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Early treatment with something as basic as saline solution may be saving the lives of a few lucky people with Ebola virus, doctors say. That's one thing giving hope to the families of two Americans who were infected in Liberia. Two Americans Stricken With Deadly Ebola Virus in Liberia'We Need More': Fight Against Ebola Is Thin on the GroundWhat Is Ebola? Since the outbreak of Ebola in West Africa early this year, more than 4,500 people are reported to have died but some patients have survived.
Ebola is spread mainly through contact with body fluids of an infected person or a corpse of one that has died of the Ebola virus disease. A nurse infected with the virus in Spain has recovered, two aid Americans who got infected with the virus while in West Africa, survived the disease when they received an experimental drug and were brought back to the U.S. So the questions on the minds of many people are, what is different with all the people that have survived the deadly Ebola virus? Evidence from an American organization, Emory Healthcare indicates that Ebola can be beaten if using the right approach. Specialists say if a patient is provided with intravenous fluids and nutrients early and you maintain blood pressure, the body of the victim can fight the virus.
If the above is not done, it will lead to vomiting and diarrhea, which will cause dehydration. The World Health Organization has made clear that there’s far more virus in blood, vomit and feces than in other bodily fluids.
He said that it’s important for doctors and nurses to focus on replacing potassium, calcium and other electrolytes in Ebola patients who are rapidly losing fluids. So apart from high-quality treatment, plasma transfusions and quick rehydration, another factor is that experimental drugs have helped some patients survive the Ebola virus.
But with a mortality rate of 50% in the current Ebola outbreak, a WHO panel said it is ethical to offer drugs to fight the virus — even if their effectiveness or adverse effects are unknown.
The experimental drugs at the center of this Ebola outbreak are ZMapp, Favipiravir, Brincidofovir and TKM-Ebola. The director of Emory’s Infectious Disease Unit cautioned against viewing ZMapp as a surefire cure. Ebola spreads by contact with bodily fluids, such as through a break in the skin or someone with contaminated hands touching the eyes or nose. To create a coordinated, networked approach, state and local health officials, in collaboration with hospital and healthcare facility executives, may designate healthcare facilities across the state to serve in one of three suggested roles outlined in this guidance document.
Whereas every state is not obligated to adopt a three-tiered approach, all states are strongly encouraged to identify Ebola assessment hospitals that can successfully manage PUIs until an EVD diagnosis is either confirmed or ruled out while awaiting transfer to an Ebola treatment center. To create a coordinated, networked approach, state and local health officials, in collaboration with hospital executives, may identify healthcare facilities across the state to serve in one of three suggested roles outlined in this guidance document. Specific CDC guidance can be found in frontline healthcare facilities, Ebola assessment hospitals, and Ebola treatment centers.
Rapidly identify and triage patients with relevant exposure history AND signs or symptoms compatible with EVD as outlined in CDCa€™s Emergency Department Evaluation and Management for Patients Under Investigation (PUIs) for Ebola Virus Disease(EVD).
Immediately isolate any patient with relevant exposure history and signs or symptoms compatible with EVD and take appropriate steps to adequately protect staff caring for the patient, including appropriate use of personal protective equipment (PPE). Frontline healthcare facilities, in accordance with the statea€™s plan, should consider immediately transferring patients who have a higher probability of EVD or are more severely ill to either an Ebola assessment hospital or to an Ebola treatment center that can provide Ebola testing and care for the higher risk patients until an EVD diagnosis is either confirmed or ruled out. Ebola assessment hospitals are facilities prepared to receive and isolate PUIs and care for the patient until a diagnosis of EVD can be confirmed or ruled out and until discharge or transfer is completed. Because it may take 72 hours or longer after symptom onset to definitively confirm or rule out an EVD diagnosis (with an additional 12 to 24 hours for specimen transport, testing, and identification of another facility for transfer if needed), Ebola assessment hospitals should be prepared to provide care for PUIs for up to 96 hours.
