Evening Ebola Update, Fri, 12/19: Detailed clin. course of EBOV case in Frankfurt/Need for Africa to build infrastructure/Severe decrease in non-EBOV admission and surgeries in S.L.   Leave a comment

12/19/14

Dear Colleagues:

l.  The Atlantic Monthly has an article on-line re: lessons learned from the EBOV epidemic in 2014.  Various players in West Africa give their opinions on what they learned.  The consensus opinion includes: health care infrastructure was/is lacking in West African countries and needs to be built to prevent future epidemics; West Africans in rural villages are fearful of whites from Europe and the U.S.; rural villagers needed/need local people to teach them what to do/what not to do in EBOV outbreaks.  See the article at: http://www.theatlantic.com/health/archive/2014/12/lessons-from-an-outbreak-how-ebola-shaped-2014/383769/?single_page=true

2.  The Lancet 18 December on-line has a very detailed report by Wolf, et. al. on the clinical course of a Sierra Leone physician airlifted to University Hospital in Frankfurt for treatment of EBOV.  Patient received mechanical ventilation and renal dialysis.  Drugs administered included: FX06-a fibrin derived peptide to prevent vascular collapse, favipiravir-a RNA polymerase, the Aethlon Hemopurifier (during dialysis), antibiotics, norepinephrine.  FX06 may have helped the patient, but fall in viral particle counts occurred simultaneously.  The Hemopurifier did not seem to help.  Of particular importance were antibiotics which treated a peritonitis/cholecystitis successfully: this peritonitis/cholecystitis with abnormal liver function tests and C-reactive protein occurred when the viral counts were decreasing.  This case report is the most detailed and explanatory EBOV case report I have read.  See the report at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62384-9/fulltext

3.  The Lancet 18 December on-line has another report by Raguin, et. al. from Paris, France, discussing the need for national stakeholders in West Africa to build capacity in prevention and treatment of EBOV.  European and American roles should transition to supplying national stakeholders with the supplies and training they need.  West African civilians do not trust Europeans and Americans, especially in an epidemic, and dressed in PPEs.  This article reinforces The Atlantic Monthly article on the need for Africa to build a health care infrastructure for future epidemics.  See the article at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62419-3/fulltext

4.  The Lancet 27 December has a detailed obituary for 9 health care leaders and physicians who died from EBOV in 2014.  The obituary makes the point that several physicians and leaders who died did not directly treat EBOV patients, but worked in general hospitals treating other types of illness.  All of the deceased were heroes: they served others in dangerous times and conditions.  See the compassionate obituary at: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62417-X/fulltext.

5.  WHO website has a short article today on their training of University of Liberia students to become EBOV case finders now that the University is closed due to the EBOV epidemic.  Along with the Liberian Health Ministry, WHO has trained 1600 students to do the dangerous work of going house-to-house to find sick people.  WHO has also begun a ‘surge’ in trained volunteers in the Western part of Sierra Leone (including Freetown) to find sick patients.  It is the Western part of the country that accounts for the recent increase in reported EBOV cases.  See: http://who.int/features/2014/ebola-western-area-surge/en/

6.  PLoS Currents Outbreaks has an article by Bolkan, et. al. from Norway on the indirect health effects of the EBOV epidemic in Sierra Leone.  Based on the data from 61 inpatient and/or surgical government facilities, the authors found a 70% decrease in admissions between May 23rd and October 12th of this year.  The also found a 50% decrease in surgical operations.  See the details at: http://currents.plos.org/outbreaks/article/ebola-and-indirect-effects-on-health-service-function-in-sierra-leone/

RGL, MD

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Posted December 20, 2014 by levittrg in Ebola

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