water alone. Nobody knew enough about Ebola to treat it properly, so we did some research. I helped analyse lab tests from 118 patients to investigate how Ebola affected a person’s organs and biochemistry. We expected to see kidney damage from dehydration, but we discovered that many patients without vomiting and diarrhoea had acute kidney failure too, and they were the ones most likely to die. We shared our findings at a clinical meeting in Freetown and warned the other treatment centres to look out for kidney failure in patients who didn’t show the normal symptoms. In a disease outbreak, sharing data and information between organisations is crucial, as the situation can change and develop quickly, and everyone is constantly learning and adapting their response.

Whiteboard from the nursing station, the first day there were no cases. We had more cases later, it was a temporary lull.

Whiteboard from the nursing station, the first day there were no cases. 

The Ebola outbreak in West Africa will be officially over when six weeks have passed without a single case, but the effects of Ebola will last much longer. The knowledge and action of health workers, policy makers, and the communities affected in the region have helped to bring the epidemic under control, but the health systems of the affected countries have been decimated, and we are only beginning to understand the long term consequences of Ebola infection for survivors.

Sign in the Ebola Treatment Centre

Sign hanging in the Ebola Treatment Centre

Do you think Ebola is a 21st century ‘Great Plague’? Let us know in the comments or join the conversation online using #PepysShow. 

For more information on the ‘Great Plague’ see Samuel Pepys: Plague, Fire, Revolution. For more information on Ebola and the work of the London School of Hygiene & Tropical Medicine visit their website

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