Ebola: There’s No Cure, But Early Intensive Treatment Boosts Survival
The Ebola outbreak in Africa has already claimed several lives, including that of Dr. Sheik Humarr Khan who was treating Ebola patients in Sierra Leone.
As we write two American Aid workers, Dr. Kent Brantly and Nancy Writebol, are currently fighting for their lives in Liberia. Each became infected with Ebola while helping stricken patients in the West African nation.
The condition of the two American patients changes day to day. Earlier this week both Dr. Kent Brantly and Nancy Writebol were reported by the Associated Press to have improved “slightly.” But an update Thursday from Samaritan’s Purse said that Brantly’s condition has “taken a slight turn for the worse overnight,” ABC News reported.
Brantly, 33, is a family physician from Texas who serves as medical director of the Samaritan’s Purse treatment center in Liberia’s capital city, Monrovia. Writebol is a hygienist who works for a group allied with Samaritan’s Purse.
https://www.youtube.com/watch?v=N6FtPIpX4ME
Virus launches assault on multiple organs, keeping patients hydrated is often key, experts say
Ebola currently is raging through the West African nations of Guinea, Liberia and Sierra Leone. As of July 29, the virus had killed 729 people and infected a total 1,323, according to the World Health Organization.
The Ebola virus has a well-earned reputation as one of the world’s most deadly illnesses. But experts stress that early and intense medical care can greatly improve a person’s chances of survival.
There’s no cure or vaccine for Ebola, which wreaks life-threatening havoc within the body by attacking multiple organ systems at the same time.
Instead, doctors must fall back on the basics of “good meticulous intensive care,” supporting the patient and targeting treatment toward the organs that are under attack by the virus, explained Dr. Lee Norman, chief medical officer for the University of Kansas Hospital and an expert on the disease.
“You treat the things that are failing,” Norman said. “If a person is dehydrated, you treat them with IV fluid support. If a person has respiratory failure, you put them on a ventilator.”
The virus is particularly tough to combat because “once it gets into the human body, it attacks so many different tissues,” explained Dr. Bruce Hirsch, an infectious diseases specialist at North Shore University Hospital in Manhasset, N.Y.
In contrast, most viruses tend to target one specific organ, Hirsch and Norman said. For example, influenza goes after the respiratory system.
But Ebola attacks every organ system, including the heart, lungs, brain, liver and kidneys, Norman said. The virus even attacks a person’s blood, thinning it and causing Ebola’s trademark bleeding from multiple orifices.
And the impact in terms of overall illness is “additive,” Norman said. “Every time you add another organ system that’s failing, a person’s chance of survival goes down exponentially.”
Hirsch explains:
The human body responds to this multiple-pronged attack by initiating a massive and intense inflammatory response — which actually adds to the damage being done.
It’s a combination of the viral destruction and the inflammation that takes place in response that’s so life threatening to us. Ebola’s ravages are such that even young, healthy patients, who usually can fight off most serious illnesses, have a high death rate.
Pumping fluids into patients remains the best front-line treatment for Ebola, to limit the damage caused by inflammation.
Beyond that, doctors must pay close attention to the patient and be ready to treat whatever organs are on the verge of failure, Hirsch and Norman said.
It doesn’t sound like much, but this basic care can dramatically enhance chances of survival.
“If you look at the overall statistics, the mortality rate is around 50 to 60 percent, but if you get out into remote areas the mortality rate increases to around 90 percent,” Norman said. “I think that reflects the fact that if more care is given and care is given early, the more survival improves.”
Indeed, there was a rare moment of good news from aid agency Doctors Without Borders, NBC News reported Wednesday. In its latest update on the West African outbreak, the group said it was closing its Ebola treatment center in the Guinea town of Telimele because no new cases have been reported for the past three weeks.
“During seven weeks, 21 people with the disease were admitted to the center, with an astonishing 75 percent of patients making a recovery,” Doctors Without Borders said. “Without medical care, as few as 10 percent of patients could be expected to survive.”
Such medical care has so far helped the two American aid workers and let us hope that these brave people will survive..
Ebola Facts – More information
Professor Lynn Basford adds some background information on the Ebola virus and its potential risk of spread to countries outside of Africa.
