Running Head: THE EBOLA OUTBREAK The Ebola Outbreak Afrah Alrazihi Thomas Jefferson University- East Falls Campus 1 Running Head: THE EBOLA OUTBREAK 2 The Ebola Outbreak Abstract The Ebola virus has claimed the lives of numerous individuals in Western African countries, which resulted in the World Health Organization, declaring it as a cause of international health emergencies during its first outbreak. The main aim of this paper is to focus on explaining what the Ebola Virus Disease is and how it is impacting individuals and countries throughout the world. The paper will also critically analyze various models that have used so far, such as the Kimberly model, the Expand Contract Model, and the Disaster Release Model to effectively manage such large-scale epidemics. Furthermore, the paper also covers the response strategy used to curb the spread of Ebola in the West African region following the first outbreak in 2014. In addition to this, the paper also discusses the disaster management cycle and its components that include mitigation, disaster preparedness, and disease response to effectively manage the outbreak of such deadly diseases. Running Head: THE EBOLA OUTBREAK 3 Introduction Affecting over a total of twenty-eight thousand people, the outbreak of the Ebola Virus Disease in Western Africa was unparalleled in its extremity, scale, and intricacy. Amidst poverty, fragile health systems, and inadequate health services, some countries, including Liberia and Guinea, are still combating the disease. The disease that first identified in the forested rural region of Guinea escalated rapidly to become the largest Ebola outbreak in history, killing over eleven thousand people. Not only did the widespread poverty aggravate the issue, but issues such as inefficient surveillance systems and inadequate public health infrastructure worsened the existing situation. Thus, the Ebola Virus Disease permeated the densely populated urban areas, extending out from the rural areas of West Africa. The deteriorating conditions led the World Health Organization to declare a Public Health Emergency of International Concern in West Africa in August 2014. As a result of the severity of the outbreak of the deadly virus, numerous individuals lost their lives. Despite efforts to curb the outbreaks of Ebola, there has been a recurrence in various parts of the world. The very recent of these is the current Ebola virus epidemic in the Republic of Congo, where the virus is claiming again a multitude of innocent lives. According to the World Health Organization estimates, an alarming number of patients were reported to have been infected by the Ebola virus in the Republic of Congo. Between August and September 2019, as many as 145 cases of the Ebola virus confirmed (WHO, 2019). By late September, however, the number of patients exponentially increased, and as many as 3145 cases of the Ebola virus disease were brought to light by health officials. A majority of these patients were females – almost 56 percent of the total cases, i.e., around 1760 patients infected were women. After women, the group affected the most was that of children who were under the age of 18; these children made up 29 percent of the total infected population (WHO, 2019). Additionally, health workers who had been exposed to the Ebola virus while Running Head: THE EBOLA OUTBREAK 4 offering treatment to the patients were reportedly also a part of the Ebola virus cases. Their percentage was 5 percent of the total infected cases (WHO, 2019). Therefore, in light of the facts mentioned above, a sound strategy must be implemented to eliminate the spread of this virus. As a result, this paper aims to highlight critical factors regarding the Ebola Virus Disease. Such as dispensing details regarding what it is the various disease management models that have been used so far along with their advantages and disadvantages, and the disaster management cycle that is in place. What is the Ebola Virus Disease (EVD)? First discovered in 1976 near the Ebola River in the Democratic Republic of Congo, Ebola virus disease is a deadly disease that has a history of sporadic outbreaks in the African Continent. The disease is caused by a group of viruses that belong to the genus Ebola virus. It is a highly contagious disease that spreads through direct contact with the skin or body fluids of an infected person, living or dead. The virus gains entry into the body through ruptured skin or mucous membranes lining the nose, mouth, or eyes. The virus is also transmitted through sexual contact. Initially, the virus is usually asymptotic. However, symptoms might become noticeable in 2 to 21 days after contact with an infected person. The symptoms include fever, body aches, fatigue, and vomiting. The Ebola Virus causes hemorrhage fever in infected individuals and has a mortality rate of about 90%. The disease is highly contagious and can spread through direct contact with the infected person’s blood, body fluids, and skin. Since the infected persons do not exhibit any specific symptoms of the disease, it is challenging to diagnose Ebola Virus Disease in advance. The absence of an early-warning system aggravated the Ebola outbreak in West Africa. Therefore, the disease spread rapidly throughout the region and was able to penetrate the crowded urban areas. In return, it made it even more difficult for healthcare professionals Running Head: THE EBOLA OUTBREAK 5 to stop the spread of the disease as it is highly contagious. The unprecedented spread of EVD in Western Africa highlighted the loopholes in the region’s healthcare system and also revealed the failures of an under-resourced system. Moreover, Sierra Leone, which experienced the outbreak in 2014, was ill-prepared to battle the disease (Oleribe, Slako, Akpalu, & Foster, 2015). The Ebola outbreak in West Africa was the first to spread across urban areas. Moreover, the outbreak was traced to a 2-year old infected child in Guinea who acquired the disease