Not sure if this belongs in GQ, but it is becoming rapidly apparently that Ebola is fairly survivable in capable (Western) hands, particularly when early intervention and supportive care occur.
Of the US cases, only Duncan has died, and he probably had a fairly large viral load prior to initiation of care. All of the others treated in the US have survived so far, and it does not sound like Spencer is doing poorly.
Many of these patients have gotten plasma (or blood; I can’t tell which from news reports) from survivors. Duncan did not, as far as I know, due to concerns over blood type compatibility. Some (all?) have gotten experimental anti-virals.
One fact seems to be emerging: Ebola, when diagnosed early and when substantial resources are available, does not seem to have a fatality rate anywhere near 50% or greater.
I wonder if there are improvements in survival in african countries as well. Certainly they should have access to blood products from survivors, and if I personally could only have one early intervention beyond supportive care, that would be it.
Case fatality rates were on the order of 45-70%, but there isn’t much detail about actual intervention; simply a comment about the difficulty of optimum intervention in africa.
Good question. Because it seems that if you are young, relatively healthy and contract Ebola, your chances of survival are well into the 90% range provide you get the top medical treatment available. There are a lot of questions swirling around about Duncan, especially since he was the only black Ebola patient in the US. But that may be better discussed in GD.
One of the authors is my friend and division colleague. He says privately what is written in the article: that basic supportive care - emphasizing volume and electrolyte management - is all that’s needed in many, if not most, cases.
From the article:
“The high mortality from Ebola continues to reflect the natural history of the illness, not an inability to alter its course”. (emphasis added)
For the record, Amber Vinson, one of the nurses infected after treating Mr. Duncan, and who’s just recovered from Ebola (she’s the one who was controversial because after she treated him, she traveled to Cleveland to plan her wedding), is also black.
Still, the survival rate for blacks in the US is 50% while the survival rate for non-blacks in 100%. Obviously the sample size is not very good, but one still wonders if you survival rate is a strong function of you socio-economic status.
I think it’s more that you have a sample size of what? 4 people who started showing symptoms in the US? 2 blacks, 1 white, 1 Southeast Asian. I don’t think that’s enough people to really draw conclusions.
It could also be an effect of dose size. It’s reasonable to hypothesize that the dose for a healthcare worker would be lower than that of an unprotected citizen.
Let’s see, is there any demographic we could use that has a stronger correlation? How about 3 people were medical professionals who knew they had been exposed to ebola and were cognizant of their symptoms and reported it very quickly and early on in the disease process and treatment was started immediately? And 1 was not a medical professional and came into the emergency room fairly ill, was sent home, and got much sicker before he went back and got appropriate treatment.
Yeah, that seems to be a correlation of 1. Pretty strong. And no race card. The poor bastard is dead because he was the first, and didn’t have the benefit of the public [del] panic [/del] awareness of the disease.
Are dose effects important in virology?
My naive approach is that virus dosages would be relatively unimportant factors since viruses reproduce in the host’s cells, making huge numbers of copies even if just a few cells are infected - but I know nothing of the subject of virology, so will defer to whoever has actual knowledge of the subject.
Life or death often hangs on how quickly your immune system can mount an effective response, the size of the initial ‘invasion’ and how quickly it replicates can be huge.
In addition to the speed and size of the infection versus the time to mount the adaptive immune response, viruses have to run through a gauntlet of passive and innate defenses. A single viral particle could be flushed out of the body, stuck in mucus, gobbled up by a macrophage, or recognized by innate immune receptors that recognize broad categories of pathogens. Even if it survives all that, it still has to rely on random chance to run into the specific cell type that it can infect. More viral particles means more chances to evade the bodies defense and infect a cell.
I can’t speak in direct relation to Ebola, but can in relation to HIV, in which I deal with some of the outskirts of the medical side of treatment.
The big thing with HIV drugs & treatment right now is getting a patient to “undetectable” - i.e. to the point where the virus can’t be detected within blood samples. With HIV it means they’re still infected, but at “undetectable”, the chances of HIV turning into AIDS are drastically lowered and chances of passing it on to loved ones or others through limited contact are reduced (though you still need to be safe and not stupid). I guess the theory goes you can live an almost-normal life at undetectable - or at least live for a lot longer than you would expect to otherwise.
I would guess that Ebola is similar, expect that when you get to that “undetectable” point you’re more “cured” than simply “much less infectious”, for the reasons pointed out by lazybratsche and outlierrn.
At least I’m hoping that the great scientific minds are screwing this one up.
The rate varies greatly by strain. In the original 1976 outbreak the mortality rate was not significantly lower in Belgian nuns who were in evacuated to modern hospitals in Belgium than it was in Africa.
Well, perhaps I should have said initial dose effects instead of just dose effects - it makes sense in the context of Red Stiletto’s question that the initial dose for a health worker might be lower than the initial dose for a family member of someone infected with ebola, for example.
I don’t know if there’s any way viral load would be different for a health worker vs. a family member once ebola has caught hold.
The comparison to HIV is not useful. Few people, if any, are able to kill off the HIV virus, so the treatment is to take drugs that keep the virus dormant. For life.
It seems that most people can fight off an ebola infection, it’s just that a good number of them die before they get that far. So with ebola, the treatment is keeping people alive while the immune system does its thing.
I’m thinking the proper administration of fluids is probably enough to increase the survival rate very significantly, and that is something that could potentially be done in Africa, not just in the best hospitals in the first world.
Do we have any data on how long immunity to Ebola lasts if you survive an infection? Some diseases like smallpox generally resulted in lifelong immunity, are there any known examples of survivors of Ebola getting another Ebola infection?
