Bloomberg, Jason
Gale, Nov 17, 2014
With
targeted drugs and vaccines at least months away, doctors and public health
experts are learning from Ebola survivors what simple steps helped them beat
the infection. Turns out drinking 4 liters (1 gallon) or more of rehydration
solution a day -- a challenge for anyone and especially those wracked by
relentless bouts of vomiting -- is crucial.
Related
Slideshow: Liberia: Ebola's Ground Zero
“When
people are infected, they get dry as a crisp really quickly,” said Simon
Mardel, an emergency room doctor advising the World Health Organization on
Ebola in Sierra Leone. “Then the tragedy is that they don’t want to drink.”
Aggressive
fluid replacement was deemed critical in saving two American health-care
workers with Ebola at the Emory University Hospital in Atlanta, according to a
study published in the New England Journal of Medicine last week. Interviews
Mardel and WHO colleagues conducted with six of the dozen patients who survived
Ebola in Nigeria, where the fatality ratio was much lower, also point to the
importance of drinking. Ada Igonoh, a doctor who caught Ebola in late July
while working at the First Consultants Hospital in Lagos, said she took oral
rehydration salts, or ORS, mixed in water as soon her gastrointestinal symptoms
started -- even before her Ebola diagnosis. Once hospitalized, she trawled the
Internet on her iPad for insights from survivors.
Studying in
Seclusion
“I knew
that in diarrheal diseases, shock from dehydration is the number one cause of
death,” Igonoh said in an e-mail. “From my research on Ebola while in
isolation, I found that to be true.”
The WHO
shared transcripts of interviews with Igonoh and five other Ebola survivors
with the patients’ permission to provide insight into clinical experiences and
management. Igonoh also answered follow-up questions in a direct e-mail.
Patients in
Liberia lost 5 liters of fluid a day from diarrhea alone, doctors treating
cases there wrote in a Nov. 5 paper in the New England Journal of Medicine.
Severe
fluid loss can cause a type of shock that prevents the heart from pumping
enough blood to the body, eventually leading to multiple organ failure.
“As I took
the ORS and treated dehydration, it provided me with energy, and my immune
system was able to battle the virus,” 29-year-old Igonoh said.
Simple
Message
Patients
become “stunningly dehydrated” because they don’t feel like eating or drinking
in the early stages of the illness, and then later they lose liters of fluid
from profuse sweating, vomiting and diarrhea, according to Mardel.
“You don’t
want to drink, then you’re too weak,” he said in a telephone interview from
Freetown. “In the last stage, you’re in shock and your gut has shut down.”
Mardel has
worked on medical aid and emergency relief operations for 30 years, including
responding to outbreaks of Lassa fever in Sierra Leone, Ebola in Uganda and
Marburg virus disease in the Democratic Republic of Congo.
Mortality
could be reduced by delivering a simple message about the importance of taking
fluids and picking the right painkillers, he said. Paracetamol, the active
ingredient in Panadol, is the preferred medication for pain and fever, and
picking others such as aspirin and ibuprofen can worsen bleeding, he said.
“We will
halve the mortality by firstly just stopping anti-inflammatories and giving
hydration, and really pushing it,” Mardel said. “I want every man and woman in
Sierra Leone to know this. I want sports personalities to be talking about it.
I want everybody to be talking about it.”
Ebola
Blueprint
In Nigeria,
40 percent of those known to have been infected died. Across the rest of West
Africa, the fatality rate is about 70 percent.
Nigeria’s
success in stopping Ebola shows how the virus can be stamped out and is a
blueprint for other developing countries at risk of the disease, the WHO said
after declaring Africa’s most-populous nation Ebola-free last month.
Related:
- Ebola Vaccine Challenge: Motorbikes and Kerosene Fridges
- Doctor Dies in Nebraska After Ebola Infection in Sierra Leone
Liberian-American
Patrick Sawyer introduced Ebola to Nigeria in July when he arrived on a flight
to Lagos, a city with an estimated 21 million people, according to the WHO. In
addition to Sawyer, five health workers and the protocol officer who received
him at the airport died of Ebola, according to Nigeria’s health ministry.
Twelve survived.
Learning
from their experience and putting those lessons to use in other West African
countries is key, because too many patients arrive at treatment centers
severely parched and difficult to salvage, Mardel said.
Spurning
Care
Patients
typically seek medical aid after five days of illness, according to a study of
Ebola cases in Conakry also published Nov. 5 in the New England Journal of
Medicine.
“Over eight
to 10 days of illness, you will need possibly 40 liters of fluid,” Mardel said.
“Day after day, if you’re not getting that, we can’t suddenly give you 20 liters
to catch up.”
A fluid
deficit and “profound electrolyte derangement” appears to increase the risk of
death, the WHO said in a Nov. 6 statement. In that document, the Geneva-based
agency recommended intravenous rehydration. Not everyone agrees that that
delivery route is the best way to go. Oral rehydration, which is taken up in
the gut, seems to help patients maintain a better balance of electrolytes,
according to Mardel.
Don’t Gulp
Most
intravenous rehydration fluids also don’t have much potassium, calcium, or
magnesium, doctors at Emory University Hospital wrote in their journal article
last week. They recommend supplementing oral rehydration with all three,
especially in patients with large-volume diarrhea.