in 2013. The ill-equipped healthcare system, along with the absence of trained staff, worsened the issue and led to the widespread presence of the virus all across West Africa. Disaster Management Models Epitomizing a disaster management dilemma, the 2014-2015 Ebola Outbreak in West Africa presented a valuable lesson: It highlighted the devastation that can result because of ill-preparation. Weak containment strategies, inefficient governance, and lack of responsiveness exacerbated the outbreak. Disaster management involves making critical management decisions and monitoring operational activities that include prevention, mitigation, preparedness, responsiveness, recovery, and rehabilitation. Modern disaster management is not merely restricted to postdisaster assistance: it involves pre-disaster planning, assessing, training, and managing that enable organizations to mitigate the adverse effects of the disaster. Essentially, crisis management is also one of the primary duties of a disaster manager. There is a variety of disaster management models applied for management. Usually, these models comprise three elements: risk management, hazard assessment, and management actions. All these three elements are essential for efficient disaster management. Therefore, comprehensive disaster management models include all these three elements (Dube, 2018). Hazard assessment, the first step of a disaster management model, provides the Running Head: THE EBOLA OUTBREAK 6 necessary information for risk management, which is the second phase. Different techniques can be employed to carry out hazard assessments. Risk management involves decision making regarding preparedness and mitigation. Efficient management actions can significantly help in reducing the negative impacts of a disaster. The disaster management models can broadly be classified into four categories: Logical Models, Integrated Models, Cause Models, and Other Models. The sub-types of logical models are traditional model, expand and contract model, Kimberly Model, Tuscaloosa Model, and Circular Model. Each of the integrated model and the cause model has two sub-categories: the Manitoba Integrated Model, Weichselgartner model, Crunch Model, and Release Model, respectively. While logical models present a simple definition of disaster stages and highlight primary events that form the disaster, integrated models organize the activities of the disaster to ensure efficient implementation. Unlike these two models, the cause models do not focus on organizing the stages or events of the disaster. These models instead seek to highlight the underlying causes that triggered the disaster (Nojavan, Salehi, & Omidvar, 2018). • Expand-contract model This model perceives disaster management as a continuous process, involving a series of activities that run alongside each other. Mitigation, preparedness, relief and response, and recovery and rehabilitation are essential elements of this model that are all parallel to each other. As per this model, all these actions are carried out side by side. However, they may expand or contract depending on the requirement; for example, relief and response strand will expand right after a disaster has occurred. Moreover, the relative weighting of the strand is dependent on the extremity of the disaster and on the vulnerability of the affected community. Running Head: THE EBOLA OUTBREAK • 7 Disaster-crunch model A pressure model, the disaster-crunch approach attempts to explain and understand the causes of the disaster. This model adopts a cause-effect approach. This model takes into account the premise that a disaster only occurs when it adversely affects the community. Vulnerability is an outcome of pressure that is engraved in socio-economic and political processes; therefore, it has to be released, managed, or addressed to mitigate the risk of a disaster. • Disaster release model This model emphasizes the reduction of risk of disasters. Risk is reduced by undertaking preventive measures that involve assessing the nature of hazards threatening the community and the nature of the underlying causes. The study of these underlying causes helps to mitigate dynamic pressure, such as the tendency to affect disaster-prone land. This model involves dealing with underlying issues as causes. When they are treated as causes, it is more convenient to develop strategies to reduce their risk. The reduction of risk can be achieved through augmenting the level of awareness, enhancing preparedness, and introducing healthcare advancements. Therefore, these strategies equip the community with the skills required to take control of the situation. • Kimberly Model As per Kimber, the four phases of disaster management are mitigation, preparedness, response, and recovery. The Kimber Model ranks response as number one in importance for disaster management. Mitigation and preparedness are perceived as drivers of an efficient response and are thus positioned at the base. The recovery phase is positioned at the top because it is led by the response undertaken to battle the disaster. However, this model can predominantly be used in hospitals and not elsewhere. Thus, the model has a limited scope. Running Head: THE EBOLA OUTBREAK • 8 Circular Model The circular Model serves to decrease the intricacy of disasters and also allows the management of non-linear disaster events. It focuses on the needs of practical disaster management. Thus, it analyzes relationships between inputs and their impacts instead of simply classifying disaster stages. The main feature of this model that allows for lessons to be learned from actual disasters (Asghar & Alahakhoon, 2006). The disaster cycle models used in the case of the Ebola outbreak in West Africa were the disaster crunch model and the disaster release, model. In-depth investigations were carried out to ascertain the cause of the outbreak in the region. The causes outlined included poverty, lack of equipment, inadequate knowledge, lack