Why The Ebola Evacuees Survived And What We Learned From Them
This is a week for reflecting on lessons learned from those who've survived Ebola.
Morning Edition aired a report on the experience of medical personnel at Emory Hospital, which has cared for four Ebola patients: three evacuees from West Africa (including Dr. Kent Brantly) and one of the Texas nurses.
Goats and Soda has also been looking into this topic. Of the 14 people who were infected in West Africa and evacuated to Europe or the U.S., 10 have survived and one is currently being treated. The only three deaths were the two Spanish physician/priests and a Senegalese medical worker from the U.N. who was transported to Leipzig, Germany.
By comparison, nearly half the number of people infected with the virus in West Africa have died.
The sample size of evacuees isn't large enough to draw any definitive conclusions. But we did ask several Ebola specialists for their insights.
1. Start Early
"After the first few cases [of evacuees], we began to understand that any early intervention allows the patients time to heal and have a better chance of surviving," says Dr. Eden Wells, an epidemiologist at the University of Michigan. The first six days or so after symptoms appear is a critical time. After that, "the virus completely overwhelms the body" and becomes "really tough to treat, even with good supportive care," Wells says. That's why the public health campaigns in West Africa, emphasizing that "Ebola is real," are vital.
Two common symptoms of Ebola are severe diarrhea and vomiting. A patient can lose 2 to 2 1/2 gallons of body fluids a day, says Dr. Jesse Goodman, director of Georgetown University's Center on Medical Product Access, Safety and Stewardship. These lost fluids contain important proteins and salts the body needs to function.
So patients must be constantly hydrated, not just with bottled water but with oral rehydration solutions, fortified with electrolytes that keep cells functioning (salt and potassium, for example) as well as protein.
But providing additional fluids will not help if the patient continues vomiting. "You'll need anti-nausea medication," says Dr. Amesh Adalja of the Infectious Diseases Society of America. That's one of the medical needs in West Africa.
3. More Monitoring
On a day-to-day basis, doctors need equipment to monitor how much fluid is lost as well as electrolyte balance. Throwing both out of whack can cause blood vessels to collapse. Such patients are at risk of organ failure. In U.S. hospitals, dialysis and respiratory machines can help keep them alive.
The hope is that state-of-the-art medical care might become available in countries like Liberia as additional treatment units are built, says Goodman. Then the question would be: How much of a difference does this equipment make in the survival rate?
As for experimental drugs and blood transfusions provided to the evacuees, no one knows the role they've played in recovery. "It's unclear whether the experimental drugs have had any effect or if it's just good supportive care that is responsible for the recovery of the American patients," says Adalja. "We need a study that compares supportive care plus experimental therapy versus supportive care alone."
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