Just how deadly is Ebola?
October 30, 2014 1 Comment
I mentioned in a previous quick hits that at least one expert thinks that Ebola might only have a 10% fatality rate with first-world health care. More on that from Jon Cohn today:
The relatively high survival rate of U.S. patients (7 of 9 with hopefully 8 soon) so far could reflect a bunch of factors, like age or the small sample size. That is one reason not to get carried away and assume the standard regimen can save all patients. It can’t. But physicians and public health experts say it should be able to save most of them. “An Ebola diagnosis need not be a death sentence,” Paul Farmer, an infectious disease specialist at Harvard, wrote in an influential essay for the London Review of Books. “If patients are promptly diagnosed and receive aggressive supportive care—including fluid resuscitation, electrolyte replacement and blood products—the great majority, as many as 90 percent should survive.”…
The higher death rate has a relatively simple explanation, one familiar to anybody who has studied health disparities around the world. Health care facilities in the affected countries lack what Farmer has identified as the four S’s: Staff, stuff, space and systems. Except in the most developed areas, the clinics and hospitals don’t have access to even routine medications, common to any American emergency room, let alone newfangled medicines like ZMapp. They may also lack the standard diagnostic tools necessary to adjust treatments. “Right now, many [Ebola treatment units overseas] are not monitoring electrolytes including sodium, potassium, and calcium that are essential to deliver accurate and adequate care,” says Charles van der Horst, an infectious disease specialist at the University of North Carolina.
Of course, even those facilities with the right drugs lack supply and capacity to handle the patient load.
There’s also a very nice explainer over at Vox on why we are so much more successful at treating the disease in America than in Africa. What I was especially interested to learn was that in large part Ebola kills you through fluid loss leading to organ failure. All the vomiting, diarrhea, etc., mean that you lose water faster than you can take it in. Give a person enough IV fluids, restore electrolytes, and thereby keep blood pressure up and organs functioning and you stand a good chance of hanging in there long enough for your immune system to fight off the disease. Absent those things (i.e., health care in a deeply impoverished nation) and you are in a lot of trouble. Of course, Cohn’s point is that we could be doing a lot more to help Africans keep infected people from dying. Ebola is certainly a super-scary and horrible disease, but the evidence seems pretty clear it does not have to be nearly as fatal as it currently is in the effected nations.
About Steve Greene
Fully Myelinated 
I wondered about this. Ebola has a very high virus load, the cells that are infected make huge numbers of copies of the virus until the cell dies. From what I’ve read it attacks the tissues that line blood vessels. With an incredibly high virus load, I wondered if there would there be permanent long term problems with Ebola survivors? So I looked it up and found this:
“Any chance of surviving Ebola largely hinges upon early access to medical care when symptoms such as fever, headache, and joint and muscle pain first arise. By the time the disease progresses to hemorrhaging, it’s almost always too late.
…
Ebola survivors do often develop certain chronic inflammatory conditions that affect the joints and eyes, problems that can follow a survivor through the remainder of their life. Dr. Amar Safdar, associate professor of infectious diseases and immunology at NYU Langone Medical Center, told CBS News these chronic conditions are a result of the body’s immune response.
He said Ebola survivors are at risk for arthralgia, a type of joint and bone pain that can feel similar to arthritis. Ebola survivors also frequently report complications with eyes and vision, an inflammatory condition known as uveitis which can cause excess tearing, eye sensitivity, eye inflammation and even blindness.”
http://www.cbsnews.com/news/surviving-ebola-for-those-who-live-through-it-what-lies-ahead/
And from Vox, the story of Gloria Tumwijuke from Uganda who got Ebola and survived:
http://www.vox.com/2014/8/12/5992083/the-story-of-an-ebola-outbreak-survivor
It’s not made clear if Gloria is a nurse or doctor, but she worked on a young pregnant woman who came in on a blood soaked mattress, the fetus was dead, the mother bleeding from various places. The mother died in six hours, she was already long past help.
GT: I was taken to the hospital by ambulance. They took a sample of my blood, and told me I had Ebola. They transferred me to an isolation room, and started to care for me. They put fluids in me through an IV, and gave me antibiotics. They were monitoring me frequently. I couldn’t move from the bed. I couldn’t talk. I couldn’t do anything. I lost 25 pounds. I was in the hospital for one month when they discharged me.
GT: I was discharged from the hospital after one month. After two months, I started to improve. But I still had problems. I was forgetting a lot. My hair was falling out. The hair from my head was all over. My skin was peeling off. I weighed 25 pounds less. I had heart palpitations. The hair took months to grow back. My memory was bad for one year.
“”People would run away from me. They were not willing to be near me.””
JB: How did people receive you when you returned to your community?
GT: They ignored me, thinking I still had a sickness because they think Ebola can’t (be survived). They hide from me. People would run away from me. They were not willing to be near me. But the hospital discharged me because they were sure I was free from Ebola. I showed people (my discharge) certificate. They started to believe I was okay. When I showed them the certificate, they started to welcome me.
JB: When your friends were avoiding you, how did you feel?
GT: I didn’t feel bad because it is their right: Ebola spreads when you contact other people who have the virus. But I could feel some stigma when they ran away from me.
JB: This virus can kill up to 90 percent of those who get it. Why do you think you survived when so many others die?
GT: I had my sister who is a medical person. She could go and buy all the drugs, fluids, and antibiotics for me. She was by my side. She changed my dirty sheets. She knew how to prevent herself from getting Ebola by using protection. My husband is a nurse. He was also helping my sister to treat me and be careful. He could pray for me. When I survived he was so happy.
GT: Actually I’m good. I don’t have any problems. After four months I was back to normal. The thing that persisted for the whole year, it was forgetting. My memory was bad. Also I couldn’t resume my period for five months.