Treatment

The human body is an amazing thing.  We’ve studied it for centuries, and still there is so much that we don’t understand.  Its ability to heal and regenerate itself must be one of the most intriguing things about it - in film and television this is often exaggerated and described as a superpower (X-Men, Heroes …) but the truth is we are all capable of self-regeneration – just not instantaneously!  Something that I didn’t know before my husband specialised in intensive care medicine is how much our most high-tech medical interventions rely on the body’s own ability to heal itself.  Notwithstanding antibiotics to kill bacteria and so on, fundamentally what intensive care offers is the skills, drugs and technology to support failing systems in the body, keeping it going and buying it time to repair itself, or not.

No matter where you are in the world, in the absence of any cure, the treatment for Ebola is supportive care.  Its purpose is to keep the patient alive as long as possible to give the immune system the time it needs to mobilise its response, which will be new and specific to the virus that it is up against.  That is why there has been some benefit in previous outbreaks in using serums to treat Ebola – that is, extracts from the blood of Ebola survivors that can be injected into Ebola sufferers.  Their blood contains the antibodies that the immune system has generated, which gives the recipient’s immune system a head start in working out what to do about the viral invasion.  The body is capable of eliminating Ebola – we just don’t know how.

In Ebola treatment centres in West Africa run by MSF or in hospitals, this supportive therapy focuses on the basics of life.  They are kept hydrated, and their oxygen status is maintained.  This keeps their blood pressure as stable as possible.  Since their immune system is otherwise occupied they are susceptible to other infections, and these can be treated.  Beyond that, all we can do it watch, and wait – but the time that this supportive treatment buys a patient can make the difference between life and death.  MSF estimates that early treatment can improve the chances of surviving Ebola by 10-15%.

Of course, what would really buy Ebola patients time is access to the full works of intensive care support – invasive ventilation, powerful drugs (inotropes) that modulate blood pressure and heart contraction, haemofiltration (like dialysis) to replace non-functioning kidneys, one-to-one nursing … Not only would this give the immune system time to work its magic, but even for those who did not recover, their death would be far less traumatic.  As soon as it became clear that the patient was deteriorating into severe multi organ failure, they would be anaesthetised and ventilated, so as well as receiving other treatments to give them a chance, they would not suffer.  The trouble is, this comes at a cost.  In the UK, a bed on intensive care costs on average around £2000 per night – so that would be £28,000 for just one patient with two weeks of Ebola.  It also requires a consistent and safe supply of a wide range of drugs, lots of nurses, complex equipment that requires a specific skill-set to operate, even amongst doctors, a lot of clean water and a reliable electricity supply – you can’t very well provide life support where there is a risk of a power cut.  Too bad it’s not countries that can afford it that get Ebola.