Daniel Kuritzkes, MD
We've really learned an enormous amount about how the Ebola virus is spread, how we can take effective measures to prevent it from spreading from person to person, and most importantly, how to effectively manage patients who get sick with Ebola virus in order to improve the survival rate for those patients.
There have been a number of Ebola epidemics over the years, but this is certainly the biggest and most sustained epidemic that we've seen, and it's certainly the epidemic that's been associated with the largest number of deaths from Ebola virus disease that has ever occurred.
Ebola virus is a virus that appears periodically in populations mostly in Central and Western Africa. We really don't know where the virus lives in its natural habitat. The thought is that it may hang out in fruit bats or in apes or monkeys that may be killed for food by local people. Periodically, the virus breaks out from those animal populations into humans and causes epidemics.
If somebody becomes ill with Ebola virus, typically they'll have fever, muscle aches and pains; they'll feel poorly. We now understand that very often they'll have diarrhea which can be quite severe. And in the late stages of the disease, in the patients who progress to die, they may actually begin to hemorrhage. The virus can be passed from one person to the next if somebody has close contact with that person, with their secretions or their blood, if they're handling the body after the patient has died without wearing gloves or other protective equipment.
The typical situation is that just a couple of people would get infected that way. And then, if those people either recovered or died, then no one else would get infected. And that's why the previous epidemics have really been very contained or limited. And for reasons that are still not fully understood, this epidemic has become much more widespread.
Ebola virus isn't really all that hard to diagnose. The symptoms themselves are relatively non-specific in that they could be similar to flu or to malaria or a lot of other infections that cause fever and aches and pains. But in terms of the ability to diagnose it in the laboratory, there's a very simple test that is quite specific for Ebola and can be performed in a matter of hours, as long as you have the right equipment to do that test.
There's really no specific proven therapy for Ebola virus disease. The only treatment that's really known to be helpful is what we call supportive care; that is, patients need lots of fluids to replace the fluids they're losing because they're having vomiting or diarrhea, or because they're sweating a lot; giving medication to help control some of their symptoms and to relieve any discomfort that they may have. But that's really the extent of any treatment.
There's been a lot of talk about experimental therapies that might be tried for patients, such as some of these antibody treatments or specific antiviral medicines, but we really don't know yet that those are effective or that they've made any difference in the people who have survived to date.
For those who make it to the hospital and get cared for, the level of care that can be provided is going to make a big difference. So if you're here in an American hospital where we have all of the diagnostic capabilities in terms of monitoring electrolytes and carefully monitoring blood pressure and precisely matching fluid replacement to fluid losses, your likelihood of surviving is going to be much greater than if you're in a field hospital in an economically less advantaged country where the simple capacity to do that is much lower.
We're becoming more effective at containing the epidemic by making sure that people in the area know how to protect themselves from Ebola, doing a better job of identifying people who are suspected of having Ebola and isolating them, making sure that when patients do get sick, if they have a confirmed case, that only people who are using appropriate protective equipment are having contact with them, and preventing spread within families.
Brigham and Women's Hospital has an extensive global health program, particularly Paul Farmer, through Partners in Health, and his group, most of whom are here at Brigham and Women's Hospital as well, have been working, particularly in Sierra Leone, to help set up treatment centers and to organize care more effectively than has been done to date. And hopefully that will have a profound influence on the epidemic there.
There's been a lot of effort devoted to trying to develop a vaccine for Ebola, especially in the last several months. There had been a number of candidate vaccines on the shelf, and these have been moved very quickly into human trials. The first vaccine candidate from the National Institutes of Health has shown preliminary evidence in initial human studies that it can generate an immune response to the virus, in terms of antibodies. Whether these are effective at preventing infection or improving outcome from Ebola infection is the next step.
I think the most important lesson we've learned from the current Ebola epidemic is the need to be vigilant for the emergence of new infectious diseases. We've been reminded about how interconnected we are across the globe, and an infection or an epidemic that emerges in a seemingly remote part of the world could quickly come to affect us here. But having a robust public health infrastructure, having the ability to respond quickly, both at the source of the epidemic and here in the United States to implement appropriate treatment and containment procedures is going to keep us safe.
One of the things that the current Ebola epidemic has done is really to force us here at Brigham and Women's Hospital to develop a plan for how we're going to deal with emerging infectious diseases, and both here and across the United States, hospitals have developed highly effective approaches to screening patients, to identifying people who have suspected Ebola infection, and a plan to then isolate and manage them safely to protect hospital staff, to protect other patients, and to make sure that the epidemic doesn't spread throughout the community.
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