Sunday, November 30, 2014

Ebola Treatment: $1 Million/patient here with 80% survival; $20/patient in Africa with 35% survival: we need to find the sweet spot between them, where doable medical care significantly raises survival

I have been desperately seeking ideas to get us to that sweet spot: where medical providers will know how to manage Ebola in Africa, and their treatments will keep most Ebola victims alive, while not costing a million dollars per patient, or more.

I envision patients having access to lab tests, iv fluids, convalescent serum, automatic blood pressure cuffs, EKGs and cardiac monitors.  Dr. Paul Farmer of Partners in Health seems to have a similar vision.

Patients would see pictures of their caregivers pasted on their PPEs.  The medical equipment would be dedicated to Ebola patients, and so contamination would not be an issue. Doctors would be able to observe their patients through windows (and speak through HEPA-covered openings) in order to take adequate time making visual assessments and speaking to patients and caregivers in the "hot" zones.

I envision detailed record-keeping for each patient, which would be tremendously useful at figuring out which treatments are working better than others.

Already licensed and approved drugs could be tried in small clinical trials to see whether they seem to yield benefits in humans.  Who might need steroid replacement?  Antibiotics? Which ones?

Interested survivors could be convalesced nearby and enrolled in caregiver training programs. Unaffected local people could be tested for the possible presence of protective antibodies, since 8.6% of blood samples obtained in Kenema, SL between 2006 and 2008 tested positive for Ebola antibodies.

Liberia Ebola West Africa Chinese soldiers stand parade during the opening of a new Ebola virus clinic sponsored by China, in Monrovia, Liberia, Tuesday, Nov. 25, 2014, Liberia got another 100 treatment beds in the fight against Ebola on Tuesday, as yet another Sierra Leonean doctor became infected with the disease sweeping West Africa. Liberian President Ellen Johnson Sirleaf toured the Ebola treatment center built by China, calling it “first-class.”(AP Photo/ Abbas Dulleh)
See above:  China has completed a large Ebola Treatment Unit in Monrovia which is air-conditioned, and uses electronic medical recordkeeping. This will allow the use of PPE for much longer, and improve data collection.  China may have other innovations ready for use in Africa.

China's hospital raises the bar several notches regarding the level of care being provided to African Ebola victims.  Hopefully Western governments will take up the challenge and improve further on the Chinese model.

I'd like to invite readers to submit their ideas in the Comments section as we brainstorm to find better ways to beat Ebola.  I will keep this thread active and describe more about what is being created as the information becomes available. Thanks!

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