of training along with numerous others. Steps were taken to mitigate the risk of future outbreaks. The post-disaster steps included spreading awareness, upgrading the existing testing facilities, social mobilization, and training of healthcare staff in the region. These measures have effectively reduced the risk of future outbreaks in West Africa. However, there is a dire need for vaccines and drugs to combat Ebola. There is still no medicine available worldwide to cure viral disease. The West Africa Ebola outbreak is one of the most valuable learning sources for the international community. It helped expose several loopholes and weaknesses such as inefficient surveillance systems, deficiencies in the protection of healthcare professionals, lack of communication, hurdles in acquiring medical equipment, and unsafe burial of infected people. However, amidst these daunting challenges, appropriate strategies were undertaken to address the epidemic establishing a precedent for a more mature response if such an emergency were to occur in the future (Shiwani, Pharithi, Khan, Egom, & Kruzliak, 2017). Disaster Management Cycle Disaster management cycle functions to reduce the damages caused by a disaster and to increase preparedness to combat similar situations in the future. Moreover, the management Running Head: THE EBOLA OUTBREAK 9 cycle also illustrates ways to recover from a disaster after it has taken place. The cycle comprises of various phases: • Mitigation: this involves reducing the risk of future emergencies and limiting their adverse effects on the community. It is essential to carry out rigorous hazard analyses that allow the understanding of the underlying causes of the disaster, to mitigate the likelihood of disasters. Moreover, mitigation also involves the implementation of strategies that will help to combat future emergencies, for example, flood-proofing homes. • Disaster preparedness: when disasters are inevitable, it is mandatory to be prepared to combat them in the best possible way. These preparedness measures include the stocking of food and screening of available volunteers. While these measures do not serve to stop the disaster from occurring, they do prove to be very helpful when it comes to minimizing their impact on the community. • Disaster response: this phase involves taking the required steps immediately after the occurrence of the disaster to save lives and to prevent further damage. Disaster response also includes the implementation of the preparedness strategies and plans as swiftly and smoothly as possible. Disaster-afflicted individuals are taken care of, and they are given the required help. • Disaster recovery: the disaster afflicted community has to be restored to the predisaster state. The disaster recovery phase involves taking the necessary steps to assess the damages caused by the disaster. Risk identification also helps understand the underlying causes of the disaster, which then may help in mitigating the risk of a similar emergency in the future. Subsequent efforts in disaster recovery include training, spreading awareness, and educating the vulnerable communities. Running Head: THE EBOLA OUTBREAK 10 While the Ebola virus cases reported in history were sporadic rural outbreaks, the one that hit West Africa shattered all conventions by growing and spreading for months. One of the many lessons from this catastrophic outbreak is that in a rapidly changing world, past experiences with deadly viruses are not enough to guide the future trajectory that needs to be followed to reduce their risk. West Africa was not prepared to battle a deadly virus like Ebola. The lack of containment allowed the virus to follow a new route and enter urban areas, including capital cities. The failure to control the initial spread of the viral disease resulted from: a) untrained management which did not know how to isolate the affected cases b) unavailability of resources c) difficulty in tracing contacts of infected individuals. Therefore, not only there were problems with the level of preparedness; the disease response itself had major loopholes. Case findings in Guinea and Sierra Leone reveal that there was a plethora of unsafe burials of the affected people in 2014 and 2015, which significantly contributed to the risk of the transmission of the virus. While mitigation and disease response were inefficient, disease recovery was carried out with meticulous attention to detail. Communities, along with governments, strived to develop a better understanding of the viral disease and to understand better and manage the risks associated with EVD. The devastating outbreak in West Africa transformed the way the world reacts to the disease. As part of disease response, the following steps were taken: • Emergency medical supplies were dispatched to the affected areas. • Health workers were given the training to deal with affected patients. • Treatment centers were called up to accommodate a higher number of positive cases. • Contact tracing procedures were upgraded. • Laboratories in the vulnerable areas were developed to inculcate better machinery and testing facilities. 