Was Ebola a near-miss?

"the nearest-run thing you ever saw in your life"

From 2021’s perspective, the advice given by UK public health authorities early in the covid outbreak reads like an attempt to sound confident and reassuring, full of what we now know to have been a lot of false assumptions built on almost very unreliable information.

We heard about the need to maintain open borders, that masks wouldn’t work, that the ‘world class’ NHS was well prepared to cope with plenty of PPE, that you couldn’t pass on the virus unless you had symptoms and above all that the most important thing to do was to wash your hands, all of which turned out to be disastrously misguided.

But imagine if covid had been contained in China and never took hold in the UK- would we have ever found out how wrong this all was? Or would we have been falsely reassured that everything was in order, and our health system stood ready to cope with disaster? Because I think this is what might have happened with Ebola. Almost every wrong ‘official’ belief of the early covid era was deployed with equal confidence against ebola six years previously.

The NHS is prepared

When a new outbreak of Ebola appeared in 2014, the UK government told the public that the NHS was ready, with “a proven record of dealing with imported infectious diseases”. Six years later that description had become slightly more grandiose, and Britons worried about covid in January 2020 were told that “UK public health measures are world-leading and the NHS is well prepared to manage and treat new diseases”. Only 9 weeks after that reassuring statement was issued about covid, the NHS reached saturation and began denying care to the most frail patients as covid ripped through the country. Would we have been well prepared to deal with Ebola? I’m not confident.

The risk is low

"The overall risk of Ebola to the UK remains low” said the then-director of Global Health at Public Health England, Brian McCloskey, recommending against any screening of passengers arriving in the UK from West Africa after a Spanish nurse was infected by in Madrid by a returning patient in October 2014. That same month, David Heymann, chairman of Public Health England, told the Today Programme that “the UK is prepared, having prepared over many, many years to deal with events such as this.” PHE described policies such as ‘surge capacity’ were there to be a UK-wide outbreak.

In January 2020 Public Health England made very similar noises, telling British passengers on the three direct flights per week between London and Wuhan “the risk to travellers to Wuhan from this disease is low and we are not advising them to change their plans”, though they should wash their hands and “avoid touching dead or dying birds”. In February, the Mayor of London was advised by Public Health England that there was “no danger using buses, the Tube or trains'. PHE also told care homes that it was "very unlikely that people receiving care in a care home or the community will become infected". Was this based on careful risk assessment, or had it become the default advice?

Masks don’t work

Just as happened with covid, people in the UK who reacted to the Ebola outbreak by buying masks and other protective equipment were told that they would be ineffective as ordinary people would be too incompetent to make use of them. "Medical staff in Spain and the US who've caught Ebola had this equipment, and they also had extensive training in infection control - yet they still became infected. I would not judge [this equipment] to be reliable in the hands of untrained individuals," said virologist Dr Chris Smith of Addenbrooke’s hospital in 2014. Just as with the NHS’s claims about its own coping capacity, his attitude too had become more forceful six years later when covid came along, telling Radio New Zealand that while respirators might be effective in the right hands, regular masks “are absolute rubbish and they do nothing."

This attitude was pervasive in public health circles: the UK decision to recommend against mask wearing in early 2020 was not based on a noble desire to conserve supplies but those same beliefs about ineffectiveness among the untrained members of the public: the representative of NHS Infection Control to the UK government’s NERVTAG committee said that “unlike the public, healthcare staff are trained and know when to change the masks when they become soggy", and scepticism about masks was so normalised that as late as February 2020 nursing home staff were told they didn’t need to wear masks when dealing with vulnerable residents.

Just wash your hands bro!

So if masks didn’t work, what were we to do? Wash our hands, of course! Others have written more extensively about the bizarre and un-evidenced commitment to handwashing among public health authorities, and this too was a core plank of the advice given to British people concerned about Ebola. While medical practitioners wore extensive PPE including respirators during the Ebola outbreak, NHS advice on ebola makes no mention of any of it, instead recommending in what has become a familiar refrain: ”wash your hands frequently using soap and water – use alcohol hand rubs if soap is not available

Border closures don’t work

Just as happened with Covid, the WHO and other bodies recommended against closing borders or suspending flights. Some countries did it anyway, violating the international norms. Even the UK, normally reticent to restrict travel, imposed some direct measures against travel to the affected areas. But after the Ebola pandemic subsided, a group of MPs looking into the UK’s response to the crisis criticised this aspect of the response:

"The revocation of licences to carriers to fly direct to the region was a political decision with no basis in science and was inconsistent with World Health Organization (WHO) advice," the Public Accounts Committee found.

The norm against border closures and travel bans was strengthened, and in 2020, after UK science advisors recommend against border checks, at Heathrow passengers reported “a litany of sick coughing people from an Air China flight waltz[ing] right out the airport” into the UK.

Contact tracing capacity is ready to protect us

If Ebola had reached the UK, experts told us that we still needn’t have worried; the UK’s contact tracing capacity was robust and would keep us secure. PHE Director of Global Health Brian McCloskey said that “anyone suspected of having Ebola would be tested quickly and their close family and contacts monitored until they are given the all clear. UK hospitals are well prepared to handle infectious disease and any patient would be cared for in isolation by specialist staff.”

We now know from the UK’s release of SAGE minutes from the Covid pandemic that the UK’s contact tracing capacity maxed out at five cases per week and was rapidly overwhelmed, being abandoned during the first wave only a few weeks after it began.

No ninjas, no door

The final reason I think the Ebola crisis was a near miss is that many of the people involved in it went on to drop balls during covid. At the start of the covid pandemic the Deputy Chief Medical Officer for England was Jenny Harries, who had got the job (and an OBE) for her work in the ebola response. In the final weeks of the UK’s pre covid pandemic ‘phoney war’ phase, she told the public that the NHS was a world leader in managing serious disease outbreaks, that the UK would manage the coming wave much better than Italy, that masks would make you more likely to catch covid, and that the UK had plenty of Personal Protective Equipment for hospitals, just weeks before a massive wave of infections overwhelmed the heath system and we had a thousand people being killed every day.

She’s since been promoted again and is now head of the UK’s Health Security Agency