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How U.S. ‘aggressive support’ for Ebola patients saves lives

November 6, 2014 at 6:20 PM EDT
In West Africa, Ebola has claimed the lives of 50 percent of people infected. In the U.S., the recovery rate is substantially better. Judy Woodruff learns more from Dr. Bruce Ribner of Emory University about the public health and infrastructure advantages that Americans have in caring for Ebola patients.
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JUDY WOODRUFF: In West Africa, Ebola has had a fatality rate of nearly 50 percent. In the U.S., there have been only a handful of cases so far, and the death rate has been far less. Nine people have been treated. Seven have recovered. One died, Thomas Eric Duncan, and one remains hospitalized in New York in stable, but improving condition. He’s Dr. Craig Spencer.

What helps explain what’s working differently in the U.S., and is it replicable?

Dr. Bruce Ribner has overseen the care of four Ebola patients at the Emory University School of Medicine.

Dr. Ribner, thank you very much for joining us.

And, first, just quickly, is it accurate to say that the recovery rate at this point in the U.S. far better than it is in West Africa?

DR. BRUCE RIBNER, Emory University Hospital: The recovery rate in the United States is substantially better than in West Africa or the cases in Central Africa, yes.

JUDY WOODRUFF: And why is that?

DR. BRUCE RIBNER: Ebola virus disease basically ravishes every organ in the body. And what the patient needs is aggressive support until the body can control the virus and the functions of the various organs can recover.

Unfortunately, the infrastructure in most of Africa is such that our colleagues over there are not capable of aggressive supportive measures. We have the luxury of very good infrastructure. And so we would anticipate that, while our fatality rates in the U.S. wouldn’t be zero, they would be substantially less than the rates we see in Africa.

JUDY WOODRUFF: And what do you mean by infrastructure?

DR. BRUCE RIBNER: In other words, when we receive our patients from Africa, more often than not, they have had no blood testing at all, no chemistries, no hematology tests, no platelet counts, any of that.

They just don’t have the capability of doing those tests in their facilities. At the other end of the spectrum, we have enormous support structure. And we can do a lot of testing that they are unable to do and manage the different organs failing much better than they’re able to do.

JUDY WOODRUFF: So, is it just a matter of sophisticated medicine? Or are we talking about hydration? Are there medicines available here that aren’t available there? We know blood plasma of former Ebola patients has been used in the U.S.

DR. BRUCE RIBNER: It’s really all of those. In many of those facilities, the nursing support is such that they can give a limited amount of fluid.

And as we have seen in our patients, patients during the most extreme form of illness are losing five to 10 liters a day, and they just can’t keep up with that. In addition, because we have the ability to measure the patients’ chemistries and fluid levels, we’re much more capable of replacing those fluids exactly to the extent that the patient is losing them.

And then, finally, blood banking in the United States, whether it be platelets, whether it be plasma, whether it be transfusion, is just dramatically more sophisticated than what our colleagues in Africa have access to.

JUDY WOODRUFF: And so my question then is, what is done in the United States right now, to what extent is that — can that be replicated in places like Sierra Leone and elsewhere in West Africa where Ebola is still raging?

DR. BRUCE RIBNER: Our colleagues in West Africa have enormous hurdles to try and reach the level of sophistication that we have in the United States.

Many of their facilities are not even air-conditioned. And in the heat and humidity that exists in many of their facilities, even if we bring some of our instrumentation over there, it rapidly fails within a few weeks to a couple of months.

And so they have enormous hurdles in terms of creating the type of infrastructure that we take for granted in the United States.

JUDY WOODRUFF: We are going to leave it there, but we thank you very much, Dr. Bruce Ribner at Emory University. Thank you.

DR. BRUCE RIBNER: Thank you.

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