Thursday, September 11, 2014

Ebola strategies/ Nass

I anticipate a huge loss of life from Ebola in Africa, due to the lack of medical and all other infrastructure in so much of the continent.

Africans are like everyone else:  they want to save their family members.  If treatment centers are available that will increase the chance of survival, they will utilize them.  The capability to give appropriate iv fluids and replace electrolytes is what is needed, at a minimum. But if all the healthcare system can do is provide quarantine centers, which guarantee exposure to ebola victims without effective treatments, why would anyone go there?  Instead, cases will be hidden from the authorities, making case-finding impossible.

Africa does not have enough people who can manage the needed number of iv's, especially when drawing blood exposes the health care worker to the disease.  Africa's medical systems lack iv fluids, medicines, personal protective equipment, laboratories and well-trained staff who can safely use these products. To give the correct iv fluids and electrolytes, you need frequent lab tests and blood draws.  (I cannot even imagine using arterial lines in bush hospitals, so will not discuss them further; they would be part of ICU monitoring here.)  The bottom line is that there will never be sufficient 'first world-style' treatment centers, given the rate of increase in cases and the inability to identify many cases and contacts, and isolate them.

But maybe there is a somewhat effective, low tech partial solution.  Dr. Brantly said that patients with Ebola sometimes would grab their chests and fall over dead.  From his own case and others, we have learned that Ebola causes electrolyte and fluid abnormalities that are associated with life-threatening cardiac arrhythmias.

What saves lives in cholera epidemics, when intensive medical car is unavailable, is oral rehydration fluid.  These products contain sugar, salts, bicarbonate and water.  If the patient can keep the fluids and electrolytes down, they rapidly enter the bloodstream from the stomach and small intestine, creating a similar effect as iv fluids.

The treatment is cheap.  It requires no trained medical staff.  It works when toxins have led to efflux of sodium, potassium, bicarbonate and water from intestinal cells.  Ebola diarrhea might require a slightly different mix or ratio of electrolytes.  From looking at what the 4 Americans, who were brought back to the US for treatment, received via iv fluids, some good guesses can be made about the best oral rehydration fluids to try.

Such "bush treatment" might save lives and encourage families to bring their loved ones to less well equipped centers for treatment, if the oral rehydration is found to be effective.  This could have a positive impact on case-finding.  Families would also potentially be able to purchase the fluid packets in the markets, for treatment at home.  (Similar packets are sold for at-home treatment of infant diarrheas.)

This idea is worthy of testing, as case numbers are bound to grow exponentially--and the world's resources are unlikely to be able to create hospitals and supply health care professionals in adequate numbers to provide standard treatments to most of those affected.  This could be a stand-in, while we await more targeted treatments.

UPDATE:  From the WaPo, a piece titled, "The World Yawns as Ebola Takes Hold in West Africa" by Richard Besser, MD and former head of Emergency Response at CDC:
... There’s no cure for Ebola, but supportive treatment as simple as supplementary fluids can save lives and slow the spread of the disease. But many treatment centers are unable to provide even rudimentary care. Last week, the World Health Organization and the U.S. Centers for Disease Control and Prevention called for more support for the region. CDC Director Tom Frieden talked about the window of opportunity for the world to respond — a window that is quickly closing...

1 comment:

host said...

Ebola is a patented lab virus, and the patent is owned by the US Government represented by secretary of health and the CDC: