Operation 'WAS' is a proposed strategy by the National Ebola Response Centre to significantly slow transmission of Ebola in the Western Area of Sierra Leone within 42 days. It involves enhancing case finding, contact monitoring, and social mobilization through increased community involvement and leveraging an upcoming malaria drug administration campaign. Key elements include scaling up treatment bed capacity, ensuring adequate WAERC resources and lab capacity, and strengthening community-WAERC linkages. Success will be measured by sustained reductions in transmission and improvements in WAERC operational effectiveness and lab processing times. Addressing potential bottlenecks like bed and lab capacity is critical. Lessons learned will inform post-operation monitoring and continuity of approaches.

1. National Ebola Response Centre (NERC)
Plans and Secretariat
1st December 2014

2. Operation ‘WAS’
• The Mission
• The Context
• The Proposed Strategy
• Timelines and Delivery
• Measuring Success and Operational Achievements
• Post Operation “WAS”

3. The Mission
To significantly slow down the transmission of
Ebola in the Western Area to a level that will
enable the WAERC to completely eradicate it
within 42 days thereafter

4. For the records, Operation ‘WAS’:
Is Not: Is Meant to:
An exercise that will send soldiers
into people’s homes to drag them out
into Holding and Treatment Centres
Enhance the WAERC structures to enable them
adequately meet the demands of a potential surge
in emerging cases
An exercise that will promote
‘vigilante-ism’ in communities
Utilise community structures and volunteers to
support existing surveillance, contact monitoring
and social mobilisation teams
Designed to allow community teams
to perform triage or handle
suspected cases in the communities
Link community teams to appropriate WAERC
teams as a means of reducing delays that increase
the risks of further transmissions in the community

5. The Context
Daily Rate of Confirmed Cases per 100,000
(Sit-Rep 23 November, 2014)3.0
2.5
2.0
1.5
1.0
0.5
0

6. The Context
1. Recent KAP II study - comprehensive knowledge significantly lower
in the Western Area with greatest tendencies to engage in unsafe
practices
2. Western Area basic repro currently highest
3. Swabs of corpses confirm that ebola patients are remaining in the
community longer than they should
4. Combination of insufficient beds and persistent non-compliant
behaviours and practices
5. WAERC efforts to break transmission hampered by inadequate
resources and operational limitations

7. The Strategy
To enhance
case finding,
contact
monitoring and
social
mobilisation
Use Malaria
MDA as spring
board
Enhance
operational
capacity of
WAERC/WACC

8. Enhance operational capacity of WAERC
Enhancing Operational Capacity by:
Securing sufficient
bed capacity
2,052 confirmed cases in Western Area as of 1st December of which currently
infectious level is estimated at 563
MDA and Operation WAS will initially push up reported cases and increase bed
demand
Sufficient bed capacity will be required to meet current and generated demand
Ensuring WAERC
adequately resourced
Inadequate resources currently impacting ability of WAERC teams to comply with
SOPs re: decontamination, quarantine, contact tracing and monitoring etc
Non compliance hampers efforts to break transmission (early detection and isolation)
Additional resources must be deployed ahead of active case finding and community
mobilisation
Ensuring lab capacity and
processes adequate &
effective
Improvements required in labs efficiency timing, labelling, transportation etc
In collaboration with Lab Technical Working Group, confirm adequate capacity and
resolution of systemic and procedural issues

