Easy mea­sures to keep Ebola at bay

Re­hy­dra­tion and the right painkillers found to be key

The Star Early Edition - - HEALTH - BY JA­SON GALE Mel­bourne

THE BEST med­i­cal ad­vice for sur­viv­ing Ebola might fit in one word: drink. With tar­geted drugs and vac­cines at least months away, doc­tors and pub­lic health ex­perts are learn­ing from Ebola sur­vivors what steps helped them beat the in­fec­tion.

It turns out drink­ing 4 litres or more of re­hy­dra­tion so­lu­tion a day – a chal­lenge for any­one and es­pe­cially those wracked by re­lent­less bouts of vom­it­ing – is cru­cial.

“When peo­ple are in­fected, they get dry as a crisp re­ally quickly,” said Si­mon Mardel, an emer­gency room doc­tor ad­vis­ing the World Health Or­gan­i­sa­tion (WHO) 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 health­care 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 that 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 (ORS) mixed in wa­ter as soon as her gas­troin­testi­nal symp­toms started – be­fore her Ebola di­ag­no­sis. Once in hos­pi­tal, she trawled the in­ter­net for in­sights from sur­vivors.

“I knew that in di­ar­rhoeal dis­eases, shock from de­hy­dra­tion is the num­ber one cause of death,” Igonoh said. “From my re­search on Ebola while in iso­la­tion, I found that to be true.”

WHO shared tran­scripts of in­ter­views with Igonoh and five other Ebola sur­vivors to pro­vide in­sight into clin­i­cal ex­pe­ri­ences and man­age­ment. Pa­tients in Liberia lost 5 litres of fluid a day from di­ar­rhoea alone, doc­tors treat­ing cases there wrote in a Novem­ber 5 pa­per in the New Eng­land Jour­nal of Medicine.

Se­vere fluid loss can cause 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,” Igonoh said.

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 litres of fluid from pro­fuse sweat­ing, vom­it­ing and di­ar­rhoea, ac­cord­ing to Mardel.

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, was the pre­ferred med­i­ca­tion for pain and fever. Oth­ers such as as­pirin and ibupro­fen could worsen bleed­ing.

“We will halve the mor­tal­ity by firstly just stop­ping an­ti­in­flam­ma­to­ries and giv­ing hy­dra­tion, and re­ally push­ing it,” Mardel said.

“I want ev­ery man and woman in Sierra Leone to know this. I want… every­body to be talk­ing about it.” – Bloomberg

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