In collaboration with public health officials, Ebola assessment hospitals also should be prepared to coordinate Ebola testing, which may involve transferring specimens to an LRN laboratory capable of EVD testing. Ebola treatment centers are facilities that plan to care for and manage a patient with confirmed EVD for the duration of the patienta€™s illness. Given current PPE shortages, Ebola treatment centers may not be able to procure in advance the amount of PPE needed to care for a patient with EVD.
Patients should be preferentially referred to an Assessment Hospital for testing and evaluation. Patient has lived in or traveled to a country with widespread Ebola transmission or a country that has had cases in urban settings with uncertain control measures or had contact with an individual with confirmed EVD within the previous 21 days. Medical staff working with Medecins sans Frontieres (MSF) prepare to bring food to patients kept in an isolation area at the MSF Ebola treatment center in Kailahun, Sierra Leone, July 20, 2014. It’s a delicate effort and many people are expressing worries that the two patients could infect people and set off outbreaks in the U.S. In theory, Ebola could spread via a wet sneeze, although it’s not been demonstrated to have infected anyone this way. People do not transmit Ebola until they have begun showing symptoms, which include the usual flu-like symptoms such as fever, achiness and extreme fatigue, as well as vomiting and diarrhea. Ebola has a fairly long incubation period — from anywhere between two and 21 days, and usually more like a week.
That would be a terrible thing for the people on board, but Ebola virus is not going to somehow escape into the atmosphere and spread, nor is it going to crawl along the ground and infect unsuspecting people. There may not be a specific drug approved to treat Ebola, but doctors on the ground say supportive care does help.


Experts say Ebola is spreading in West Africa for several reasons, not least of which is that many of the people affected have never seen Ebola before, don't understand how it is spread and don't understand or trust Western medicine. In contrast, the United States has modern facilities with well-equipped staff well trained in the basic hygiene that is needed to prevent the spread of any disease, including Ebola. There's a track record on this — patients with SARS, MERS and Lassa fever have all shown up in the U.S. PARIS - A United Nations health worker suffering from Ebola has been flown to France from Sierra Leone for treatment, the French health ministry said in a statement overnight.
The UN worker is the second Ebola sufferer to have received treatment in France since the start of the epidemic ravaging West Africa. Eluding Ebola: Gear Matters, But Technique Matters MoreSloppy Smooches and Smiles: Ebola Nurse and Dog ReuniteHave Ebola Controversies Harmed the Fight?
Quick treatment has raised survival rates to as high as 75 percent in one small clinic in Guinea, the group Medecins Sans Frontieres (MSF or Doctors Without Borders) reports.
In the current outbreak, the death rate’s been about 60 percent, the World Health Organization says.
Joseph McCormick of the University of Texas School of Public Health says it is not yet clear why Ebola runs a different course in different people, but how rapidly symptoms appear depends partly on how much virus a patient was initially exposed to. Then the patient’s blood vessels will start to leak, causing blood pressure to drop to dangerous levels and fluid to build up in the lungs. She has a Bachelor’s degree in Mass Communication from Makerere University and also manages the social media pages of UGO ie Facebook, twitter and Google+.
This guidance does not address Ebola preparedness for primary care offices and other non-emergent ambulatory care settings. Whereas every state is not obligated to adopt a three-tiered approach, all are strongly encouraged to identify Ebola assessment hospitals that can successfully manage PUIs or confirmed cases of EVD until an EVD diagnosis is ruled out, especially in states where there is not expected to be an Ebola treatment center.
Guidance for Monitoring and Movement of People with Potential Ebola Virus Disease (EVD) recommends active monitoring by state and local public health agencies for all people who have a recognized potential exposure to EVD within the previous 21 days. If the patient has vomiting or bleeding follow the PPE guidance for confirmed Ebola patients or PUIs that have vomiting and diarrhea as outlined here. Patients who are deemed to have low likelihood of EVD on the basis of clinical and epidemiologic factors and have mild illness, but who nonetheless require EVD testing, may, in some circumstances, remain at the frontline healthcare facility while testing is conducted.
