Saturday, December 6, 2014

Addressing Ebola—Let’s Do Better

In a report published recently by The Lancet, Drs. Ian Roberts and Anders Perner suggest that life-saving treatments against Ebola are being neglected. At the moment, no pharmaceutical treatment is available, but they suggest that alternative therapies need to be better implemented.

Although hemorrhaging is a severe complication related to Ebola, patients regularly die of dehydration. Ebolavirus (EBOV) can cause vomiting and diarrhea, which consequently lead to significant water loss. 

In order to treat patients for these symptoms, they can receive IV fluids or rehydration salts, two fairly standard treatments that can have dramatic health benefits. Salt injections can address low levels of sodium in the blood, which are associated with brain swelling, comas, and in severe cases, death. Admittedly, administering fluids intravenously or injections can present another challenge: patients with EBOV are prone to bleeding, for the virus triggers signaling via immunological messengers, like cytokines, that increase vascular permeability and bleeding.

Regardless, methods that address symptoms are available, and they should be implemented readily. The absence of drug therapies does not mean that all patients are condemned to death, and assuming that no treatment is available (a perspective Drs. Roberts and Perner call “therapeutic nihilism”) may prevent powerful medical interventions from saving lives.

From the public health perspective, poor planning and communication also undermine efforts against Ebola. In the New York Times, Jeffrey Gettleman writes that a new and fully stocked treatment center was built in Sierra Leone—without enough personnel to staff the clinic. Clinical beds remain empty, but patients continue to die.

Gettleman reports that the response system may be suffering from poor coordination between different aid groups, government errors, and other inefficiencies. Testing blood samples for EBOV can sake several days, for example, thereby keeping patients that test negative in clinic beds that could otherwise be occupied by sick patients.

Recent commentary and news reports like this underscore a more significant message:  in order to better address the EBOV outbreak in West Africa—and future epidemics everywhere—the healthcare infrastructures of lower income countries need to be developed and strengthened.

The long-term impact of international aid is hugely compromised if, after an outbreak, a country is equally as vulnerable to the next infectious disease. Given the United States’ obsession with cost-effectiveness and efficiency, it only makes sense to ensure that today’s aid is done with the next epidemic in mind.

It is time to revisit the definition of sustainability and do better.

-Luis Garcia


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