Responding to the risk posed by Ebola requires action both here in the UK and overseas.
And though the best way to remove the Ebola risk altogether is beat the virus at its source in West Africa, substantial work goes into preparations for if we see any cases in the UK, such as the recent confirmed case in Glasgow.
It’s this careful planning from PHE and our partners which allows us to confidently state that the risk to the UK from Ebola is low. In this blog we introduce some of the PHE staff working behind the scenes to ensure an outbreak like the one we see in West Africa will not happen here.
Sian Reece-Loram – Microbiology Services (MS) Cell
The “MS Cell” is one of the largest Ebola response teams or “cells”, charged with both reducing the risk of Ebola at home and fighting it in West Africa.
MS Cell is a coordinating team bringing together the activities of a large and diverse division of microbiology, ensuring that there is consistency of advice, planning of activities and dissemination of information between two PHE microbiology centres (at Colindale and Porton) and regional PHE labs.
Activities within the MS Cell include deployment of lab and medical staff to run laboratories in Sierra Leone. This involves complex logistics, provision of information to meet parliamentary questions, advice on decontamination and infection control for the NHS and coordination testing of suspect cases.
PHE’s microbiology professionals also test samples from people returning to the UK carrying illnesses much more familiar than Ebola, such as Dengue Fever or Malaria.
We are working to ensure that if we see a suspected Ebola case anywhere in the UK, we can get an Ebola test processed as quickly as possible
And for our microbiology teams there is still a business as usual “day job” including important diagnostic work (like testing flu samples) or reference microbiology (monitoring how viruses are changing over time).
On her role Sian said: “I am a clinical fellow on a one year placement with PHE. When joining PHE I didn’t expect to be working on Ebola but I’m proud to make a contribution to such important work. I’ve been impressed with the willingness of microbiology services colleagues to deploy to Sierra Leone to set up or maintain labs, overcoming initial challenges like lack of electricity and damaged blood samples”.
“A big role for the UK team is ensuring our testing capacity is available throughout the country, whether you are in London, Cornwall, Yorkshire or Guernsey. We are working to ensure that if we see a suspected Ebola case anywhere in the UK, we can get an Ebola test processed as quickly as possible.”
Cat O’Connor and Mandy Walsh – Epidemiology and Intelligence Cell
“Epi Cell” has three main roles, all of which are integral in keeping the UK’s Ebola response ticking over; epidemiology, intelligence and guidance.
The team provides international intelligence, scanning for new outbreaks of Ebola (and other diseases), taking on data from the World Health Organisation and information from many sources, and keeping a record of the number of global cases. In fact, the team picked up on the current Ebola outbreak right from the start after their global monitoring identified a cluster of gastro illness in Guinea.
Providing reliable advice to a wide range of professionals is a key PHE responsibility. In the early days of the outbreak, Epi Cell was responsible for developing guidance for healthcare settings and for humanitarian aid workers who would be travelling out to affected countries, and for compiling the UK’s Ebola risk assessment. Since the Ebola “Level 4 response”, Epi Cell has worked alongside other key teams to develop or update guidance for a wide variety of settings.
The Cell also carries out surveillance work such as monitoring returning health and aid workers, or working closely with the Contact Tracing Cell to ensure follow-up of all those who had potentially been in contact with the recent UK case.
We’re used to seeing Ebola outbreaks in Africa that affect 30-60 people, but this outbreak really has been a humanitarian disaster of unprecedented proportions
Two core members of the EpiCell are Mandy Walsh & Cat O’Connor, scientists normally based within PHE’s Emerging Infections and Zoonoses section.
Mandy, whose more familiar day to day role includes monitoring for and responding to rare infections like rabies or anthrax said: “The viral haemorrhagic fevers, of which Ebola is one, are part of our normal day job. As such we’re used to seeing Ebola outbreaks in Africa that affect 30-60 people, but this outbreak really has been a humanitarian disaster of unprecedented proportions. Getting to grips with the scale of this outbreak and the complexity of the UK response has been eye opening, with long days in a pressured environment.”
Cat, whose normal job is monitoring international outbreaks of rare infections, has also been affected by the magnitude of this outbreak. “The impact is unimaginable, but the strength of the West African people is astounding.
There are health workers in hospitals in Guinea, Liberia and Sierra Leone who have lost their entire families to Ebola yet they are striving every day to rid their country of this horrible disease. Their dedication, and that of the volunteers from all over the world, is inspiring. It was a real boost to see TIME Magazine award Ebola workers their person of the year. It’s very easy for me to moan about the amount of work we’ve had to do to prepare the UK response to Ebola but then I remember the enormity of the situation in West Africa which puts it all into perspective”.
