National Ebola Response Centre (NERC)

Plans and Secretariat1st December 2014

Operation ‘WAS’

• The Mission• The Context• The Proposed Strategy• Timelines and Delivery• Measuring Success and Operational Achievements• Post Operation “WAS”

The Mission

To significantly slow down the transmission of Ebola in the Western Area to a level that will enable the WAERC to completely eradicate it within 42 days thereafter

For the records, Operation ‘WAS’:

Is Not: Is Meant to:

An exercise that will send soldiers into people’s homes to drag them out into Holding and Treatment Centres

Enhance the WAERC structures to enable them adequately meet the demands of a potential surge in emerging cases

An exercise that will promote ‘vigilante-ism’ in communities

Utilise community structures and volunteers to support existing surveillance, contact monitoring and social mobilisation teams

Designed to allow community teams to perform triage or handle suspected cases in the communities

Link community teams to appropriate WAERC teams as a means of reducing delays that increase the risks of further transmissions in the community

The Context

Daily Rate of Confirmed Cases per 100,000 (Sit-Rep 23 November, 2014)3.0

2.5

2.0

1.5

1.0

0.5

0

Bonthe

Pujehun

KambiaKono

Koinadugu Bo

Moyamba

Kenema

Tonkolili

National

Western (urban)

Kailahun

Port Loko

Bombali

Western (rural)

The Context1. Recent KAP II study - comprehensive knowledge significantly lower

in the Western Area with greatest tendencies to engage in unsafe practices

2. Western Area basic repro currently highest

3. Swabs of corpses confirm that ebola patients are remaining in the community longer than they should

4. Combination of insufficient beds and persistent non-compliant behaviours and practices

5. WAERC efforts to break transmission hampered by inadequate resources and operational limitations

The Strategy

To enhance case finding,

contact monitoring and

social mobilisation

Use Malaria MDA as spring

board

Enhance operational capacity of

WAERC/WACC

Enhance operational capacity of WAERC

Enhancing Operational Capacity by:

Securing sufficientbed capacity

2,052 confirmed cases in Western Area as of 1st December of which currently infectious level is estimated at 563

MDA and Operation WAS will initially push up reported cases and increase bed demand

Sufficient bed capacity will be required to meet current and generated demand

Ensuring WAERC adequately resourced

Inadequate resources currently impacting ability of WAERC teams to comply with SOPs re: decontamination, quarantine, contact tracing and monitoring etc

Non compliance hampers efforts to break transmission (early detection and isolation)

Additional resources must be deployed ahead of active case finding and community mobilisation

Ensuring lab capacity and processes adequate & effective

Improvements required in labs efficiency timing, labelling, transportation etc

In collaboration with Lab Technical Working Group, confirm adequate capacity and resolution of systemic and procedural issues

Bed Capacity and Pipeline

Facility NameOperational Status

Opening Date

Beds as at 1st Dec

Beds as at 8th Dec

Beds as at 15th Dec

Beds as at 22nd Dec

Beds as at 29th Dec

Paed Beds at 29th Dec Operator

Police Training Sch-Hastings 2 EHC 12/8/2014 0 100 250 250 250 RSLAF/MOHConnaught Hospital active 16 16 16 16 16 2 Kings/MOHMacauley Street Hospital active 7 7 15 15 15 Kings/GOALLumley Hospital active 12 12 12 12 12 2 Kings / GOAL34th Military Hospital active 10 10 10 10 10 RSLAFOla During Childrens Hospital***** active 20 20 20 20 20 20 Cap Anamur/GOALNewton Healthcare Centre active 12 15 15 15 15 Kings / GOALPCMH (Maternity Hospital)*** 12/1/2014 12 12 12 12 12 PIHKing Harmen Road Hospital* 12/8/2014 0 2 2 2 2 Kings/MOHKissy Mental Hospital** 12/1/2014 0 4 4 4 4 Kings/MOHRokupa active 22 22 22 22 22 Kings / GOALLakka Emergency Hospital active 10 10 22 22 22 EmergencyChina-SL Friendship Hospital, Jui active 40 40 40 40 40 Chinese GovtPrince of Wales School ETC & EHC 12/8/2014 0 8 20 36 36 MSF SwitzerlandADRA Waterloo Hospital 12/1/2014 0 66 66 66 66 MOHSPolice Training Sch-Hastings 1 ETC active 125 125 125 125 125 MOHS/RSLAFPolice Training Sch-Hastings 2 ETC 11/30/2014 0 0 20 20 20 MOHS/RSLAFHastings Airfiled ETC 12/14/2014 0 0 5 5 5 Aspen MedicalKerry Town ETC active 11 11 20 20 20 Save the ChildrenGoderich ETC + Lakka Emergency ETC**** 12/14/2014 12 12 30 30 60 Emergency34 Military Hospital ETC 12/1/2014 10 20 30 30 30 RSLAFPrince of Wales School ETC & EHC 12/8/2014 0 12 12 32 64 MSF SwitzerlandHolding Centres 161 278 460 476 476Treatment Centres 158 246 308 328 390Total Beds 319 524 768 804 866

W. Area Centre Mapping

Bed Capacity and Demand Forecast

1st December 15th December 29th December

Estimated number of infectious 563 670 753

Confirmed Holding Beds 144 443 459

Confirmed Treatment Beds 156 298 390

Total Western Area Beds 300 741 849

Scale up of bed capacity

Beds as at 1st Dec Beds as at 8th Dec Beds as at 15th Dec Beds as at 22nd Dec Beds as at 29th Dec0