11 Running Head: THE EBOLA OUTBREAK Conclusion The Ebola outbreak in West Africa deteriorated because of several factors, such as the weak capacity for response, poverty, the scale of the epidemic, ineffective risk communication and coordination, community resistance, and inadequate healthcare facilities. Although Africa has continuously been experiencing Ebola outbreaks since 1976, Western Africa was still not prepared to combat the epidemic. The delayed response resulted in the invasion of the virus in urban areas, infecting thousands of people. WHO, CDC, and other concerned authorities took a while to prepare themselves to fight the viral disease. The horrendous outbreak did cause not only an immense loss of life but also had a plethora of adverse impacts on the economy. Economic losses worth $25 billion were estimated. Tourism and trade in the region were directly affected. The outbreak was prolonged because of the lack of preparedness of the community. The management models applied were of the cause type. The causes of the outbreak were identified, and remedies were taken against them so that future outbreaks could be prevented. These response measures were a healthy initiative that helped control and prevents future outbreaks in West Africa. Moreover, a two-day meeting on the Ebola outbreak was also organized by the WHO Regional officer for Africa. A strategy was devised to prevent similar outbreaks in the future and to reduce the vulnerability of the community to the viral disease. The goals of the strategy were to obstruct the transmission of the Ebola virus in the affected countries by upgrading evidence-based control measures and to prevent the spread of the virus to the vulnerable neighboring countries. To achieve the second objective, successful endeavors were made to fortify epidemic preparedness and improve response measures. The strategy also required the implementation of immediate actions by the three affected countries: Guinea, Liberia, and Sierra Leone (Liberiia, 2014). Running Head: THE EBOLA OUTBREAK 12 The WHO’s strategic plan was not merely restricted to taking immediate actions to support the three affected areas but also extended to enhance the preparedness of neighboring at-risk countries to battle the outbreak. Another tremendously helpful undertaken by WHO was the social mobilization through which experts engage in dialogues with the community leaders to equip them with the knowledge of EVD. This information is essential to curb transmissions. Moreover, these dialogues also ensure that only the correct information spreads in the community — the WHO also provided support to the vulnerable communities to implement locally-relevant solutions. Workshops and joint-communication sessions were also organized to provide locals with a chance to share their experiences with others (Organization, 2015). Moreover, in July 2014, CDC appointed a team of epidemiologists, emergency management specialists, health communicators, and data loggers to assist MOHSW in gaining control over the Ebola epidemic. This led to the establishment and implementation of Incident Management Systems principles in order to augment the efficiency of the response. The violent Ebola outbreak was brought under control because of a clearly defined chain of command, effective resource management, and strategic planning (Pillai, Nyenswah, Rouse, & Cock, 2014). This highlights the importance of incident management systems for battling large disease outbreaks. The Ebola outbreak necessitated a mammoth international response in addition to a strong coordination platform. The two frameworks that were mostly employed to control the epidemic include the Emergency Operation Center and the National Ebola Response Center. Since timely decision making is crucial to combating such a deadly outbreak, incident management system-based communications should be fortified. In addition, the decentralization of coordination systems is also a prerequisite for efficient control of disease outbreaks. Enhanced community participation can also help control the spread of the virus. Increased community participation can also play a pivotal role in Running Head: THE EBOLA OUTBREAK 13 mitigating the risks of future outbreaks because an informed community will be more prepared to battle the disease. The outbreak presents a significant lesion for the international health community. While preparedness is essential to combat disease outbreaks, adaptability is also equally important. Community resistance can significantly aggravate the situation. Therefore, community involvement must be carried out to deal with the emergency effectively as the best possible way to both curb and prevent the spread of Ebola outbreaks is via a concerted effort. The Ebola virus has wreaked havoc across different parts of the world, with West African nations being plagued the most by this malice. However, this does not imply that only West African countries have to make an effort to rid themselves of the disease, but rather the international community at significant needs to play its part. This is in part due to how the disease can be spread across continents via infected carriers, which entails the lives of everyone and anyone who is in danger. In conclusion, the issue must be handled in order to prevent any further distress to those who have been infected and also to those who are at risk of being infected. Running Head: THE EBOLA OUTBREAK 14 References Asghar, S., & Alahakhoon, D. (2006). A Comprehensive Conceptual Model for Disaster Management. Dube, E. (2018). USING MODELS TO DEAL WITH HAZARDS AND DISASTERS: A TRAJECTORY TOWARDS EFFECTIVE DISASTER MANAGEMENT IN ZIMBABWE. International Journal of Social Sciences. Liberiia, G. o. (2014). Liberia Operatioanl Plan For Accelerated Response to Re-occurrence of Ebola Epidemic. Nojavan, M., Salehi, E., & Omidvar, B. (2018). Conceptual change of disaster management models: A thematic analysis. Journal of Disaster Risk Studies, 101-451. Oleribe, Slako, B., Akpalu, A., & Foster, M. (2015). Ebola virus disease epidemic in West Africa: lessons learned and issues arising from West African countries. Organization, W. H. (2015). WHO Strategic Plan For Ebola Outbreak Response. World Health Organization. Pillai, S., Nyenswah, T., Rouse, E., & Cock, K. (2014). Medscape. Retrieved 2019, from Developing an Incident Management System to Support Ebola Response — Liberia, July–August 2014: https://www.medscape.com/viewarticle/833247 Shiwani, H., Pharithi, R., Khan, B., Egom, C., & Kruzliak, P. (2017). An Update on the 2014 Ebola Outbreak in Western Africa. Asia Pacific Journal of Tropical Medicine. World Health Organization. (2019, September 19). Disease Outbreak News. Retrieved November 23, 2019, from WHO website: https://www.who.int/csr/don/19-september2019-ebola-drc/en 1 