What is EBOLA?
Ebola virus was first identified in 1976 when there were two simultaneous outbreaks in Nzara, Sudan, and the Democratic Republic of Congo1. The name EBOLA was taken from the EBOLA river that flows near the village from which one of the first outbreaks of the disease occurred. To date it does have a high fatality rate. As much as 90% of people who contact the disease do intact die. So it is not to be taken lightly, given its affect on mortality not least the emotional, social and financial hardship it can cause on individuals, groups and communities.
Where did EBOLA originate from?
The African landscape through which this virus spreads is often near or close to rain-forests and flowing rivers. Normal transmission of the disease is said to occur from wild animals (possibly fruit bats, chimpanzees, gorillas, monkeys, antelope, or porcupines), to humans, followed then by human to human transmission by contact through bodily fluids or broken skin or mucous membrane. It is not surprising to note that health care workers or burial workers (the virus can live a few days after the person has died), are at greater risk from infection than any other population groups.
Ebola Symptoms – What are the Signs and Symptoms?
As with most virus infections there is on onset of high temperature (fever) which is a normal function of the body when under immune attack. This is followed by intense weakness, muscle pain, headaches, sore throats, vomiting, diarrhoea, urticaria rash.
In the final stages there is renal and liver failure and then death. These symptoms can be mimicked by most tropical diseases, but what is different here is that the patient suffers from internal and external bleeding. Hence this condition was once known as the EBOLA HAEMORRHAGIC DISEASE.
The incubation period, the time before symptoms present, is usually about 2-21 days.
NB. Haemorrhage is not solely a characteristic of EBOLA, so diagnosis must exclude other similar diseases.
Ebola Treatment Regimes
Currently, there is no known specific drug therapy, or vaccine, therefore the current outbreak in Sierra Leone, Liberia, Guinea and Nigeria, which has killed more than 670 people to date, is a real threat.2
Care regimes involve in making sure people are comfortable, not dehydrated and have fluids that restore the electrolyte balance.
Ebola – Preventing Spread
To prevent the spread of the disease (as with all infectious diseases) one should;
- Reduce the risk from wildlife-to-human virus transmission by appropriate ways identified by the WHO.3 .
- Ensure that those in close proximity to the patients have no exchange of bodily fluids. Wear disposable gloves and protective clothing at all times.
- Ensure proper hygiene controls are undertaken, and hand washing undertaken regularly and thoroughly.
- Give attention to every and any element of potential cross infection and ensure risk avoidance tactics are undertaken.
- Appropriately dress any abrasions to the skin surface and avoid skin contact with infected persons.
- For those who have sadly died from the disease, ensure that the burial workers are not infected and that the deceased is buried speedily (as religious and society dictates), and using an appropriate burial method.
- Once outbreak has been detected the area is quarantined, as per WHO standards.
- Suitable cleansing and control of livestock, which may include culling.
- Reduce foreign travel to and from the region.
- Communities/Countries to undertake an active education programme that sets out clearly the aetiology of the disease, the known spread, the incidence and prevalence of the disease, disease prevention and control methods.
AND, To avoid mass public hysteria. According to Dr Ben Neuman, a virologist at Reading University, “the chance of the virus spreading to the UK was very, very, small”.4
Border staff are trained to detect visitors who may be infected and there is a standard protocol for transference and treatment within a hospital setting. This is not to suggest that as a nation we should be complacent, but prepared in the acknowledgement that this disease is in West Africa and not yet controlled after several months.
References
1. Ebola Virus Disease, http://www.who.int/mediacentre/factsheets/fs103/en/ April 2014
2. WHO ibid
3, WH ibid
4. Ben Neuman The Ebola Virus, the BBC. 30-07-14 12/19
For more information on the Ebola virus, visit the U.S. Centers for Disease Control and Prevention.
Additional sources: Lee Norman, M.D., chief medical officer, University of Kansas Hospital, Kansas City; Bruce Hirsch, M.D., infectious diseases specialist, North Shore University Hospital, Manhasset, N.Y.; July 30, 2014, NBC News; ABC News; 9 News.com.au
Professor Lynn Basford, Dennis Thompson, HealthDay.
Health Aware 