Basic medical care of Ebola patients is neglected and must improve
5 December 2014
The widespread misconception that there are no proven treatments for Ebola virus disease has meant that simple treatments - especially intravenous fluids and electrolytes, which could reduce the number of deaths caused by the virus - have been neglected, according to a School expert writing in The Lancet.
Professor Ian Roberts co-director of the Clinical Trials Unit at the London School of Hygiene & Tropical Medicine, and Dr Anders Perner, intensive care specialist at the University of Copenhagen, Denmark, write that: "It is often stated that there are no proven therapies for Ebola virus disease but that potential treatments, including blood products, immune therapies, and antiviral drugs, are being evaluated. This view is inaccurate."
"Ebola virus disease is a febrile illness with severe gastrointestinal symptoms. Nausea, vomiting, and diarrhoea cause profound water and electrolyte depletion leading to circulatory collapse and deathâ€¦Whereas many patients with Ebola virus disease receive oral rehydration and some electrolyte substitution, the use of intravenous fluids and electrolytes varies and it is likely that many patients die from deficiencies in fluid volume and electrolytes."
Implementation of practical protocols for managing fluids and electrolytes has not been given sufficient priority, say the authors, adding that this could substantially reduce the death rate. And in situations where there is uncertainty about the best way to treat patients, the authors call for rigorous clinical trials. "Before assuming that west Africans will reject the benefits of high quality clinical research we should first seek their opinions," say the authors.
They conclude that: "A stronger policy focus on providing effective care for patients with Ebola virus disease is not only a humanitarian imperative, but could also help to bring the epidemic under control. Patients cared for in Ebola treatment centres are less likely to infect other people than those cared for in the community. However, Ebola treatment centres must be more than a setting for quarantine. Patients will be reluctant to attend treatment centres unless the care they receive from them is superior to the care provided by family members. Treatment centres must be a setting where the best information is applied in the interest of improving patient outcomes, and where valid information is generated in the interests of future patients."
The comment is accompanied by a video for health workers on how to give parenteral (non-oral) fluids.