What can cure Ebola? Apparently if it’s prompt enough and intensive enough, aggressive supportive care has a good chance of curing it. The better the hospital, the better the cure rate. Poverty is key here.
The two American Ebola patients, medical missionaries Nancy Writebol and Dr. Kent Brantly, have walked out of Emory University Hospital in Atlanta infection-free.
They were the first human beings to receive an experimental drug called ZMapp. But they are not the first people to have recovered from Ebola, and good hospital care is likely more responsible for their recovery than any mysterious “serum,” as the charities they work for termed it.
“They are the very first individuals to have ever received this agent,” Dr. Bruce Ribner, director of Emory’s Infectious Disease Unit, told a news conference. “There is no prior experience with it, and frankly, we do not know whether it helped them, whether it made no difference, or even, theoretically, if it delayed their recovery.”
But there is plenty of prior experience with dehydration and rehydration and electrolytes.
There’s no specific cure for Ebola, but doctors with experience treating it say they have found that if people get early supportive care, including saline solution and fever reducers, they are far more likely to recover.
Ribner says three weeks of treating Writebol and Brantly have shown them something else: Just like with cholera, patients have severe diarrhea and they lose important chemicals called electrolytes. Replacing these minerals — notably potassium, magnesium and sodium — helps patients recover better, he said.
“The key to resolving Ebola virus infection was aggressive supportive care,” he said. This level of care just isn’t available in most parts of Liberia, Sierra Leone and Guinea, where clinics struggle to even provide clean water and beds for patients.
“We knew certainly we could do that at a better level than the facility that they were in in Liberia,” Ribner added. The equivalent, he said, would be if “we took all of our patients in the intensive care unit here and sent them home and see how well they survived.”
Heartbreaking, isn’t it. I suspected it and wondered about it, as I’m sure everyone did – was the sky-high death rate partly to do with the poverty of the medical infrastructure? The answer seems to be yes, it is.
The World Health Organization, the relief group Doctors Without Borders and other experts in Africa have all called on rich nations to help poorer countries, especially those hit by Ebola in Africa, to develop their health systems so they can provide better care to patients.
Brantly, who walked out of an ambulance into Emory three weeks ago and Writebol, who remains weak, according to her husband David, both started out in better physical condition than the patients they were working to help.
“And clearly for any acutely ill patient, nutritional status is extremely important,” Ribner said. “If you have somebody who’s well-nourished and somebody who is poorly nourished and they suffer the same illness, infectious or otherwise, the person with better nutrition has better survival outlook.”
Poverty kills, just as we’ve always known.