As Liberia reaches a milestone in its struggle against Ebola, with the World Health Organization on Saturday declaring the nation Ebola-free, new contact tracing technology may help health workers remain vigilant in preventing another outbreak.
As of Saturday, May 9, it's been 42 days since the last known case in Liberia, double the incubation period and long enough for officials to consider the outbreak there officially over. But with neighboring Sierra Leone and Guinea still reporting cases of the disease, the Liberian government is setting systems in place to monitor the borders and other high-risk parts of the country.
Assisted Contact Tracing (ACT) technology, a new mobile application developed by American social entrepreneur Camilla Hermann, will form part of the public health surveillance at Liberia's borders, and it will also provide a way to continue monitoring affected communities within Liberia.
Touched by the enormity of the Ebola crisis in West Africa, 25-year-old Hermann felt called to help. She developed the ACT system to provide a link for people living in rural, hard-to-reach areas of Liberia and to also protect the lives of health workers who were trying desperately to contain the outbreak.
"Because I had done work in West Africa prior to the Ebola epidemic, I had an understanding of what the initial barriers would be and what was required for a tech platform to be successful there. Telecommunications form the backbone of infrastructure in the region. For a public health crisis like Ebola, where transmission occurs through physical contact, rapid response marks the difference between outbreak and epidemic," Hermann told CBS News.
ACT allows people to self-report symptoms of Ebola via an app on their cellular phones. After a confirmed Ebola case is isolated in a treatment facility, the app allows health workers to monitor anyone who has had close physical contact with the patient for 21 days -- without having to travel to the affected area. People who are being monitored will receive a phone call twice a day asking them in their native dialect if they are experiencing any symptoms. This information is quickly reviewed by health workers who can respond according to each person's level of risk. The quick feedback allows for someone to be isolated immediately if symptoms emerge, thus containing the risk of spreading the virus to others.
After collaborating with health officials in the U.S. to get ACT up and running last fall, Hermann traveled to Liberia and began working with the National Ebola Response Incident Management System. In the last few weeks, she completed her first successful trial measuring the effectiveness of ACT. Findings showed a 74 percent call completion rate in which people self-reported symptoms and enabled information gathering by health workers.
Hermann hopes that the initial success of ACT in Liberia will open the door to more opportunity to assist other developing countries in public health surveillance and beyond.
"ACT is a low-cost, highly scalable tool for cross-border public health surveillance and contact tracing. Because the system is highly adaptable, diverse applications outside of public health provide potential revenue generating opportunities to ensure long-term sustainability of the tools for public good," says Hermann.
Though the Ebola crisis has finally waned in Liberia, the outbreak took a terrible toll, killing more than 4,700 people in that country and 11,000 across West Africa. Implementing public health surveillance tools for developing countries in the event of another outbreak is still vital.
"There is no systematic disease-surveillance process in place today in most poor countries, which is where a naturally occurring epidemic seems most likely to break out," Bill Gates wrote in the New England Journal of Medicine. "Even once the Ebola crisis was recognized last year, there weren't resources to effectively map where cases were occurring and in what quantity."
Hermann and her team will continue to address this issue by working with Dr. Mosoka Fallah's Community Based Initiative team in Liberia to map out how to sync ACT with existing human capacity on the ground. Moving forward, Hermann says this team will be one the main implementation partners in ongoing public health surveillance in Liberia.