Running Head: THE EBOLA OUTBREAK The Ebola Outbreak Name University Name Running Head: THE EBOLA OUTBREAK 2 The Ebola Outbreak Abstract The Ebola virus has claimed the lives of numerous individuals in Western African countries, which resulted in the World Health Organization, declaring it as a cause of international health emergencies during its first outbreak. The main aim of this paper is to focus on explaining what the Ebola Virus Disease is and how it is impacting individuals and countries throughout the world. The paper will also critically analyze various models that have used so far, such as the Kimberly model, the Expand Contract Model, and the Disaster Release Model to effectively manage such large-scale epidemics. Furthermore, the paper also covers the response strategy used to curb the spread of Ebola in the West African region following the first outbreak in 2014. In addition to this, the paper also discusses the disaster management cycle and its components that include mitigation, disaster preparedness, and disease response to effectively manage the outbreak of such deadly diseases. Running Head: THE EBOLA OUTBREAK 3 Introduction Affecting over a total of twenty-eight thousand people, the outbreak of the Ebola Virus Disease in Western Africa was unparalleled in its extremity, scale, and intricacy. Amidst poverty, fragile health systems, and inadequate health services, some countries, including Liberia and Guinea, are still combating the disease. The disease that first identified in the forested rural region of Guinea escalated rapidly to become the largest Ebola outbreak in history, killing over eleven thousand people. Not only did the widespread poverty aggravate the issue, but issues such as inefficient surveillance systems and inadequate public health infrastructure worsened the existing situation. Thus, the Ebola Virus Disease permeated the densely populated urban areas, extending out from the rural areas of West Africa. The deteriorating conditions led the World Health Organization to declare a Public Health Emergency of International Concern in West Africa in August 2014. As a result of the severity of the outbreak of the deadly virus, numerous individuals lost their lives. Despite efforts to curb the outbreaks of Ebola, there has been a recurrence in various parts of the world. The very recent of these is the current Ebola virus epidemic in the Republic of Congo, where the virus is claiming again a multitude of innocent lives. According to the World Health Organization estimates, an alarming number of patients were reported to have been infected by the Ebola virus in the Republic of Congo. Between August and September 2019, as many as 145 cases of the Ebola virus confirmed (WHO, 2019). By late September, however, the number of patients exponentially increased, and as many as 3145 cases of the Ebola virus disease were brought to light by health officials. A majority of these patients were females – almost 56 percent of the total cases, i.e., around 1760 patients infected were women. After women, the group affected the most was that of children who were under the age of 18; these children made up 29 percent of the total infected population (WHO, 2019). Additionally, health workers who had been exposed to the Ebola virus while Running Head: THE EBOLA OUTBREAK 4 offering treatment to the patients were reportedly also a part of the Ebola virus cases. Their percentage was 5 percent of the total infected cases (WHO, 2019). Therefore, in light of the facts mentioned above, a sound strategy must be implemented to eliminate the spread of this virus. As a result, this paper aims to highlight critical factors regarding the Ebola Virus Disease. Such as dispensing details regarding what it is the various disease management models that have been used so far along with their advantages and disadvantages, and the disaster management cycle that is in place. What is the Ebola Virus Disease (EVD)? First discovered in 1976 near the Ebola River in the Democratic Republic of Congo, Ebola virus disease is a deadly disease that has a history of sporadic outbreaks in the African Continent. The disease is caused by a group of viruses that belong to the genus Ebola virus. It is a highly contagious disease that spreads through direct contact with the skin or body fluids of an infected person, living or dead. The virus gains entry into the body through ruptured skin or mucous membranes lining the nose, mouth, or eyes. The virus is also transmitted through sexual contact. Initially, the virus is usually asymptotic. However, symptoms might become noticeable in 2 to 21 days after contact with an infected person. The symptoms include fever, body aches, fatigue, and vomiting. The Ebola Virus causes hemorrhage fever in infected individuals and has a mortality rate of about 90%. The disease is highly contagious and can spread through direct contact with the infected person’s blood, body fluids, and skin. Since the infected persons do not exhibit any specific symptoms of the disease, it is challenging to diagnose Ebola Virus Disease in advance. The absence of an early-warning system aggravated the Ebola outbreak in West Africa. Therefore, the disease spread rapidly throughout the region and was able to penetrate the crowded urban areas. In return, it made it even more difficult for healthcare professionals Running Head: THE EBOLA OUTBREAK 5 to stop the spread of the disease as it is highly contagious. The unprecedented spread of EVD in Western Africa highlighted the loopholes in the region’s healthcare system and also revealed the failures of an under-resourced system. Moreover, Sierra Leone, which experienced the outbreak in 2014, was ill-prepared to battle the disease (Oleribe, Slako, Akpalu, & Foster, 2015). The Ebola outbreak in West Africa was the first to spread across urban areas. Moreover, the outbreak was traced to a 2-year old infected child in Guinea who acquired the disease in 2013. The ill-equipped healthcare system, along