9. Bed Capacity and Pipeline
Facility Name
Operational
Status
Opening
Date
Beds as at
1st Dec
Beds as at
8th Dec
Beds as at
15th Dec
Beds as at
22nd Dec
Beds as at
29th Dec
Paed
Beds at
29th Dec Operator
Police Training Sch-Hastings 2 EHC 12/8/2014 0 100 250 250 250 RSLAF/MOH
Connaught Hospital active 16 16 16 16 16 2 Kings/MOH
Macauley Street Hospital active 7 7 15 15 15 Kings/GOAL
Lumley Hospital active 12 12 12 12 12 2 Kings / GOAL
34th Military Hospital active 10 10 10 10 10 RSLAF
Ola During Childrens Hospital***** active 20 20 20 20 20 20 Cap Anamur/GOAL
Newton Healthcare Centre active 12 15 15 15 15 Kings / GOAL
PCMH (Maternity Hospital)*** 12/1/2014 12 12 12 12 12 PIH
King Harmen Road Hospital* 12/8/2014 0 2 2 2 2 Kings/MOH
Kissy Mental Hospital** 12/1/2014 0 4 4 4 4 Kings/MOH
Rokupa active 22 22 22 22 22 Kings / GOAL
Lakka Emergency Hospital active 10 10 22 22 22 Emergency
China-SL Friendship Hospital, Jui active 40 40 40 40 40 Chinese Govt
Prince of Wales School ETC & EHC 12/8/2014 0 8 20 36 36 MSF Switzerland
ADRA Waterloo Hospital 12/1/2014 0 66 66 66 66 MOHS
Police Training Sch-Hastings 1 ETC active 125 125 125 125 125 MOHS/RSLAF
Police Training Sch-Hastings 2 ETC 11/30/2014 0 0 20 20 20 MOHS/RSLAF
Hastings Airfiled ETC 12/14/2014 0 0 5 5 5 Aspen Medical
Kerry Town ETC active 11 11 20 20 20 Save the Children
Goderich ETC + Lakka Emergency ETC**** 12/14/2014 12 12 30 30 60 Emergency
34 Military Hospital ETC 12/1/2014 10 20 30 30 30 RSLAF
Prince of Wales School ETC & EHC 12/8/2014 0 12 12 32 64 MSF Switzerland
Holding Centres 161 278 460 476 476
Treatment Centres 158 246 308 328 390
Total Beds 319 524 768 804 866

10. W. Area Centre Mapping

11. Bed Capacity and Demand Forecast
1st December 15th December 29th December
Estimated number of infectious 563 670 753
Confirmed Holding Beds 144 443 459
Confirmed Treatment Beds 156 298 390
Total Western Area Beds 300 741 849

12. Scale up of bed capacity
0
100
200
300
400
500
600
700
800
900
Beds as at 1st Dec Beds as at 8th Dec Beds as at 15th Dec Beds as at 22nd Dec Beds as at 29th Dec
Treatment
Centres
Holding
Centres

13. Ensuring WAERC adequately resourced
WAERC Non –Compliance Resources required for resolution Cost for 6 weeks
(Le)
Houses not decontaminated after
corpses removed
• 13 Vehicles
• Risk allowance for 20 decontamination teams
• Fuel and operating costs
• Fleet management
2,963,750,000
Homes not sprayed after removal of
live suspect patients
• 16 motorbikes
• Risk allowance for 32 sprayers
• Fuel and operating costs
• Fleet management
209,250,000
Nurses and drivers unable to follow
protocols for safe transfer of
patients
• Risk allowance for 16 nurses and drivers
• Fuel and operating costs
• Fleet management 225,000,000
Homes not quarantined within
24hrs of positive lab results
• 9 Quarantine Officers
• 21 motorbikes
• 21 motorbike drivers
• Risk allowance
• Fuel and ongoing operating costs
• Fleet Management
408,375,000

14. Ensuring WAERC adequately resourced
Operational challenges Resources required for resolution Cost for 6 weeks
(Le)
DSOs inadequately resources to
respond to alerts across 11
Western Area zones and existing
and new holding facilities
• 35 District Surveillance Officers (DSOs)
• 48 motorbikes
• Risk allowance for 20 decontamination teams
• Fuel and operating costs
• Fleet management
784,125,000
No quality assurance personnel
checking to see whether roles are
being carried out or that the roles
are being executed diligently
(Specific Focus on DSOs and
CTs)
• 11 Quality Assurance Officers
• 5 vehicles
• 5 drivers
• Risk allowance for 20 quality assurance officers
• Office and equipment
• Fuel and operating costs
• Fleet management
233,437,500
Total Leones 4,823,937,500
Total US Dollars 1,026,369.00

15. Labs capacity and processes
Lab. Location
Lab.
Operator
Operating
hours
Reported Max
daily capacity
Max samples
per run
Lab Run
Duration
Batch Run
Times
Jui Chinese ? 68 34 ? ?
Kerry Town PHE 06:00 - 22:00 200
n/a batch
processing
? n/a
Lakka NICD 09:00:00 - 21:00 58 29 ? 09:00, 15:00
Goderich ⁰ Emergency 08.00 - 20.00 80 ?
? ?
⁰ To be opened from 14th December

