Evening Ebola Update, Thurs, 12/4: WHO concerned about Sierra Leone stats/Common drugs to tx EBOV pts./Nitty-Gritty of EBOV are at Nebraska   Leave a comment

12/4/14

Dear Colleagues:

l.  WHO is concerned with the accuracy of the Sierra Leone’s statistics re: reported cases and case mortality rate (just as we are).  Dr. Chan, DG of WHO,  spoke to French ambassadors in Geneva yesterday and noted in her speech that only 50% of case in Sierra Leone are reported.  She promised that WHO is ‘on the case’.  See Dr. Chan’s speech at: https://col128.mail.live.com/mail/ViewOfficePreview.aspx?messageid=mguxT3D7575BGOgAAiZMHTjA2&folderid=flinbox&attindex=0&cp=-1&attdepth=0&n=6197393

2.  I understand that some readers in Europe have not been able to access Dr. Lai’s review of common drugs to treat EBOV using the URL link I posted.  Dr. Lai has sent us a document file of his article which I have attached to my email to all of you about tonight’s blog.  Note that Dr. Lai’s review focuses on drugs used to treat other diseases that block EBOV from replicating in the host cells.  These drugs work on the host cell, not EBOV.  Figure 1 in his article is a beautiful schematic of where (i.e., at which site) commonly used drugs block EBOV from replicating in host cells.  Table 1 lists the drugs and how they act on host cells; Figure 1 and Table 1 are complementary.

3.  Dr. Lai’s article also suggests drug protocols for HCW prophylaxis, HCW treatment for EBOV, and for needle sticks to HCW.  See Table 2 and Table 3 in his article.

4.  Becker’s Infection Control today refers to an article by Lowe, et. al. from University of Nebraska Medical Center in the Journal of Infection Control on how to handle waste from EBOV patients.  Dr. Lowe has provided his journal article to us. See the article at: http://www.ajicjournal.org/pb/assets/raw/Health%20Advance/journals/ymic/YMIC_3269.pdf. This article goes into the ‘nitty-gritty’ of EBOV patient waste by addressing solid waste management (around 50# per day) and liquid waste management and transportation issues.  Basically, Nebraska Medical Center converted Category A waste (EBOV waste) to Category B waste in the EBOV isolation unit (also called ‘biocontainment unit’) so that the waste could be handled by ‘normal’ hospital standards.

5.  Dr. Lowe also sent us two additional articles related to hospital care of EBOV patients.  The first article discusses how Nebraska Medical Center handled lab tests for EBOV patients.  The Medical Center performed some tests within the biocontainment unit, some tests at a BSL-3 lab facililty about a block from the Medical Center, and some tests in the core laboratory (a BSL-2 lab) in the Medical Center.  The article addresses specifics, not generalities, and even has a Q/A section at its conclusion.  See this article at: http://labmed.ascpjournals.org/content/45/4/e146.short.

6.  Dr. Lowe’s other article is all about transportation of EBOV patients, including EMS preparation, EBOV patient preparation, ambulance preparation, how to travel from airport to hospital.  Illustrations are included.  A section on decontamination is included.  See this article at: http://informahealthcare.com/doi/pdf/10.3109/10903127.2014.983661

7.  Ebola Deeply reports that an 11th physician in Sierra Leone now has EBOV.  He is being treated in Freetown at the Ebola Treatment Center for HCW.

8.  One of the common drugs which Dr. Lai believes should be used to treat EBOV patients is Amiodarone.  The Italian NGO called Emergency is going to do a RCT with this drug in Sierra Leone in a few weeks.  See: https://col128.mail.live.com/mail/ViewOfficePreview.aspx?messageid=mgMROAfp975BGJYgAjfePx5A2&folderid=flinbox&attindex=0&cp=-1&attdepth=0&n=8281872

RGL, MD

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Posted December 5, 2014 by levittrg in Ebola

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