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November 7, 2014

How do hospitals care for Ebola patients?


As Ebola cases have appeared outside West Africa, hospitals are facing the challenge of caring for patients infected by an aggressive virus with no cure.

Ebola is a viral hemorrhagic fever and typically begins with a fever, weakness and muscle pain. As the disease progresses, it attacks bodily organs by breaking down connective tissues, rendering them incapable of functioning. The virus is also marked by hemorrhaging – bleeding from many parts of the body.

Though there is no cure or vaccine for Ebola, health workers can counteract the symptoms of the disease by replacing the fluid that a patient is losing, which can be as much as five to 10 liters a day, explains Dr. Bruce Ribner, who oversaw care for four Ebola patients at the Emory University School of Medicine.

But in Liberia, Sierra Leone and Guinea—the three first countries to be affected and the worst-hit by the virus—health infrastructures do not support intensive care for Ebola patients, particularly in rural areas that may lack developed medical care. Access to fluid and donated blood for patients is limited.

“They have enormous hurdles in terms of creating the type of infrastructure that we take for granted in the United States,” Ribner said.

The Ebola outbreak began in Guinea in March and spread to several neighboring West African countries. A handful of cases have been diagnosed outside West Africa in Europe and the U.S. A person may show symptoms from two to 21 days after being exposed to the virus, according to the Centers for Disease Control and Prevention.

The Ebola outbreak has infected nearly 8,000 people and killed over 4,800 people, though the numbers could be even higher, according to the CDC. The current outbreak has shown a case fatality rate of about 50 percent, according to the World Health Organization.

Nine people have been diagnosed with Ebola in the U.S. The first patient, Thomas Eric Duncan, died at a Dallas hospital, and one other patient, Dr. Craig Spencer, remains in hospital care but is improving.

The case fatality rate so far in the U.S. has been much lower than in West Africa because of the intensive patient support that hospitals have been able to provide.

Warm up questions
  1. Where is Guinea?
  2. How many cases of Ebola have appeared in West Africa? How many in the U.S.?
Critical thinking questions
  1. A number of hospitals in Liberia and Guinea have shut down in the wake of the outbreak. How would this affect people with other diseases?
  2. The CDC has stated that there have been nearly 8,000 confirmed cases of Ebola in the outbreak, but the actual number could be higher. What are the challenges of tracking an outbreak in rural areas without an organized health infrastructure?
  3. What support is required for Ebola patients, and what resources (equipment, manpower, etc.) are required to provide this support? How would caring for Ebola patients become more difficult without these resources, and how can the U.S. help provide support for areas that lack them?
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