“We’ve been so impressed by the willingness of people from across PHE to volunteer to help us in EpiCell – they come from different teams locally and nationally and normally arrive with only a basic knowledge of Ebola but by the end of day one are fully integrated EpiCell members and are invaluable to us.”
Deepti Kumar – Port Screening
A number of countries around the world carry out screening at ports or airports, including Ebola affected countries, which screen passengers as they exit.
In the UK, PHE works with UK Border Force who identify passengers travelling to the UK from/via Sierra Leone, Guinea or Liberia. People coming from affected areas receive a health assessment, which includes a temperature check, but most importantly assesses their previous risk of exposure to Ebola so that anyone at higher risk can receive information on how to monitor themselves and act quickly if they later experience symptoms.
The largest PHE Port Screening operation is at Heathrow Airport with staff working on one of two possible shifts, starting from 5.30am each day to meet flights coming from locations such as Belgium, France or Morocco (there are currently no direct flights to the UK from the countries most affected by Ebola). Screening teams typically include staff who carry out health assessments, health protection practitioners and a consultant in communicable disease control (CCDC).
I was completely humbled recently when I met a young British man returning from a project working for an NGO in West Africa
Deepti, whose usual day to day role is a CCDC in South Mids & Herts said: “This work has broadened my experience of working with different people from within and outside PHE and I’ve been amazed at both how good and how dedicated people are.
“I was completely humbled recently when I met a young British man returning from a project working for an NGO in West Africa. He explained that he’d spent the last 8-10 weeks working in very difficult conditions helping the local teams fighting Ebola. It’s inspiring to meet people who have travelled to the front line and we are here to reassure them that there is a system in place to meet them as they return, provide information and advise them how to report any concerns immediately if they start to feel unwell.”
Karen Reddin – Corporate Resilience Team
The Corporate Resilience Team has a 365-day a year role maintaining Public Health England’s emergency plans, including keeping the National Incident Coordination Centre (NICC) in central London in a permanent state of operation. The NICC is activated for any ‘Level 4’ emergency, including the current Ebola response and it is also activated for some ‘Level 3’ incidents requiring national support - over the last year this has included the response to wide-spread flooding across England, a Hepatitis-C patient notification exercise and cases of Bacillus cereus infection in premature babies.
Since the start of the Ebola response Karen and her team have provided logistical support to the NICC as well as arranging extra personnel for any of the operational cells.
Regular reports on our activities are provided so we can keep improving on the way we respond to health emergencies
She said: “A key part of our role is ensuring that national plans are in place which set out the PHE Emergency Preparedness, Resilience and Response arrangements. The Corporate Resilience Team also maintains a database of Level 3 and above incidents and gathers together the learning from them.
“Regular reports on our activities are provided so we can keep improving on the way we respond to health emergencies.
“We also worked with our exercises team, the Department of Communities and Local Government and Department of Health to run “Off-the-Shelf” Ebola preparedness exercises in all Local Resilience Forum areas during October and November last year. It was important to look at local readiness as well as national and this series of exercises was used all over the country.
Éamonn O’Moore, National Incident Director, PHE National Incident Coordination Centre (NICC)
Sitting right in the centre of PHE’s Ebola response is the National Incident Coordination Centre led at all times by a senior public health professional acting as National Incident Director, or “NID”.
The NID’s primary role is to ensure PHE delivers on all the functions assigned to it, including leading the response if any Ebola cases are identified in the UK. Each day, the NID signs off on new guidance and regular situation reports as well as ensuring that new risks are identified early and any duplication of efforts is avoided.
This blog features a number of key roles and teams under the supervision of the NID, but alongside these, our response also includes experts working specifically on diagnostics (testing), liaising with partners like CDC and ECDC, focussing on new guidance or the vital issue of governance, ensuring that our operation runs according to best clinical practice.
A huge number of people working right across PHE have been absolutely critical to this response both nationally and internationally
The NID also coordinates professional teams who manage the deployment of our staff to Sierra Leone, lead on our logistical and supplies needs or register all healthcare and humanitarian workers deployed to outbreak countries.
Finally, the National Incident Coordination Centre provides expert advice to PHE communications staff who ensure the media and public are kept informed about the developing situation.
Éamonn said: “Working as a National Incident Director is a very demanding but stimulating role and it has been inspirational to interact with such dedicated and talented colleagues. A huge number of people working right across PHE have been absolutely critical to this response both nationally and internationally.
I pay tribute to the large number of staff who have volunteered to work in controlling the outbreak in Sierra Leone but also to those volunteers who have been working around the clock seven days a week in operations like port screening which is critical to ensuring we protect the UK from imported cases of infection.”