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Ebola Elimination Means Isolation of Sickest, Dying Patients

2014-10-31

New research has revealed that patients who survive Ebola infection have a different profile of virus load than those who succumb.  The typical patient who survives Ebola infection has maximum virus load after four days of symptoms and then progressively reduces amounts of virus.  The dying patient will show ever increasing virus load and ever worsening symptoms, with maximum load a hundred fold higher than that in a surviving patient.

Therefore, evaluation of the patterns of infection suggest that isolation of the sickest patients within four days of symptom onset can lead to complete interruption of transmission and end the epidemic.  The patients with milder symptoms can be isolated too but it is the sickest ones who really need to be removed from the community.

Ironically, it is those who die of Ebola infection who are most often treated secretly at home and then buried surreptitiously with traditional washing and handling practices.  These fatalities are the most efficient modes of epidemic spread for the Ebola virus.

Thus it behooves the government that wants to eliminate Ebola to encourage the people to bring in and surrender their sickest patients so that they can be properly isolated and buried aseptically.  Perhaps one way to encourage the surrender of sick Ebola patients would be to ensure that every patient who dies is treated humanely and indentified individually so that the family has a place to lay flowers and perform traditional mourning rites.

Instead, it appears that patients are cut off from their families when they go downhill and die, and then the corpses are incinerated, making traditional ceremonies impossible.  This policy in Liberia has, it is alleged, resulted in widespread surreptitious burials.  If this is the case, a number of new infections should result from post mortem contamination.

Maybe it’s too difficult given the resources of the countries involved and the number of deaths, to provide individual graves for each victim.  So far, we have had almost five thousand deaths in the three countries affected: Liberia, Sierra Leone, and Guinea.  That’s a small cemetery in less than a year.  None of these countries’ governments has more than a few cents per annum per person to spend on health care.  Even the United Nations appeal for donations hasn’t been going well as yet.

Nonetheless, if careful isolation of the sickest patients is practiced, there is likely to be a quick extinction of this epidemic.  It should be easy to start isolation of a very sick patient within four days of the onset of the first symptoms.  Public education has been effective so far in this epidemic and this should be emphasized, especially the need to be isolated within four days to prevent others from falling ill.

On the other hand, it is clear that respiratory isolation and the quarantines that have been enforced are completely unnecessary.  The nurse who has been in quarantine despite testing negative and having no symptoms is apparently going to court to get the quarantine lifted.  We hope that, if a judge is forced to decide the wisdom of the quarantine order, that she will come down on the nurse’s side and award damages against the state of Maine.

 

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