A room reserved for patients with Ebola in the University Medical Center Groningen in the Netherlands
PHOTO :. REMKO WAAL dE / AFP / GETTY IMAGES
When the people of the United States and Europe working in West Africa have developed Ebola, over and over After the first thing they wanted was to take an experimental drug. There was a plane that the cart home.
care for patients with Ebola in Liberia, Sierra Leone and Guinea varies considerably in different clinics, but it never matches what the rich countries provide. This partly explains why the Ebola epidemic has had a case fatality rate (CFR) of 70%, according to calculations by the World Health Organization. Too few Ebola patients were treated outside Africa to make comparisons and scientifically valid, they may have been in better health before falling ill, but only five out of 20 to date have died, a rate lethality of 25%.
Now there is a push to improve care in West Africa. Just a handful of basic interventions to fight against Ebola killer effects, including dehydration and secondary infections could dramatically reduce the CFR there, said Michael Callahan, an infectious disease specialist at Massachusetts General Hospital in Boston . An example appeared online Nov. 5 in The New England Journal of Medicine ( NEJM ) :. Care relatively intensive in Conakry has led to a fatality rate of 43%
With so much room for improvement supportive care, the current international focus on drugs is "wrong," says Callahan, who recently worked in Monrovia and provided care in four previous Ebola outbreaks. "While we wait for months to experimental therapies to come, many lives can be saved, certainly hundreds, perhaps thousands, using simple and inexpensive therapies," he said.
Callahan using an international team to develop guidelines lined maximum use of supportive therapy (MUST), aimed at keeping more patients alive. It includes intravenous (IV) drip to replace the massive fluid loss from diarrhea and vomiting, a risk factor for shock; balancing electrolytes such as calcium or potassium, which prevents the kidneys and heart failure; nasogastric tubes for food; and testing and treatment of secondary infections such as malaria. MUST presentation will also be easier to study new treatments, Callahan said, strained-randomized controlled trials ethic because only some patients get the new treatment (see main story, p 08). -Will Be much more acceptable if everyone receives high-level care. In addition, IS could be the side effects of new drugs that would otherwise be masked by symptoms of Ebola, and it could reduce the rate of complications that could be blamed on bad medicine.
This is an important proposal, but Ebola clinics will need more resources to provide MUST, said John Fankhauser, an American physician who worked at ELWA hospital in Monrovia since before the outbreak area. Overwhelmed by patients and logistical challenges, many clinics have provided minimal support care. "We are able to give IV hydration, but the trial is limited to malaria and Ebola virus," says Fankhauser. Tests for electrolytes and other types of calls MUST for monitoring are just out of reach, he said. Callahan says that additional measures cost less than $ 0 per additional patient in a Monrovia clinic in August
Armand Sprecher of Doctors Without Borders (MSF) in Brussels, who co-wrote the NEJM Report acknowledges that the standard of care fell when Ebola exploded this summer. But Sprecher, who is "very supportive supportive care," said MSF clinics have corrected several problems and doubts that MUST now can save many more lives. "I am less optimistic than some people on how much effect we're having," he said. "I hope I'm wrong."
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