The state plan may include plans to transfer the patient out of state based on the patienta€™s risk and severity of illness and the geographic location of Ebola assessment hospitals and Ebola treatment centers.
All states, particularly those not planning to designate Ebola treatment centers, should strongly consider identifying Ebola assessment hospitals to ensure that people with symptoms and exposure history consistent with EVD can be cared for until the diagnosis of EVD is confirmed or ruled out. Public health authorities may identify people under monitoring who need testing for EVD if they develop compatible signs or symptoms, and may refer them to Ebola assessment hospitals. Therefore, initial isolation and evaluation of these minimally symptomatic patients can be performed using PPE according to CDCa€™s guidance for clinically stable persons under investigation for Ebola. Therefore, Ebola assessment hospitals should have PPE for Ebola sufficient for at least 4 to 5 days of patient care and ensure that staff members involved in or supporting patient care are appropriately trained for their roles.
Decisions about when to transport to an Ebola treament center a PUI for EVD or patient with confirmed EVD should be informed by discussions among public health authorities and the referring and receiving physicians on a case-by-case basis. State and local decisions to designate Ebola treatment centers are informed by the results of a CDC site visit conducted by an interdisciplinary team of subject matter experts.
Therefore, at a minimum, to be ready to accept and care for patients with EVD, hospitals will need sufficient PPE for at least 7 days. All staff who may be required to use PPE should be trained for their roles and demonstrate proficiency in putting on (donning) and removing (doffing) of PPE. Sierra Leone now has the highest number of Ebola cases, at 454, surpassing neighboring Guinea where the outbreak originated in February.
Kent Brantly, 33, the doctor infected while treating other patients during his work with Samaritan's Purse, was the first to arrive.
Thomas Frieden says any hospital with an intensive care unit and isolation facilities could handle a patient with Ebola. A single patient can infect several other people because these bodily fluids do carry a lot of the virus and someone who is violently ill with Ebola is going to be throwing up copiously and having a lot of diarrhea. Again, you’d have to be fairly close — the virus doesn’t hang in small particles suspended in the air for a long time. That should give medical personnel enough time to track down people who may have, for instance, been sitting next to someone on a plane with Ebola.
Giving saline and fever reducers has cut the mortality rate in the current West African outbreak, perhaps because patients don’t get severely dehydrated from the vomiting and diarrhea that Ebola can cause. People who are sick usually do not hesitate to seek care and if someone died from Ebola, their family members would be very unlikely to wash and bury the body on their own. The worker, whose name and nationality have not been disclosed, was transported to France aboard a specially equipped jet and placed in isolation at the Begin military hospital in the eastern Paris suburb of Saint-Mande, the statement said.
A French nurse repatriated in September has since made a full recovery from the virus, which has killed almost 5,000 people. But it’s been hard to tell what might happen with early treatment, since most patients get treatment late, if at all.
However, the roles and the preparations required to perform these tasks will differ by facility.
This is particularly important in states where there is not expected to be an Ebola treatment center.


Frontline healthcare facilities do not include primary care offices and other nonemergent ambulatory care settings. If the patient is clinically stable, and is not vomiting or having obvious bleeding, follow the PPE guidance for clinically stable persons under investigation for Ebola found here.
Such plans should ensure that transport providers are aware of the patienta€™s status and have appropriate training and PPE to safely transport a patient to a treatment center.
States should consider selecting enough hospitals to provide adequate geographic coverage across the state and avoid extended transport times of more than 1 to 2 hours from areas in which there are large populations of returning travelers, if possible. These people are likely to have been previously identified as at some level of risk for EVD through airport screening [PDF - 2 pages] and will be actively monitored by public health authorities during the 21 days following travel to an affected country or other potential EVD exposure.
This includes demonstrated proficiency in donning and doffing (putting on and taking off) PPE, proper waste management, infection control practices, and specimen packaging and transport.
