Evening Ebola Update, Wed, 11/5: Two NEJM articles on clin. presentation/What will $6 Billion from U.S. do?   Leave a comment


Dear Colleagues:

1.  One of our EVOV Contact Group members brought to my attention today an article by F.D. Flam in Forbes today discussing the poor job that the White House and government health officials have sometimes done in presenting EBOV information to the country.  Their messages have suffered from: asking us to trust their statements w/o giving scientific evidence for these statements; failing to say ‘We don’t know’ when they do not have answers to EBOV questions; ducking questions and asking us instead ‘not to worry’.  See Ms. Flam’s article at: http://www.forbes.com/sites/fayeflam/2014/11/05/three-ways-health-officials-and-doctors-fumbled-in-communicating-ebola-risk/

2.  NEJM this week presents two articles on the clinical presentation of EBOV in a clinic in Monrovia, Liberia and also in Conakry, Guinea.  The article by Chertow, et. al. reports on 700 patients treated at a center in Monrovia.  Highlights include: PCR tests may be falsely negative up to 72 hours after the onset of symptoms; up to 60% of EBOV will suffer hypovolemic shock; <5% of EBOV patients will hemorrhage; onset of GI symptoms is Day 3-5; death occurs typically between Day 7-12; if EBOV patient survives to Day 13, he/she usually lives; MDs are limited to two or three 45 minute periods within the ‘hot zone’ ward so each patient gets 1-2 min for a care plan to be established; anti-emetics and anti-diarrheal meds are crucial in preventing hypovolemia w/o shock from progressing to shock.  The Ban, et. al. article on EBOV in Conakry makes the point that patients over 40 y.o. have 3.5x the death rate than patients less than 40 y.o.  See Monrovia, Liberia, article at:  http://www.nejm.org/doi/full/10.1056/NEJMp1413084?query=TOC and article on Conakry,Guinea, at:  http://www.nejm.org/doi/full/10.1056/NEJMoa1411249?query=featured_ebola.

3.  NY Times reports today that President Obama will ask Congress for $6 Billion toward the EBOV epidemic in West Africa and toward protecting U.S. from EBOV epidemic.  $4 Billion will go to HHS to build 50 Ebola treatment centers in the U.S; $2 Billion will go to USAID to establish clinics and distribute food and meds in West Africa; $200 Million will go to State Department to pay for evacuation of American HCW from West Africa if infected with EBOV.

4.  Ebola Deeply reports today that cases in rural Sierra Leone are increasing.

5.  USA Today reports that 70 USPHS uniformed volunteers will be deployed to Monrovia, Liberia, to treat EBOV infected physicians and nurses.  Treatment may be at the 25 bed Ebola treatment center Major General Darryl Williams’ troopers have just built in Monrovia.

6.  CDC has published their risk catagories of EBOV exposure and their relation to self or HCW monitoring.  See: http://www.cdc.gov/media/releases/2014/fs1027-monitoring-symptoms-controlling-movement.html for the four CDC categories and what CDC wants done in each risk category.



Posted November 6, 2014 by levittrg in Ebola

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