America’s success against Ebola shows disease ’eminently treatable’
The successful treatment of Westerners with Ebola in the United States and Europe is changing the way doctors think about the disease.
The conventional wisdom about Ebola has been that it’s usually fatal, with a mortality rate of up to 90 percent. That was based largely on experience with Ebola in developing countries in Africa, where many hospitals have no running water and soap, let alone personal protective equipment for the medical staff.
All eight American patients with Ebola treated in America have survived. So have most Europeans evacuated to their home countries for care.
Although those are small numbers, even cautious infectious-disease experts say the trend is clear.
With early and aggressive care, “Ebola can be an eminently treatable disease,” says Amesh Adalja, senior associate at the Center for Health Security at UPMC.
“We need to work to give patients in Africa the same benefit,” says Daniel Bausch, head of the virology and emerging infections department at the Naval Medical Research Unit No. 6 in Lima, Peru.
In some ways, Ebola is a different disease in America and Europe than it is in Africa, just as cancer is a different disease here than in developing countries, says Jeffrey Duchin, a professor at the University of Washington-Seattle and spokesman for the Infectious Diseases Society of America.
Both conditions are fearsome and dangerous, but experience shows that cancer and Ebola can often be survived if caught early and treated aggressively.
“We have a better public health system to get people into care early,” Duchin said. “All of these things can increase survival rates.”
The American patients had much in common. They were probably healthier and better nourished than many African patients, said Thomas Geisbert, a professor of microbiology and immunology at the University of Texas Medical Branch who is working on Ebola therapies.
All of the Americans were treated in modern intensive care units, and many were treated at the first sign of illness, Adalja said. For example, physician Craig Spencer, who was discharged from a New York hospital Tuesday, sought care as soon as he developed a fever.
In West Africa, patients get to the hospital an average of about five days after symptoms begin. Many never make it to the hospital, a fact that explains the outbreak’s high mortality rate.
Doctors who have treated Ebola in Africa have suspected that getting patients to modern hospitals quickly would dramatically increase survival rates, said Susan McLellan, a clinical associate professor of tropical medicine at Tulane University.
“I don’t think this shocks anyone who knows what minimal care we are able to provide in West Africa,” McLellan says. Comparing the United States with West Africa, she said, “Instead of having three people taking care of one patient, you have three people taking care of 90 patients.”
In America, doctors can administer intravenous fluids to prevent dehydration and take regular blood tests, replacing electrolytes such as potassium when they are low. In West Africa, many hospitals no longer have the staff to give IV fluids, and they don’t have labs to run blood tests, McLellan said.
Still, even experts wouldn’t have predicted America’s 100 percent survival rate, said Michael Osterholm, director of the Centers for Infectious Disease Research and Policy at the University of Minnesota.
Providing top-flight Ebola care in Africa, in the middle of an epidemic, is a huge challenge, Osterholm said. Even before Ebola, Liberia had only about 50 doctors. Ebola has since caused health systems in the three hardest-hit countries to collapse. More than 500 health workers in Guinea, Liberia and Sierra Leone have been infected with Ebola, and about half of them have died.
Treating Ebola patients in Africa, Osterholm said, is “like taking care of someone on a battlefield compared to a major medical center.”
The only Ebola patient to have died in the United States was Thomas Eric Duncan, a Liberian national who was initially sent home from a Dallas emergency room. He returned to the hospital a few days later when he was vomiting. He was not eligible for a blood transfusion because his blood type didn’t match that of any Ebola survivors, and he received an experimental therapy only a couple of days before he died.
McLellan says no one in Duncan’s family came down with the disease even though they shared an apartment with him.
None of the people who flew on a plane with nurse Amber Vinson or shared a subway car or bowling alley with Spencer has become ill.
That shows that people can relax and stop worrying that returning aid workers will infect the rest of us, McLellan says.
“There is no evidence of community transmission (of Ebola) in the Western world,” McLellan says. “No evidence. Zero. None.”