12/24/14 Christmas Eve
NEJM Ebola Outbreak website has 3 new articles on the state of the EBOV epidemic on its one year anniversary in West Africa:
1. A NEJM Editorial by Drazen, et. al., editors at the NEJM, notes that the EBOV case rate in West Africa has slowed and EBOV treatment centers have been built and are operational. But more volunteers are needed, especially from U.S. academic medical centers (AMC). The authors request that U.S. AMC remove ‘roadblocks’ (loss of health care insurance, loss of malpractice insurance, loss of salary, no temporary replacement staff for volunteer’s clinical assignments) so that qualified trainees who wish to volunteer in EBOV-infected countries may do so. The Wellcome Trust in the U.K. has done so for AMC in the U.K. See this Editorial at: http://www.nejm.org/doi/full/10.1056/NEJMe1415398?query=featured_ebola.
2. In my opinion, HHS should issue a directive that permits CDC to accept such AMC volunteers as 3-6 month ‘EBOV clinical fellows’ for training, deployment, and post-deployment isolation; CDC could then provide AMC volunteers with health care insurance, malpractice insurance, stipend, and travel expenses, HHS has both the money and authority to do so.
3. A NEJM Correspondence by Ansumana, et. al. reports on the clinical data from a series of 581 EBOV patients treated at an EBOV treatment center just outside of Freetown, Sierra Leone. These EBOV patients were treated between September 20th and December 7th. During that time period, the case fatality rate decreased from 48% to 31% to 23%. The treatment protocol involved IV fluids, antibiotics, anti-malarials, pain and anti-vomiting meds, calorie replacement, electrolyte replacement, and vitamins/minerals. See the specific treatment plan at: http://www.nejm.org/doi/suppl/10.1056/NEJMc1413685/suppl_file/nejmc1413685_appendix.pdf.
4. Ansumana, et. al. state they do not know why their overall case mortality rate (31%) was so much lower than the reported case mortality rate (74%) at Kenema Hospital, Sierra Leone, in EBOV patients treated in May and June. Perhaps the season change affected the virulence of EBOV or perhaps EBOV has mutated between June and September. See the entire Ansumana, et. al. report at: http://www.nejm.org/doi/full/10.1056/NEJMc1413685?query=featured_ebola
5. WHO Ebola Response Team reports in NEJM Correspondence on the West Africa EBOV epidemic after one year. The incidence rate of EBOV is stable in Guinea and Sierra Leone and decreased in Liberia, according to the Team. New cases have shifted from the rural regions to the capital cities in all 3 countries. Time to patient isolation has decreased, and percentage of safe burials has increased. But the threat of EBOV spreading to other countries remains. See the WHO Ebola Team report at: http://www.nejm.org/doi/full/10.1056/NEJMc1414992?query=featured_ebola