Friday, December 05, 2014

Ebola need not be a death sentence

Ebola patients are suffering the double whammy of poor quality care and lack of research

Basic medical interventions such as giving Ebola patients rehydration salts and fluids from bigger bags could cut the death toll in west Africa in the absence of a proven cure, experts in tropical diseases write in the Lancet. Doctors say it is “therapeutic nihilism” to assume there is no treatment for Ebola just because there are no drugs. It is likely, they say, that many patients die because of dehydration. Improving the basic care that Ebola patients are receiving will have an effect on people’s willingness to leave their homes and go into a treatment centre, which will in turn help to slow the spread of the disease, the paper argues.

“It is often stated that there are no proven therapies for Ebola virus disease but that potential treatments, including blood products, immune therapies, and antiviral drugs, are being evaluated. This view is inaccurate,” say Dr Ian Roberts of the London School of Hygiene and Tropical Medicine and Dr Anders Perner, intensive care specialist at the University of Copenhagen.

Ebola virus disease, they say, is “a febrile illness with severe gastrointestinal symptoms. Nausea, vomiting, and diarrhoea cause profound water and electrolyte depletion [the loss of salts that the body needs, such as sodium, potassium and calcium] leading to circulatory collapse and death.”

Some simple interventions could save lives. Intravenous fluids, for instance, are not given as standard in west Africa, Roberts said. Low levels of sodium in the blood, which can cause brain swelling, leading to coma and death, could be treated with salt injections. There are also proven treatments that can help patients overcome pain, agitation and secondary bacterial infections, as well as malaria.

There are not enough nurses to care for patients overnight, so fluid bags do not get replaced when they are finished. Staff are also under heat stress during the day, from wearing personal protective equipment in a hot climate. The simple solution, he said, is to supply treatment centres with five-litre bags in place of one-litre bags. The paper argues that a series of pragmatic clinical trials in the current epidemic should be launched to establish the best ways of managing patients, bringing down death rates and safeguarding health workers at the same time.

“In earlier outbreaks, the death rate was about 90% and, in this outbreak, it started out at about 70% and it’s come down but it could come right down again and we could see this largely fatal disease became a largely survivable disease. That is eminently possible,” Roberts said. “A stronger policy focus on providing effective care for patients with Ebola virus disease is not only a humanitarian imperative, but could also help to bring the epidemic under control. Patients cared for in Ebola treatment centres are less likely to infect other people than those cared for in the community. However, Ebola treatment centres must be more than a setting for quarantine. Patients will be reluctant to attend treatment centres unless the care they receive from them is superior to the care provided by family members.”

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