Colebunders and Felicity Fitzgerald and their

Colebunders and Felicity Fitzgerald and their colleagues also question whether we overestimate the potential for nosocomial Ebola virus transmission. In order ll-37 with the low nosocomial transmission ates that they cite in Freetown, our experience in rural areas—which are so much more poorly resourced than the capital that they are deemed internal colonies—revealed, at times, much less effective infection prevention and control than in the metropole. For example, upon arrival at a rural district hospital in November, 2014, we entered wards crowded with corpses, pools of infectious vomit and excreta, and large amounts of contaminated personal protective equipment. Patients with suspected Ebola virus disease were admitted on clinical grounds because samples, if they were taken, took several days until results were attained; nine (100%) of nine nurses working there contracted Ebola virus disease. Additionally, it was not uncommon for several patients with suspected Ebola virus disease who were vomiting and had diarrhoea to be transported over great distances in a single ambulance. Thus, for the absurdist exercise presented in our Comment, we did not feel that it was far-fetched to posit that a quarter of negative individuals exposed to a similar field of risk could have become infected. Even so, the purpose of our Comment was to counter the notion that is useful to think in terms of “Ebola suspects” and their ostensible options, while reminding us to question whether the fetishisation of isolation over treatment was “an institutionalized form of non-assistance” that resulted in “a high number of presumably avoidable deaths”. As such, our suggestion of the term “PPE [personal protective equipment]-bereft care-nexus” refers to a pragmatic re-description of the “Ebola suspect”, in an attempt to provide a more adequate vocabulary for outbreak containment by decolonising humanitarian illusions of bounded subjects. To extend the re-description even further, we suggest viewing Guinea, Sierra Leone, and Liberia as one large West Africa Ebola Holding Unit (WAEHU) for high-income and upper-middle-income countries around the world, with the implication that the focus on local statistics—including the often cited 70% mortality rate of Ebola virus disease—makes it difficult to distinguish the outbreak from its origins in transnational relations of inequality. A 0% case-fatality ratio in repatriated white American clinicians was achieved outside the WAEHU, which should remind us that such re-descriptions of outbreaks are necessary if we want to integrate power into an understanding of disease dynamics.
Lancet Glob Health —In this Article, a missing affiliation has been added for Laila Bruni. This correction has been made to the online version as of April 26, 2017.
Lancet Glob Health In this Article, the spelling of two author names have been corrected: Maziar Moradi-Lakeh and Saeide Aghamohamadi. Additionally, the correct affiliation for the author Hamidreza Jamshidi is the Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The section numbering for the appendix has also been corrected. These corrections have been to the online version as of June 12, 2017.
Lancet Glob Health —In this Article, the date at the top of the address box in the far right column should have been 2017. This change has been made to the online version as of May 9, 2017.