Lori Kestenbaum, MD

is a fellow in Pediatric Infectious Diseases at The Children’s Hospital of Philadelphia. She graduated with a BS in Psychology from Duke University and received her MD from the Perelman School of Medicine at the University of Pennsylvania. She completed her residency in Pediatrics at The Children’s Hospital of Philadelphia in 2012.  She is currently a member of the American Academy of Pediatrics, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Follow her on Twitter @lorikestenbaum.

Containing disease

This weekend I played a board game, Pandemic (intended for ages 10 and up, but I played with four adults.) The premise of the game is that all players work together to cure the world of four diseases. Roles are assigned; including scientist, medic, dispatcher, and researcher. Each player has different strengths. Players’ turns must be elegantly thought out to maximize their potential. For example, a medic can quickly fly to a region to wipe out disease if the dispatcher uses a turn to send him there. Resources are limited, including the ability to fly or set up a research station. We lost the game three times in a row due to epidemics before we finally wiped out disease on our fourth try.

While designed for 10-year-olds, the Pandemic game illustrated what the WHO and other aligned organizations are up against with Ebola: complicated logistics, limited resources and coordination in underdeveloped areas. WHO has identified significant barriers to containing the Ebola outbreak, which are worrisome in that there are no rapid, simple solutions to these barriers. Lack of capacity includes the ability to make a diagnosis rapidly, provide protective equipment and supply disinfectants. The managerial framework was recently revised to coordinate the number of staff needed to the patient demand. Fear allows contacts of cases to escape surveillance, and health care workers fear for their lives. Transmission through contact by providing care and at burial practices continues to occur.

In contrast, in just two short weeks, certain US hospitals mobilized resources to identify potential cases, quarantine patients and stop movement of bodily fluids through laboratory systems. Ebola “kits” became available with boots and eye shields. When all key players are able to easily work together armed with endless resources, disease can be controlled. In this case, the international community must come together with money, resources and science to stop the spread of Ebola.