16. Use Malaria MDA
as spring board
Active case finding, contact
monitoring and
social mobilisation
Two fold impact anticipated Phased approach beginning with hotspots
Malaria treatment eliminating related
febrile cases
Use existing WAERC structures of DSOs
and CTs
Household campaign will potentially
expose more ebola cases
Augmented by community involvement via
wards
Align MDA strategy with WAS messaging
Delivery mechanism and appropriate clear
messaging and script to be developed by
WAERC and relevant pillars
Lessons learnt from MDA to be
incorporated
Difference context of Western Urban and
Western Rural to be reflected
Malaria MDA and Active Case Finding…

17. Community-WAERC Linkages
Ward Councilors
(1 per Ward – Ward Team Leaders)
Ward Section Representatives
(10 reps per Ward – Section Team Leaders)
Ward Section Teams
(10 Teams per Section; x Members Per Team)
Mayor
W. A. Urban
Chairman
W. A. Rural
Households
WAERC Social
Mobilisation
Consortium
(SMAC)
WAERC
Surveillance Teams
WAERC
CT Teams
Messages
& Gloves
Monitoring
Alerts
W. Area District ERC W. Area Command Centre
Waterloo
Model
Messages & Home IPC Items
(e.g. Gloves)
Community Structures

18. Community Mobilisation Intensity
•High transmission Communities will have temporary community-based Triage facilities
and additional motorbikes for transporting samples

19. Timelines and Delivery
30-Nov-14
01-Dec-14
02-Dec-14
03-Dec-14
04-Dec-14
05-Dec-14
06-Dec-14
07-Dec-14
08-Dec-14
09-Dec-14
10-Dec-14
11-Dec-14
12-Dec-14
13-Dec-14
14-Dec-14
15-Dec-14
16-Dec-14
17-Dec-14
18-Dec-14
19-Dec-14
20-Dec-14
21-Dec-14
22-Dec-14
23-Dec-14
24-Dec-14
25-Dec-14
26-Dec-14
27-Dec-14
28-Dec-14
29-Dec-14
30-Dec-14
31-Dec-14
01-Jan-15
02-Jan-15
03-Jan-15
04-Jan-15
05-Jan-15
06-Jan-15
Delivery Commencement Delivered by:
Planning
Confirm engagement with Malaria MDA
Determine Engagement Messaging
Determine Delivery Mesaging
Determine phased hotspot approach
Collaborate with LTWG re labs
Staff training as required
Confirm delivery of beds against schedule
Secure funding for WAERC operationl activities
Confirm roll-out programme
Operational Mobilisation
Procure Staff, Vehicles and other resources
Staff training as required
Operation Break Camp Delivery
Roll-out of Operation Break Camp
Post Operation Break Camp
Review of Lessons Learnt
Development of Strategies
Delivery Completion
Post Operation ‘WAS’
Operation ‘WAS’ Delivery
‘WAS’

20. Potential Bottlenecks
• Bed capacity
• Lab capacity (Efficiency)
• Financial resources
– risk allowance
– medical and non-medical supplies
• Transportation
– Patients
– Samples
– Corpses

21. Measuring Success
• Sustained reduction in R0 in Western Area zones for 42 days
subsequent to completion of ‘WAS’
• Sustained improvement in operational effectiveness of
WAERC, measured against agreed KPIs and benchmarks
• Sustained improvement in lab process measured against
agreed detailed KPIs and benchmarks (inc sampling, testing
turnaround time, accuracy)
• Improvement in data capture specifically risk exposure,
addresses, line list recording and patient outcomes

22. Measuring Operational Achievements
Outcome Area Indicators
Increased early
detection and
isolation
(>90% from ≈53%)
Reduction in number and proportion of deaths that
test EVD positive
Initial increase in the number of cases; and subsequent
‘flattening out’ of new cases
Behavioral change
Increase in number and proportion of alerts
(117+Community level) that meet case definition
Improved
response capacity
Reduction in time delays between alerts and response
for all aspects (triage, lab results, referrals, quarantine,
burials, psycho-social assistance)

23. Post Operation ‘WAS’
• Lessons learnt exercise
• Continuity of approach re early recognition
• Triage for ebola in all healthcare facilities
• Triage for ebola in communities
• Monitor impact on referral and other social behaviours