Wanna know how not to DIE from Ebola? First off, try not to exchange bodily fluids with a floridly infected person (as we talked about in an earlier post). However, if you do end up catching Ebola you probably got it by taking care of a sick family member or you are a healthcare worker taking care of the infected. If you are youngish (under 45) and get medical care early, you have a good chance of survival.
The highly respected medical journal, The New England Journal of Medicine, recently published two very interesting articles on Ebola treatment in Africa. One article looked into what characteristics infected people had in common, while the second looked at the differences between people who survived and those who died.
- Clinical Presentation of Patients with Ebola Virus Disease in Conakry, Guinea, E. I. Bah, et al, NEMJ, 5 Nov 2014
- Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone, J.S. Schieffelin, et al, NEMJ, 29 Oct 2014*
In the first article, 37 Ebola patients admitted to the Donka Hospital in Conakry, Guinea during one month early in 2014, were followed during their hospital stay until they died or got better. The Ebola unit in this hospital is operated by the Guinea Ministry of Health, the World Health Organization, and Doctor’s Without Borders. Data from these patients were examined for important factors that might relate to surviving Ebola. This is important epidemiologic work that helps us learn how the disease progresses so that we can better prevent and treat it. (As you may know, epidemiology is the study of the spread of disease in populations. More info –> here.) I have distilled some of the key findings from this study in the bullet points and table below.
In an article chock full of interesting information, the things that stand out for me are:
- most people who caught Ebola were either family of infected, or health care workers
- older people and those with higher viral loads are more likely to die
- patients were given fluids by mouth, and only about 1 liter of intravenous fluid
- the heat stress from wearing protective gear may cause nurses and doctors to do fewer checks on patients
The fact that all the infected people either had sick family members, or were healthcare workers, stresses that up close and personal contact is needed to transmit the disease, as we discussed in our earlier post. Older persons are less able to cope with the ravages of the disease, including the massive fluid loss from vomiting and diarrhea, and the things like kidney failure that go with it. Higher viral loads may indicate a larger initial exposure (lots of virus particles), or taking a long time to get to the hospital due to distance, too many sick people, not enough beds, distrust of the medical system, or for whatever reason. Fluids by mouth are great if you’re well enough to swallow, but getting only one liter of IV fluid for a disease like Ebola would be unheard of in the U.S. I think this points to very limited resources in that hospital (and in much of Africa for that matter). And last, wearing protective gear is hot and sweaty business. I know from personal experience, it can be incredibly uncomfortable. I can’t even imagine wearing that stuff in a tropical climate, inside a poorly air-conditioned hospital. This is another reason patients treated in developed countries like the U.S. do better — air conditioning(!).
| Mechanism of Contact |
number / total, (%) |
|
Health Care |
12 / 34 (35%) |
|
Household |
23 / 37 (62%) |
|
Funeral |
6 / 37 (16%) |
| Symptoms | |
|
Fever |
31 / 37 (84%) |
|
Fatigue |
24 / 37 (65%) |
|
Diarrhea |
23 / 37 (62%) |
|
Headache |
12 / 21 (57%) |
|
Vomiting |
21 / 37 (57%) |
| Treatments | |
|
Fluids by mouth |
36 / 37 (97%) |
|
Intravenous (IV) fluids |
28 / 37 (76%) |
|
Median volume of IV Fluid |
1 liter |
The second paper, looked at the treatment of people sick from Ebola and what characteristics were associated with their survival or death. This work was done during the early days of the outbreak (March – April, 2014) at the Kenema Government Hospital, in Kenema, Sierra Leone. In this study, the laboratory work and treatment of 106 patients was examined in detail. This is another paper that is just chock full of information. First off, the Kenema Government Hospital was ideally prepared to handle Ebola patients, because it had a clinical research program for Lassa Fever, which is another nasty hemorrhagic virus that is endemic to Africa. Among many golden nuggets contained in this paper, here are a few that caught my eye…
- patients younger than 21 years old did much better than those over 45
- the higher the viral load (numbers of the little Ebola buggers) in the blood, the worse infected people did
- weakness, dizziness, and diarrhea were the only three symptoms closely associated with dying
- laboratory studies showed that dehydration and worsening kidney function were also associated with a high chance of death
- destruction of red blood cells and liver failure were not significant in any infected person
Figure 1 from the article, pasted below, shows the first two points nicely. Basically, the older you are the worse you do. And the more virus you have inside you, the worse you do. The younger you are, the more active your immune system, so this makes sense (although some viruses, like pandemic influenza kill more younger persons). The viral load thing probably relates to how quickly your body responds to the virus, or how soon you get to medical care, or maybe both. The signs and symptoms of 40 of the 106 patients was examined, and the three that were most closely associated with dying were weakness, dizziness and diarrhea. To me this says that lots of IV fluids and other supportive care is helpful. Unfortunately, they did not look at this particular factor in detail. Also, patients who had signs of dehydration and poor kidney function also did poorly, which again, means that IV fluid can be a big help. The last point I’d like to mention is that destruction of red blood cells and liver damage were not a big contributor. Which to me is a little odd, because those things are often found in other so-called hemorrhagic diseases, such as dengue fever.
The authors close with an important thought, “… it is incumbent on health care professionals to ensure that EVD facilities are focussed on treating and improving the survival of patients, rather than merely on providing a setting for quarantine. The clinical and laboratory findings that we describe here should provide some insight for the rational design of clinical strategies aimed at improving care in this and future EVD outbreaks.”
So these articles are both timely and full of excellent and important information about Ebola. This disease is ravaging West Africa mostly because these countries, Liberia, Guinea, and Sierra Leone, are very poor and have weak medical systems. If you are a westerner, should you catch Ebola, your odds of survival are pretty good. Lots of IV fluids and supportive care should do the trick. Hopefully, it won’t come to that. The way to stop Ebola is to stop it in West Africa. This takes money, people, and political will. While this topic can be a bit depressing, we should be thankful for the hard work and sacrifices that went into this research. These authors have pointed the way, and shown us that Ebola may be a readily treatable disease.
* On a sad note, seven of the co-authors on the second paper died, 6 of them from Ebola. In the footnotes of the article, it states… “This article is dedicated to six of our coauthors who contributed greatly to public health and research efforts in Sierra Leone — Alex Moigboi, Mohammed Fullah, Mbalu Fonnie, Vandi Sinnah, Alice Kovoma, and Hummar Khan — and who died of EVD (ebola virus disease) before this article could be published; and to Sidiki Saffa who also died during the course of this work from a non-EVD illness.”
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