with the absence of trained staff, worsened the issue and led to the widespread presence of the virus all across West Africa. Disaster Management Models Epitomizing a disaster management dilemma, the 2014-2015 Ebola Outbreak in West Africa presented a valuable lesson: It highlighted the devastation that can result because of ill-preparation. Weak containment strategies, inefficient governance, and lack of responsiveness exacerbated the outbreak. Disaster management involves making critical management decisions and monitoring operational activities that include prevention, mitigation, preparedness, responsiveness, recovery, and rehabilitation. Modern disaster management is not merely restricted to postdisaster assistance: it involves pre-disaster planning, assessing, training, and managing that enable organizations to mitigate the adverse effects of the disaster. Essentially, crisis management is also one of the primary duties of a disaster manager. There is a variety of disaster management models applied for management. Usually, these models comprise three elements: risk management, hazard assessment, and management actions. All these three elements are essential for efficient disaster management. Therefore, comprehensive disaster management models include all these three elements (Dube, 2018). Hazard assessment, the first step of a disaster management model, provides the Running Head: THE EBOLA OUTBREAK 6 necessary information for risk management, which is the second phase. Different techniques can be employed to carry out hazard assessments. Risk management involves decision making regarding preparedness and mitigation. Efficient management actions can significantly help in reducing the negative impacts of a disaster. The disaster management models can broadly be classified into four categories: Logical Models, Integrated Models, Cause Models, and Other Models. The sub-types of logical models are traditional model, expand and contract model, Kimberly Model, Tuscaloosa Model, and Circular Model. Each of the integrated model and the cause model has two sub-categories: the Manitoba Integrated Model, Weichselgartner model, Crunch Model, and Release Model, respectively. While logical models present a simple definition of disaster stages and highlight primary events that form the disaster, integrated models organize the activities of the disaster to ensure efficient implementation. Unlike these two models, the cause models do not focus on organizing the stages or events of the disaster. These models instead seek to highlight the underlying causes that triggered the disaster (Nojavan, Salehi, & Omidvar, 2018). • Expand-contract model This model perceives disaster management as a continuous process, involving a series of activities that run alongside each other. Mitigation, preparedness, relief and response, and recovery and rehabilitation are essential elements of this model that are all parallel to each other. As per this model, all these actions are carried out side by side. However, they may expand or contract depending on the requirement; for example, relief and response strand will expand right after a disaster has occurred. Moreover, the relative weighting of the strand is dependent on the extremity of the disaster and on the vulnerability of the affected community. Running Head: THE EBOLA OUTBREAK • 7 Disaster-crunch model A pressure model, the disaster-crunch approach attempts to explain and understand the causes of the disaster. This model adopts a cause-effect approach. This model takes into account the premise that a disaster only occurs when it adversely affects the community. Vulnerability is an outcome of pressure that is engraved in socio-economic and political processes; therefore, it has to be released, managed, or addressed to mitigate the risk of a disaster. • Disaster release model This model emphasizes the reduction of risk of disasters. Risk is reduced by undertaking preventive measures that involve assessing the nature of hazards threatening the community and the nature of the underlying causes. The study of these underlying causes helps to mitigate dynamic pressure, such as the tendency to affect disaster-prone land. This model involves dealing with underlying issues as causes. When they are treated as causes, it is more convenient to develop strategies to reduce their risk. The reduction of risk can be achieved through augmenting the level of awareness, enhancing preparedness, and introducing healthcare advancements. Therefore, these strategies equip the community with the skills required to take control of the situation. • Kimberly Model As per Kimber, the four phases of disaster management are mitigation, preparedness, response, and recovery. The Kimber Model ranks response as number one in importance for disaster management. Mitigation and preparedness are perceived as drivers of an efficient response and are thus positioned at the base. The recovery phase is positioned at the top because it is led by the response undertaken to battle the disaster. However, this model can predominantly be used in hospitals and not elsewhere. Thus, the model has a limited scope. Running Head: THE EBOLA OUTBREAK • 8 Circular Model The circular Model serves to decrease the intricacy of disasters and also allows the management of non-linear disaster events. It focuses on the needs of practical disaster management. Thus, it analyzes relationships between inputs and their impacts instead of simply classifying disaster stages. The main feature of this model that allows for lessons to be learned from actual disasters (Asghar & Alahakhoon, 2006). The disaster cycle models used in the case of the Ebola outbreak in West Africa were the disaster crunch model and the disaster release, model. In-depth investigations were carried out to ascertain the cause of the outbreak in the region. The causes outlined included poverty, lack of equipment, inadequate knowledge, lack of training along with numerous others. Steps