Easy measures to keep Ebola at bay

Rehydration and the right painkillers found to be key

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