Still,
drinking has its challenges. Patients must overcome recurring nausea, as well
as debilitating joint pain that can make gripping and movement difficult.
Ebola
survivor Fadipe Akinniyi Emmanuel, another doctor at the First Consultants
Hospital where Igonoh works, said gulping down the rehydration solution made
him sick.
“Each time
I attempted to take the ORS, I vomited,” he told the WHO, according to the
transcript. Eventually, Emmanuel found he could keep down 4 liters of fluids a
day by taking frequent, small sips between bouts of nausea.
‘Most
Important Thing’
Rehydration
is “the single most important thing” in the management of Ebola, Emmanuel said
in an e-mailed response to questions.
“It really
helped restore what I was losing when I was stooling and vomiting
relentlessly,” said the 29-year-old doctor, who still suffers occasional joint
pain and stiffness as a result of his past Ebola infection.
Flavoring
the liquid also helps. The granules that Emmanuel’s colleague Igonoh took at
home were orange-flavored and much more pleasant than the flavorless kind she
was given in the hospital, she said.
“I had to
mentally force myself,” she said, according to the transcript.
Igonoh used
less of the rehydration salts per liter of water than recommended because a
more diluted brew was easier to stomach, helping her to increase her intake,
she said.
“You don’t
want to drink anything,” Igonoh said. “You are too weak.” That’s when morale is
key, said the doctor, who now sports a shaved head after the viral illness
caused most of her hair to fall out. “You should be able to tell yourself, no
matter how many people die, you are going to survive. And you will survive.”
To contact
the reporter on this story: Jason Gale in Melbourne at j.gale@bloomberg.net
To contact
the editors responsible for this story: Elyse Tanouye at etanouye@bloomberg.net
Marthe Fourcade, Terje Langeland
Related Article:
"Revelations of Darkness" - Oct 1, 2014 (Kryon Channelling by Lee Carroll) - (Text version)
“ .. The Role of Gaia in Human Consciousness
One of those times might be frightening for you to know about, since it was a full cooperation with Gaia for your termination, and a pandemic almost wiped humanity off the map. A pandemic! Now, you say, "What has that got to do with Human consciousness, Kryon?" Pay attention, dear ones, because this is the day where the teaching was given by my partner, and he put together the Nine Human Attributes. One of the attribute sets included three Gaia attributes and one of them was the consciousness of the planet. Gaia is related to Human consciousness!
Are you starting to connect the dots? You are connected to this planet in a profound and spiritual way. As goes humanity goes the planet's consciousness. Gaia, Mother Nature, whatever you want to call it, cooperates with Human consciousness. If you spend 1,000 years killing each other, then Gaia will do its best to cooperate with your desires! Gaia will look at Human consciousness and try to help with what you have shown you like to do! Did you know this role of Gaia with you? It's a partner with you, fast tracking what you give to it. You may wish to review what the indigenous of the planet still understand. Gaia is a partner!
Pandemic: Don't you find it odd that in the last 50 years, when you have a population of seven billion Human Beings, with up to 2,000 airplanes in the air at any given moment, going between almost every conceivable place, that there has not been a pandemic in your lifetime? There have been five starts of potential pandemics over the last 20 years, yet none became serious. Did any of you put this together? Dear ones, when the world was far less populated a few hundred years ago, with no mass travel to spread a virus, there were still millions wiped out by a pandemic. With the increased population and mass travel, there is far more danger today than before. It doesn't make sense, does it? What happened to stop it?
When you know humanity's relationship to Gaia, it makes sense. Gaia is a life-force that is your partner, watching you change the balance of light and dark and reflecting what Humans want. It has polarity, too! Perhaps it's time to start your meditations with thanking your planet Earth for supporting you in the spirituality of your Akash, for always being with you, a life-force that is always present. The ancients started their ceremonies in that way. Have you forgotten?
Ebola
Now, I've just set the stage for the next subject, haven't I? Ebola. Are you afraid yet? Gaia is a life-force that is a part of Human consciousness. My partner put it on the screen today so you could see the connections [during the lecture series]. Now it's time to connect the dots. Dear one, Gaia is in the battle, too, for here comes something scary that you haven't had in your lifetime and you're afraid of it - the potential of a pandemic on the planet.
There's a very famous film that has some dialogue that my partner will quote. Some of you will know it and some of you won't, but here it is: "Have a little fire, scarecrow?" What are you afraid of? Darkness? Gaia is in the battle with you and is actively pursuing solutions through light. The energy of the planet is with you in this fight! The ebola virus is a shock and a surprise. It is propelled by ignorance and fear, so it can flourish. Look at where it started and look at how it gets its ability to continue. It expands its fear and power easily with those who believe it's a curse instead of those who understand the science.
Villages are filled with those who refuse to leave their family members because they believe the disease is a curse! FEAR! Instead of understanding that they should be in isolation from the virus, the family dies together through ignorance and fear. This represents how darkness works. Are you going to become afraid also? Dear ones, ebola will be conquered. Know this and be at peace. Pray for light for those in the villages who are afraid, that they can know more about how to keep the spread of this disease and live to see their families. .”
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