Doctors and politicians must unite in public health messages on Ebola, says expert.

The UK doctor who is leading efforts to control the outbreak of Ebola virus disease in west Africa and to ensure that the NHS is ready to deal with cases that might emerge in the United Kingdom has called for doctors and politicians to be consistent in their messages to the public. Brian McCloskey, director of global health for Public Health England and currently working in Geneva to help coordinate the global response to the crisis, said that the right balance of public health and politics had not been found across the globe. He was referring to the move by the Australian government to withhold visas for people from the affected countries in west Africa and the decision by some US states to require health staff who had had contact with people infected with the Ebola virus to be quarantined for 21 days. The policy in New Jersey received added publicity in the past few days when a nurse who had been working in Sierra Leone was given a police escort to a hospital in Newark after arriving back in the United States and kept in a tent for three days before being discharged after testing negative for the virus. “We need to find a balance of the right public health messages and the right political messages,” said McCloskey. He was speaking at an event organised by Chatham House in London on the global response to the Ebola crisis on 29 October. McCloskey said that the simplest message about Ebola was also the most difficult to convey. “The message is that when a person is not symptomatic they are not infectious. That is a very reassuring message for the public. The logic of that is, though, that anybodywho comes [back from an endemic country] should be allowed to walk around New York, New Jersey, or London without any interference. Once you start to compromise that message—by saying maybe they are not infectious but they have to be quarantined—that is when you start to lose the confidence of the public,” he said. McCloskey defended the introduction in October of screening for symptoms of Ebola virus disease at Heathrow and Gatwick airports and Eurostar train terminals among travellers coming from the three worst affected countries, Sierra Leone, Liberia, and Guinea. He said that the policy was introduced not to keep Ebola out of the UK: “Screening will not do that,” he said. “What we are trying to do [with screening] is to identify people who are at higher risk of Ebola who are entering the UK. We are trying to see if people coming into the UK who may have been exposed are aware of their risk,” McCloskey told the meeting. McCloskey said that preparations were under way in Sierra Leone to test a new model of Ebola control centred on community care rather than the hospital model. The community model has not been tested before, and 10 such centres would be evaluated to ascertain their effectiveness. “Bringing people into community centres could increase the spread of the virus. There is a certain amount of nervousness about how the model will work,” he said. Michael Edelstein, a doctor and consultant research fellow at ChathamHouse who has recently returned from Liberia, warned that mortality and morbidity from conditions other than Ebola but a consequence of the epidemic may be higher than from Ebola virus disease itself. He said that hospitals in the affected areas had closed after staff became infected or were reassigned to dealing with the outbreak, leaving local populations without access to medical help for trauma, maternity services, and other emergencies. There was evidence that vaccination coverage had fallen in some areas and that there were fewer safe deliveries of babies. “Keeping the balance between allocating workforce to the response while maintaining essential healthcare services is a huge challenge. It is a lesson that needs to be learnt for next time,” he said.