Why did the first few U.S. Ebola patients recover so quickly?

Mudassir Ali
Mar 10, 2020 06:18 PM 0 Answers
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Mudassir Ali
- Mar 10, 2020 06:18 PM

Because they were treated in a country with a modern healthcare infrastructure.

The estimated mortality rates of 50-90% (case fatality of 70.8% for the most recent outbreak [2]) of Ebola is in the context of third-world countries with no modern healthcare systems (1, 3, 4) compounded by lack of education, distrust of the government/doctors, and many more socioeconomic factors. The baseline expectations for Ebola patients in west Africa is quite low. Comparing an Ebola case in the US to an Ebola case in West Africa is like comparing Apples and Oranges. A specific challenge is not in the diagnosis of Ebola, but rather providing the supportive and intensive care a patient needs to overcome the illness (1):

EVD presents much as many other viral infections do, with nonspecific signs such as fever, asthenia, and body aches. After a few days, however, the predominant clinical syndrome is a severe gastrointestinal illness with vomiting and diarrhea. Volume depletion with a range of metabolic disorders ensues, and hypovolemic shock ultimately occurs.
A common assumption is that a lack of material resources constitutes the dominant barrier to clinical care. That is not the case. Intravenous catheters, fluids, and electrolyte replacement are readily available but thus far are being used much too sparingly…. Simple interventions can prevent deaths attributable to hypovolemia and metabolic abnormalities. The high mortality from Ebola continues to reflect the natural history of the illness, not an inability to alter its course.

This is all standard practice even in the most basic healthcare setting in the United States, but in an are where the healthcare system is stretched so thin (5),

Extraordinary resources are required by any health service confronted by Ebola; those in Guinea, Liberia, and Sierra Leone are severely stretched. Health services are understaffed. Essential personal protective equipment is in short supply. Capacities for laboratory diagnosis, clinical management, and surveillance are limited, and delays in diagnosis impede contact tracing.

On top of these problems, health services are operating in a climate of fear and discrimination. Some contacts of patients with confirmed cases have evaded follow-up by medical teams (which ideally covers the full incubation period of 3 weeks). Some patients and their contacts have been ostracized in areas where Ebola is thought to be a product of witchcraft. Health care workers are aware of the risks they face: more than 150 health care workers have already been infected, and at least 80 have died. Fear has also turned to hostility against national and international response teams and has compromised care delivery and transport of essential equipment and samples to laboratories.

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