were taken to mitigate the risk of future outbreaks. The post-disaster steps included spreading awareness, upgrading the existing testing facilities, social mobilization, and training of healthcare staff in the region. These measures have effectively reduced the risk of future outbreaks in West Africa. However, there is a dire need for vaccines and drugs to combat Ebola. There is still no medicine available worldwide to cure viral disease. The West Africa Ebola outbreak is one of the most valuable learning sources for the international community. It helped expose several loopholes and weaknesses such as inefficient surveillance systems, deficiencies in the protection of healthcare professionals, lack of communication, hurdles in acquiring medical equipment, and unsafe burial of infected people. However, amidst these daunting challenges, appropriate strategies were undertaken to address the epidemic establishing a precedent for a more mature response if such an emergency were to occur in the future (Shiwani, Pharithi, Khan, Egom, & Kruzliak, 2017). Disaster Management Cycle Disaster management cycle functions to reduce the damages caused by a disaster and to increase preparedness to combat similar situations in the future. Moreover, the management Running Head: THE EBOLA OUTBREAK 9 cycle also illustrates ways to recover from a disaster after it has taken place. The cycle comprises of various phases: • Mitigation: this involves reducing the risk of future emergencies and limiting their adverse effects on the community. It is essential to carry out rigorous hazard analyses that allow the understanding of the underlying causes of the disaster, to mitigate the likelihood of disasters. Moreover, mitigation also involves the implementation of strategies that will help to combat future emergencies, for example, flood-proofing homes. • Disaster preparedness: when disasters are inevitable, it is mandatory to be prepared to combat them in the best possible way. These preparedness measures include the stocking of food and screening of available volunteers. While these measures do not serve to stop the disaster from occurring, they do prove to be very helpful when it comes to minimizing their impact on the community. • Disaster response: this phase involves taking the required steps immediately after the occurrence of the disaster to save lives and to prevent further damage. Disaster response also includes the implementation of the preparedness strategies and plans as swiftly and smoothly as possible. Disaster-afflicted individuals are taken care of, and they are given the required help. • Disaster recovery: the disaster afflicted community has to be restored to the predisaster state. The disaster recovery phase involves taking the necessary steps to assess the damages caused by the disaster. Risk identification also helps understand the underlying causes of the disaster, which then may help in mitigating the risk of a similar emergency in the future. Subsequent efforts in disaster recovery include training, spreading awareness, and educating the vulnerable communities. Running Head: THE EBOLA OUTBREAK 10 While the Ebola virus cases reported in history were sporadic rural outbreaks, the one that hit West Africa shattered all conventions by growing and spreading for months. One of the many lessons from this catastrophic outbreak is that in a rapidly changing world, past experiences with deadly viruses are not enough to guide the future trajectory that needs to be followed to reduce their risk. West Africa was not prepared to battle a deadly virus like Ebola. The lack of containment allowed the virus to follow a new route and enter urban areas, including capital cities. The failure to control the initial spread of the viral disease resulted from: a) untrained management which did not know how to isolate the affected cases b) unavailability of resources c) difficulty in tracing contacts of infected individuals. Therefore, not only there were problems with the level of preparedness; the disease response itself had major loopholes. Case findings in Guinea and Sierra Leone reveal that there was a plethora of unsafe burials of the affected people in 2014 and 2015, which significantly contributed to the risk of the transmission of the virus. While mitigation and disease response were inefficient, disease recovery was carried out with meticulous attention to detail. Communities, along with governments, strived to develop a better understanding of the viral disease and to understand better and manage the risks associated with EVD. The devastating outbreak in West Africa transformed the way the world reacts to the disease. As part of disease response, the following steps were taken: • Emergency medical supplies were dispatched to the affected areas. • Health workers were given the training to deal with affected patients. • Treatment centers were called up to accommodate a higher number of positive cases. • Contact tracing procedures were upgraded. • Laboratories in the vulnerable areas were developed to inculcate better machinery and testing facilities. 