On 6 November 2014, the Prime Minister Xavier Bettel, the Minister of Health Lydia Mutsch and the Minister of Home Affairs Dan Kersch presented the main pillars of inter-ministry cooperation in the fight against the Ebola virus based on the emergency response plan for probable/confirmed cases of Ebola on a national level.
Although Luxembourg is well prepared, which will reduce to a minimum the risk of infection with the Ebola virus within the country, vigilance remains key. The press conference was followed by a presentation on the Luxembourg Air Rescue (LAR) site of the plan for ambulance transport and repatriation by air (MEDEVAC) of those infected.
The 'Ebola' plan
The 'Ebola' plan, developed under the leadership of the High Commission for National Protection (HCNP) and adopted by the Council of Government on 22 October 2014, sets the actions the government must take:
- when a probable or confirmed case of Ebola must be repatriated from the country of origin to the Grand Duchy of Luxembourg
- when a probable or confirmed case of Ebola is detected within Luxembourg.
The plan sets the bodies that will manage the crisis, how the alert should be spread in line with the different scenarios and the emergency measures.
The Crisis Cell is activated by the Prime Minister and convened by the High Commissioner for National Protection as soon as the Health Inspection Department of the Department of Health confirms a probable case of Ebola on national territory.
Under the authority of the government, the Crisis Cell initiates, coordinates and monitors the execution of all the measures intended to deal with the crisis and its effects with the aim of returning to a normal situation. The alert procedure and the composition of the Crisis Cell are defined in line with four different scenarios:
- a probable/confirmed case of Ebola at Luxembourg airport;
- a probable/confirmed case of Ebola detected on national territory (excluding the airport);
- repatriation of a Luxembourg resident or national who has been exposed to a high risk of Ebola or a probable/confirmed case of Ebola;
- a probable/confirmed case of Ebola is found on board a vessel sailing under the Luxembourg flag.
In line with these scenarios, the plan provides for four emergency measures:
- management of a probable/confirmed case of Ebola at Luxembourg airport;
- management and diagnosis/treatment of the probable/confirmed case at the Luxembourg Hospital Centre (CHL);
- transportation of a probable/confirmed case of Ebola to a hospital;
- repatriation of a Luxembourg resident or national who has contracted the Ebola virus from the country of origin to Luxembourg airport.
The Minister of Health Lydia Mutsch then reviewed measures one and two.
Management of a probable/confirmed case of Ebola at Luxembourg airport
She explained that the specialist doctors of the Department of Health carry out an evaluation of the health of the person concerned at site, after having been alerted by lux-airport via 112, and decide whether to transfer the person to the National Service for Infectious Diseases depending on the risk profile of the person in question who will be placed in isolation until the ambulance arrives. The other passengers are also subject to a medical evaluation. Posters placed in different locations around the airport (and Luxembourg train station) by the Ministry of Health provide information for travellers arriving from countries at risk to raise their awareness.
The Department of Health also intervenes on the front line in a similar manner when cases are detected on Luxembourg territory outside of the airport. The Ministry of Health has sent specific guidance to the different hospitals, doctors offices, medical centres and pharmacies containing clear instructions on how to act in the event of a suspected, probable or confirmed case of Ebola.
Management and diagnosis/treatment of a probable/confirmed case at the CHL
A detailed procedure is in place at the CHL to ensure the security of the patients and the staff treating them. The government has undertaken to ensure that the laboratory's immunology department has access to the equipment needed to make specific diagnoses in high security conditions and in very short periods of time, without needing to call on foreign assistance. The National Service for Infectious Diseases has a number of negative pressure chambers and can house up to two Ebola patients.
Simulation exercises that are regularly organised in the CHL's premises have enabled staff to integrate the protocol of the different procedures required.
Information sessions for healthcare professionals put on by the Ministry of Health have been planned. An agreement has been concluded with France and Germany to enable Luxembourg to make use of the university hospitals of Strasbourg, Nancy and Düsseldorf in the unlikely event that national capacity is exceeded and extra capacity is required. The French Agency for the Safety of Medecine has limited stocks of one of the rare medicines currently administered to treat the Ebola virus and, if necessary, will provide Luxembourg with supplies of this drug.
