Thursday, October 16, 2014

Ebola - misplaced priorities

In March of 2014 an outbreak of Ebola, a hemorrhagic viral infection, began in the West African nation of Guinea; It subsequently spread to neighboring countries (Liberia and Sierra Leone); It has a death rate of 50-70%; It is spread primarily through contact with body fluids of any kind. Here and here are links to more technical information about this virus.

Since this is the largest outbreak known to date there have been multiple mis-steps by a variety of people and agencies attempting to address this - not the least is the bone-headed decision of politicians to not close our border or ban in-coming flights from areas of the world that have been the focus of the epidemic. Quarantine can be an effective measure in control of infectious disease and limiting immigration (legal or illegal) and banning travel from affected areas would be forms of this (of course, this does not apply to certain physicians who work as journalists in the MSM).  Oddly enough, while those responsible for protecting the public's health will not ban travel from affected areas nor close the borders, they will consider putting healthcare workers who have cared for patients with Ebola on a "no-fly" list! Go figure. Because this is the most significant outbreak yet experienced the situation is fluid and we are continuing to learn more about Ebola and how best to deal with it.

There is currently no vaccine approved for use, though one is in development. Currently, the treatment is symptomatic and supportive - there are no specific medications targeting Ebola at this time, though zMapp is a treatment/medication in development, as is Brincindofovir or Chimerix.

While the mortality rate is high some do recover. Those who recover are a reservoir of known effective treatment - antibodies. If we're going to send the military to Africa to help manage the Ebola crisis surely we can unleash their brainpower and manpower to organize the collection and use of immune-globulin from those who have recovered. Dr. Brantley has already provided this for several people. Apparently a black market for the blood of Ebola survivors has emerged. While one might survive Ebola, surviving a transfusion reaction from receiving blood of the wrong type can kill you very quickly! Or you may survive Ebola only to come down with HIV (or some other blood borne disease) from unscreened blood.

Since intravenous fluids are standard supportive treatment for those with Ebola why not use Vitamin C as an adjunct? Another nutrient that may be important as an adjunctive treatment of Ebola is selenium, see here also.

With a mortality and morbidity as high as Ebola's why limit treatment options? There is little to lose and lives to gain. What stops us is the prejudice of pride. We're waiting for man-made options (zMapp/Chimerix/vaccines) while there are other God-provided resources that are not considered. Even if they are not "the" answer, why limit ourselves in the face of such a significant threat? The risk of death in Ebola is high, while the risk of these treatment options is low - that's a ratio that favors their use as there is a theoretical basis for potential benefit with low likelihood of harm. These treatments are available for immediate use and are also relatively low in cost and technical complexity (unlike vaccines or the medications that are currently in development).

If the priority is people there is every reason to begin using IV vitamin C, selenium supplementation and use of immune globulin. If pharmaceutical profits and never letting a good crisis go to waste are the priority, then we'll just have to keep waiting.