100

200

300

400

500

600

700

800

900

Treatment Centres

Holding Centres

Ensuring WAERC adequately resourced

WAERC Non –Compliance Resources required for resolution Cost for 6 weeks (Le)

Houses not decontaminated after corpses removed

• 13 Vehicles• Risk allowance for 20 decontamination teams• Fuel and operating costs• Fleet management

2,963,750,000

Homes not sprayed after removal of live suspect patients

• 16 motorbikes• Risk allowance for 32 sprayers• Fuel and operating costs• Fleet management

209,250,000

Nurses and drivers unable to follow protocols for safe transfer of

patients

• Risk allowance for 16 nurses and drivers• Fuel and operating costs• Fleet management 225,000,000

Homes not quarantined within 24hrs of positive lab results

• 9 Quarantine Officers• 21 motorbikes• 21 motorbike drivers • Risk allowance • Fuel and ongoing operating costs• Fleet Management

408,375,000

Ensuring WAERC adequately resourced

Operational challenges Resources required for resolution Cost for 6 weeks (Le)

DSOs inadequately resources to respond to alerts across 11 Western Area zones and existing and new holding facilities

• 35 District Surveillance Officers (DSOs)• 48 motorbikes• Risk allowance for 20 decontamination teams• Fuel and operating costs• Fleet management

784,125,000

No quality assurance personnel checking to see whether roles are being carried out or that the roles are being executed diligently (Specific Focus on DSOs and CTs)

• 11 Quality Assurance Officers• 5 vehicles• 5 drivers• Risk allowance for 20 quality assurance officers• Office and equipment• Fuel and operating costs• Fleet management

233,437,500

Total Leones 4,823,937,500

Total US Dollars 1,026,369.00

Labs capacity and processes

Lab. Location

Lab. Operator

Operating hours

Reported Max daily capacity

Max samples per run

Lab Run Duration

Batch Run Times

Jui Chinese ? 68 34 ? ?

Kerry Town PHE 06:00 - 22:00 200 n/a batch processing ? n/a

Lakka NICD 09:00:00 - 21:00 58 29 ? 09:00, 15:00

Goderich ⁰ Emergency 08.00 - 20.00 80 ?? ?

⁰ To be opened from 14th December

Use Malaria MDAas spring board

Active case finding, contact monitoring and

social mobilisation

Two fold impact anticipated Phased approach beginning with hotspots

Malaria treatment eliminating related febrile cases

Use existing WAERC structures of DSOs and CTs

Household campaign will potentially expose more ebola cases

Augmented by community involvement via wards

Align MDA strategy with WAS messaging Delivery mechanism and appropriate clear messaging and script to be developed by WAERC and relevant pillars

Lessons learnt from MDA to be incorporated

Difference context of Western Urban and Western Rural to be reflected

Malaria MDA and Active Case Finding…

Community-WAERC Linkages

Ward Councilors(1 per Ward – Ward Team Leaders)

Ward Section Representatives(10 reps per Ward – Section Team Leaders)

Ward Section Teams (10 Teams per Section; x Members Per Team)

MayorW. A. Urban

ChairmanW. A. Rural

HouseholdsHouseholds

WAERC Social Mobilisation Consortium

(SMAC)

WAERC Social Mobilisation Consortium

(SMAC)

WAERC Surveillance Teams

WAERC

CT Teams

Messages & Gloves

Monitoring

Alerts

W. Area District ERC W. Area Command Centre

Waterloo Model

Messages & Home IPC Items (e.g. Gloves)

Community Structures

Community Mobilisation Intensity

•High transmission Communities will have temporary community-based Triage facilities and additional motorbikes for transporting samples

Timelines and Delivery

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Delivery Commencement Delivered by:

Planning

Confirm engagement with Malaria MDADetermine Engagement Messaging

Determine Delivery MesagingDetermine phased hotspot approach

Collaborate with LTWG re labsStaff training as required

Confirm delivery of beds against scheduleSecure funding for WAERC operationl activities

Confirm roll-out programme

Operational Mobilisation

Procure Staff, Vehicles and other resourcesStaff training as required

Operation Break Camp Delivery

Roll-out of Operation Break Camp

Post Operation Break Camp

Review of Lessons LearntDevelopment of Strategies

Delivery Completion

Post Operation ‘WAS’

Operation ‘WAS’ Delivery‘WAS’

Potential Bottlenecks

• Bed capacity• Lab capacity (Efficiency) • Financial resources

– risk allowance– medical and non-medical supplies

• Transportation – Patients– Samples– Corpses

Measuring Success

• Sustained reduction in R0 in Western Area zones for 42 days subsequent to completion of ‘WAS’

• Sustained improvement in operational effectiveness of WAERC, measured against agreed KPIs and benchmarks

• Sustained improvement in lab process measured against agreed detailed KPIs and benchmarks (inc sampling, testing turnaround time, accuracy)

• Improvement in data capture specifically risk exposure, addresses, line list recording and patient outcomes

Measuring Operational AchievementsOutcome Area Indicators

Increased early detection and

isolation (>90% from ≈53%)

Reduction in number and proportion of deaths that test EVD positive Initial increase in the number of cases; and subsequent ‘flattening out’ of new cases

Behavioral changeIncrease in number and proportion of alerts (117+Community level) that meet case definition

Improved response capacity

Reduction in time delays between alerts and response for all aspects (triage, lab results, referrals, quarantine, burials, psycho-social assistance)

Post Operation ‘WAS’

• Lessons learnt exercise• Continuity of approach re early recognition • Triage for ebola in all healthcare facilities• Triage for ebola in communities• Monitor impact on referral and other social behaviours