Transportation of a probable/confirmed case of Ebola to a hospital
The Minister of Home Affairs then discussed the issue of transporting a probable/confirmed case of Ebola to a hospital.
He stressed that the absolute priority is to ensure the protection and safety of the ambulance team, hence the provision of the most secure protective clothing currently available on the market. Two specialised ambulances for transporting patients suffering from an infectious disease are available, one located at the Response Centre of Dudelange and the other at the Fire and Ambulance Service of the City of Luxembourg. The professional firefighters of the City of Luxembourg will ensure transportation within the territory of the capital, and the team of Dudelange will do so throughout the Grand Duchy. It can take the teams up to three quarters of an hour to prepare before departure. During this waiting period, 112 will provide instructions to the caller on what to do.
Dan Kersch also spoke of the implementation of a new decontamination/disinfection method of fumigation with formaldehyde (the benefit of which is that it avoids the risk of a person carrying out the decontamination who himself would be exposed to the risk of contamination).
The Minister of Home Affairs stressed that specialist equipment was already available and that staff had the appropriate training well before the Ebola crisis. Transport of infectious patients occurs regularly. It was necessary to purchase additional equipment and implement adapted procedures in order to ensure that transporting Ebola patients abroad to specialist hospitals is secure. These transfers are more complex given the length of the journey and the need to change staff along the route.
Repatriation of a Luxembourg resident or national who has contracted the Ebola virus from the country of origin to Luxembourg airport
This does not concern repatriating patients generally from Africa to Europe, but rather guaranteeing the repatriation of those participating in aid missions in the countries affected by Ebola. In 2012, Luxembourg signed up to the MEDEVAC module of the European Commission's EU Civil Protection Mechanism. On 16 October 2014, the voluntary pool, a new element of the EU Civil Protection Mechanism, entered into force. On 23 October 2014, Luxembourg announced the MEDEVAC module in the voluntary pool for a duration of two years with a commitment of up to 48 missions, requiring two of the Luxembourg Air Rescue's Learjets XR45. Luxembourg Air Rescue (LAR) will be able to repatriate category 1 patients from mid-December 2014 and category 2 and 3 patients from January 2015. Before MEDEVAC is deployed, a case-by-case risk analysis is carried out by Luxembourg Air Rescue.
The MEDEVAC module will be provided on the condition that the Grand Duchy of Luxembourg can reserve the right to refuse a mission in specific cases and after consultation with the European Commission:
in the event of a national emergency when Luxembourg must repatriate a Luxembourg citizen, a resident or border dweller infected by Ebola or a NGO employee under contract with the Directorate for Development Cooperation and Humanitarian Affairs;
In the event of force majeure such a technical issues with the plane, volatile weather conditions, etc.;
In the event of any other serious situation, in particular when the risk analysis carried out on a case-by-case basis by the LAR does not favour an evacuation.
The Minister of Home Affairs also announced that a large-scale exercise bringing together all the stakeholders who will be required to act in the event of an Ebola alert will take place on 27 November under the auspices of the High Commission for National Protection.
Contributions in the area of development cooperation
The Prime Minister Xavier Bettel listed the different contributions that Luxembourg has made in the field of development cooperation and humanitarian affairs in the fight against Ebola. Luxembourg's contribution to programmes run by MSF, WHO, WFP (UNHAS), HCR, Luxembourg Institute of Health (CRP-Santé), Luxembourg Red Cross and the UN trust fund stands at over a million euros. Add to this a contribution of 654,500 euros dedicated to financing a national Ebola action plan in connection with our bilateral health programmes in Senegal. In addition, the Directorate for Development Cooperation and Arcelor Mittal have committed 200,000 euros in total to a project that will be implemented by the Luxembourg Red Cross. What is more, seven satellite telecommunications systems from the project emergency.lu will be deployed in the region.
Transmission of the Ebola virus
- only a person displaying very clear symptoms of the disease, such as a very high temperature (over 38.5 degrees), can transmit the virus.
- The virus is only transmitted through bodily fluids. It is not transmitted through the air.
- It is recommended that citizens call 112 rather than visiting a doctor or going to hospital.