When the decision has been made to transport a patient, preparations should ensure that transport providers are aware of the patienta€™s status and have appropriate training and PPE to safely transport a patient to a treatment center. Site visits assess the hospitalsa€™ ability to meet the minimum criteria (including infection control capacity, physical infrastructure, staffing resources, PPE supplies, waste management processes, worker safety training, environmental services, and laboratory set up).
If hospitalization is anticipated to exceed 7 days, state and local health authorities, in collaboration with CDC, may provide or facilitate the procurement of additional PPE supplies. More restrictive facilities are only needed for airborne pathogens — that would include treatment areas with negative air pressure to handle, for instance, someone with a particularly pathogenic strain of pandemic influenza. And these fluids do remain infectious for a time after death, which is why people can get infected while washing a body in preparation for a funeral.
Ebola also spreads via needle sticks and that’s one reason healthcare professionals are at such high risk. People who are starting to show symptoms of Ebola feel very ill and it would be very difficult for them to hide it. Medecins Sans Frontieres (MSF or Doctors Without Borders) says in one clinic, early treatment lowered the mortality rate to 25 percent from about 60 percent. There's a shortage of doctors and nurses, so many people are not even being diagnosed, and many of the worst affected placed have very little in the way of facilities to care for patients or to keep them clean so they don't infect others. The worker is being treated at the request of the World Health Organization, the ministry said, adding that there were currently no other confirmed Ebola cases in France. There are no specific drugs to treat Ebola but doctors say providing saline can help replace the fluids lost to vomiting and diarrhea and fever reducers can help control spiking temperatures. Acute healthcare facilities can serve one of three roles: as a frontline healthcare facility, Ebola assessment hospital, or Ebola treatment center (see Figure).
Designating assessment hospitals helps to ensure that PUIs have in-state access to care while awaiting transfer to an Ebola treatment center. However, it is also possible that patients with unrecognized EVD will present to a frontline healthcare facility without warning or, rarely, patients may be temporarily referred to frontline healthcare facilities when it is not feasible to refer them to an Ebola assessment or Ebola treatment center, based on distance, bed availability, or other considerations. Therefore, patients at high risk for EVD should be referred primarily to Ebola assessment hospitals (or treatment centers) rather than frontline healthcare facilities. Staff must be trained in and have practiced putting on and taking off (donning and doffing) PPE for Ebola, as well as providing clinical care using PPE. CDC Ebola Response Teams (CERTs) are ready to deploy to any Ebola treatment center to provide technical assistance for infection control procedures, clinical care, and logistics of managing patients with EVD as soon as the health department or hospital requests assistance.
Aircraft personnel are trained to watch for anybody who gets sick on a flight and they will radio ahead to alert medical staff and, if necessary, divert to land at an airport with the right facilities to assess the patient. CDC often tracks down people who have been with or near people with infectious diseases such as measles. Kent Brantly, a doctor with Samaritan’s Purse, and Nancy Writebol, who works for SIM, to get the best possible care. State and local public health authorities will coordinate closely with facilities when directing patients to a designated Ebola assessment hospital or Ebola treatment center. This is different from influenza, a disease that gets transmitted before people begin showing symptoms and which patients can also spread after they start feeling better. Facilities in Liberia, as well as Sierra Leone and Guinea, are very limited, doctors, nurses and other workers are pulling long shifts and supplies are short.
Some hospitals may serve simultaneously as an Ebola assessment hospital and an Ebola treatment center.
In some situations, frontline healthcare facilities may also arrange for Ebola testing at the nearest Laboratory Response Network (LRN) laboratory capable of performing testing for EVD, in accordance with the statea€™s plan. That’s why new strains of influenza are considered potential pandemic agents while Ebola is not. Frontline healthcare facilities are not expected to provide prolonged care (>12a€“24 hours) for a severely ill patient. As part of Ebola hospital preparedness efforts, hospital officials should develop an internal communications plan to ensure that information is shared in a coordinated way if the facility needs to care for PUIs. An external communications plan to effectively communicate with media, partners, and others should also be developed.



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