11 Running Head: THE EBOLA OUTBREAK Conclusion The Ebola outbreak in West Africa deteriorated because of several factors, such as the weak capacity for response, poverty, the scale of the epidemic, ineffective risk communication and coordination, community resistance, and inadequate healthcare facilities. Although Africa has continuously been experiencing Ebola outbreaks since 1976, Western Africa was still not prepared to combat the epidemic. The delayed response resulted in the invasion of the virus in urban areas, infecting thousands of people. WHO, CDC, and other concerned authorities took a while to prepare themselves to fight the viral disease. The horrendous outbreak did cause not only an immense loss of life but also had a plethora of adverse impacts on the economy. Economic losses worth $25 billion were estimated. Tourism and trade in the region were directly affected. The outbreak was prolonged because of the lack of preparedness of the community. The management models applied were of the cause type. The causes of the outbreak were identified, and remedies were taken against them so that future outbreaks could be prevented. These response measures were a healthy initiative that helped control and prevents future outbreaks in West Africa. Moreover, a two-day meeting on the Ebola outbreak was also organized by the WHO Regional officer for Africa. A strategy was devised to prevent similar outbreaks in the future and to reduce the vulnerability of the community to the viral disease. The goals of the strategy were to obstruct the transmission of the Ebola virus in the affected countries by upgrading evidence-based control measures and to prevent the spread of the virus to the vulnerable neighboring countries. To achieve the second objective, successful endeavors were made to fortify epidemic preparedness and improve response measures. The strategy also required the implementation of immediate actions by the three affected countries: Guinea, Liberia, and Sierra Leone (Liberiia, 2014). Running Head: THE EBOLA OUTBREAK 12 The WHO’s strategic plan was not merely restricted to taking immediate actions to support the three affected areas but also extended to enhance the preparedness of neighboring at-risk countries to battle the outbreak. Another tremendously helpful undertaken by WHO was the social mobilization through which experts engage in dialogues with the community leaders to equip them with the knowledge of EVD. This information is essential to curb transmissions. Moreover, these dialogues also ensure that only the correct information spreads in the community — the WHO also provided support to the vulnerable communities to implement locally-relevant solutions. Workshops and joint-communication sessions were also organized to provide locals with a chance to share their experiences with others (Organization, 2015). Moreover, in July 2014, CDC appointed a team of epidemiologists, emergency management specialists, health communicators, and data loggers to assist MOHSW in gaining control over the Ebola epidemic. This led to the establishment and implementation of Incident Management Systems principles in order to augment the efficiency of the response. The violent Ebola outbreak was brought under control because of a clearly defined chain of command, effective resource management, and strategic planning (Pillai, Nyenswah, Rouse, & Cock, 2014). This highlights the importance of incident management systems for battling large disease outbreaks. The Ebola outbreak necessitated a mammoth international response in addition to a strong coordination platform. The two frameworks that were mostly employed to control the epidemic include the Emergency Operation Center and the National Ebola Response Center. Since timely decision making is crucial to combating such a deadly outbreak, incident management system-based communications should be fortified. In addition, the decentralization of coordination systems is also a prerequisite for efficient control of disease outbreaks. Enhanced community participation can also help control the spread of the virus. Increased community participation can also play a pivotal role in Running Head: THE EBOLA OUTBREAK 13 mitigating the risks of future outbreaks because an informed community will be more prepared to battle the disease. The outbreak presents a significant lesion for the international health community. While preparedness is essential to combat disease outbreaks, adaptability is also equally important. Community resistance can significantly aggravate the situation. Therefore, community involvement must be carried out to deal with the emergency effectively as the best possible way to both curb and prevent the spread of Ebola outbreaks is via a concerted effort. The Ebola virus has wreaked havoc across different parts of the world, with West African nations being plagued the most by this malice. However, this does not imply that only West African countries have to make an effort to rid themselves of the disease, but rather the international community at significant needs to play its part. This is in part due to how the disease can be spread across continents via infected carriers, which entails the lives of everyone and anyone who is in danger. In conclusion, the issue must be handled in order to prevent any further distress to those who have been infected and also to those who are at risk of being infected. Running Head: THE EBOLA OUTBREAK 14 References Asghar, S., & Alahakhoon, D. (2006). A Comprehensive Conceptual Model for Disaster Management. Dube, E. (2018). USING MODELS TO DEAL WITH HAZARDS AND DISASTERS: A TRAJECTORY TOWARDS EFFECTIVE DISASTER MANAGEMENT IN ZIMBABWE. International Journal of Social Sciences. Liberiia, G. o. (2014). Liberia Operatioanl Plan For Accelerated Response to Re-occurrence of Ebola Epidemic. Nojavan, M., Salehi, E., & Omidvar, B. (2018). Conceptual change of disaster management models: A thematic analysis. Journal of Disaster Risk Studies, 101-451. Oleribe, Slako, B., Akpalu, A., & Foster, M. (2015). Ebola virus disease epidemic in West Africa: lessons learned and issues arising from West African countries. Organization, W. H. (2015). WHO Strategic Plan For Ebola Outbreak Response. World Health Organization. Pillai, S., Nyenswah, T., Rouse, E., & Cock, K. (2014). Medscape. Retrieved 2019, from Developing an Incident Management System to Support Ebola Response — Liberia, July–August 2014: https://www.medscape.com/viewarticle/833247 Shiwani, H., Pharithi, R., Khan, B., Egom, C., & Kruzliak, P. (2017). An Update on the 2014 Ebola Outbreak in Western Africa. Asia Pacific Journal of Tropical Medicine. World Health Organization. (2019, September 19). Disease Outbreak News. Retrieved November 23, 2019, from WHO website: https://www.who.int/csr/don/19-september2019-ebola-drc/en
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