Not a single American victim has died of Ebola; the majority
of Europeans infected have survived; a Cuban survivor is already back here at
work. Across West Africa, 70 per cent of those afflicted die. And that figure
applies only to the sick who receive care at treatment centres: More than 90
per cent of those who stay home perish. What accounts for the extreme variation
in death rates? Firstly, it is not that foreign aid workers are shipped home
and receive experimental treatments.
What kills most Ebola patients is a massive loss of the
body's vital fluids - up to 10 litres of day - along with proteins and
electrolytes, primarily through vomiting and diarrhoea. We often hear there's
no treatment for Ebola or other hemorrhagic viruses. That's not true. Survivors
all received was excellent supportive care, most of it from nurses. In medical
parlance, the term "supportive care" does not mean hand-holding but
the replacement of fluids and electrolytes; treatment of secondary infections
(bacteria escaping from the gut, say, or malaria); and, in some cases, renal
dialysis and assisted ventilation.
Three weeks ago, a baby named Jariatu was found by a burial
team, barely alive, in a house full of dead family members. She was taken to
Port Loko, where nurses and doctors were unable to locate a vein for an IV; the
baby was dying, too unresponsive to drink. So they did what they would do in
Boston or London: They inserted an infusion needle into the bone marrow of her
tibia. It was three days before Jariatu was conscious enough to show any
interest in taking anything by mouth. She's expected to survive.
What was always needed to improve survival in West Africa is
the capacity to safely deliver excellent supportive care. It's hard to deliver
supportive care there, due to the obvious lack of staff and stuff and space,
and it's dangerous.
Nevertheless, though they're afraid of Ebola, as any sane
person should be, thousands of medical professionals, most of them African,
show up for work every day (a lack of electricity makes it hard to make a
similar claim about night shifts, which is another cause of high mortality). Could
there be a relationship between poor-quality care and people's reluctance to
seek it in hot and raggedy Ebola units, where patients are interned until death
or until blood tests show no circulating virus?
The quality of care in this part of West Africa - not simply
for Ebola but for more common ailments and injuries - must be improved. It means
cooler units - even fans would help - and personal protective gear made for
tropical conditions. It means improved nutrition and a lot more support for the
public health delivery system. Since hospitals with poor infection control have
always amplified Ebola's spread, the two tasks - stopping transmission and
improving care - are the means by which the world's largest outbreak will be
halted and proper health systems built.
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