Ebola

[Lalaith]

So many of my friends are freaking out about the two Ebola patients (Dr. Brantly and Nancy Writebol, Samaritan's Purse workers) being brought to the US.

I'd like your thoughts.

I've directed them to the CDC's website, which I really do value as an accurate and good source of info. (I don't trust them blindly, but they do tend to be reliable.) http://www.cdc.gov/vhf/ebola/outbreaks/guinea/qa.html

One friend posted this study:

http://www.nature.com/srep/2012/121115/ ... 00811.html

(She actually posted 3 things that referenced this one study.) My response was this:

Well, one study does not a conclusion make, and, as far as I could tell, all of these articles are referencing the same study. There are also a lot of extra parameters they threw in there that may not even occur in the wild. So, while it is troubling and deserves much more research, it can't be viewed as definitive. One of the researchers said [in one of her other links] that it might be transmitted via large droplets which can't hang in the air for very long. If it is airborne at all, this seems the most likely scenario. Otherwise, like your friend, Doug, said above, the outbreak would be much worse than it already is. I do think the bigger concern is the lack of restrictions on air travel. I know there are some measures being taken, but I'd like to see them close the borders to these countries except to medical personnel and the like until the outbreak is under control.

Is that an accurate assessment of the study? Other thoughts? Are my friends right to be freaking out?

[Voronwë the Faithful]

in my opinion, your friends are over reacting.

[Frelga]

I think part of the reason people are freaking out is that we all know what would happen next if this were a movie. But it's not.

Of course, the thought of dying while bleeding out of your eyeballs is also pretty terrifying.

[Lalaith]

Nah. What's scary about that?

[Impenitent]

An expert (who's name I didn't consign to memory, but he's a research professor in contagious diseases at the Burnet Centre) was interviewed on the news here, and he said he wouldn't be worried about sitting across the aisle from an ebola patient, but would be careful not to come into contact with any body fluids.

[Passdagas the Brown]

An expert (who's name I didn't consign to memory, but he's a research professor in contagious diseases at the Burnet Centre) was interviewed on the news here, and he said he wouldn't be worried about sitting across the aisle from an ebola patient, but would be careful not to come into contact with any body fluids.

That's all well and good if you KNOW the person has Ebola.

[Primula Baggins]

It is actually a bad idea to come in contact with the body fluids of any stranger if you can possibly avoid it. Many more diseases than Ebola can be passed that way, and the person transmitting one of them to you may not know he/she is infected.

[Impenitent]

True enough!

Pardon my typos - tiny phone keyboard probs.

[nerdanel]

http://www.nytimes.com/2014/08/13/world ... ebola.html

Very interesting (and troubling) ethical questions posed by the limited supply of the drug ZMapp - and its administration to stricken Westerners rather than to Africans. In a highly anecdotal sense, the drug has correlated with short-term survival in some cases.

[Frelga]

That seems to me much ado about nothing, honestly. The literal nothing, in this case, being the (lack of) supply of the untested drug, which is now exhausted. It was given to two Americans and two African doctors, and it's gone.

Would it be more ethical to use the desperate African patients as guinea pigs when we don't know if it's likely to help or kill them?

Here's an interesting account of another aspect of the situation

I’m the head nurse at Emory. This is why we wanted to bring the Ebola patients to the U.S.

[Primula Baggins]

"We can fear, or we can care."

[River]

From the ethical standpoint, the use of a very limited supply of a completely and utterly unproven drug (it hasn't even been through Phase I trials) in an uncontrolled Ebola epidemic is, to put it bluntly, an impossible situation. How do you give informed consent when first there's no information and second, you've contracted a disease that has a greater than 50% chance of killing you? Frankly, I'm rather relieved Westerners who were voluntarily involved in the epidemic got the first doses only because of what it would look like if the drug turned out to be useless and they used dying Africans who had no choice about whether or not they were in the hot zone in the first place as their lab rats. As it is, we still don't know if this drug is helpful or not. The American lab rats are still alive and under care/study in an isolation unit at Emory. The Spanish lab rat died. But the Spanish lab rat was also older than either American and that may have been a factor. Or not. Maybe the Americans were going to get better even without the drug. Or maybe they weren't. Maybe the drug will help with the virus but then cause kidney failure or some other fabulously horrible complication. Or maybe it's the magic bullet. We don't know. We only know that anti-serums, given in time, can do wonderful things. Except when they don't. Biology is fun like that.

Today the WHO determined that it was ethical to use experimental treatments on Ebola patients. That loosens up part of the problem. Producing more drug is another issue altogether. ZMapp is antibodies produced by tobacco plants and I suspect the limiting factor is growing the plants. There are some other potential drugs in the works, but I gathered from NPR this morning that none of those drugs are actually ready to be put in someone's arm.

[River]

From the ethical standpoint, the use of a very limited supply of a completely and utterly unproven drug (it hasn't even been through Phase I trials) in an uncontrolled Ebola epidemic is, to put it bluntly, an impossible situation. How do you give informed consent when first there's no information and second, you've contracted a disease that has a greater than 50% chance of killing you? Frankly, I'm rather relieved Westerners who were voluntarily involved in the epidemic got the first doses only because of what it would look like if the drug turned out to be useless and they used dying Africans who had no choice about whether or not they were in the hot zone in the first place as their lab rats. As it is, we still don't know if this drug is helpful or not. The American lab rats are still alive and under care/study in an isolation unit at Emory. The Spanish lab rat died. But the Spanish lab rat was also older than either American and that may have been a factor. Or not. Maybe the Americans were going to get better even without the drug. Or maybe they weren't. Maybe the drug will help with the virus but then cause kidney failure or some other fabulously horrible complication. Or maybe it's the magic bullet. We don't know. We only know that anti-serums, given in time, can do wonderful things. Except when they don't. Biology is fun like that.

Today the WHO determined that it was ethical to use experimental treatments on Ebola patients. That loosens up part of the problem. Producing more drug is another issue altogether. ZMapp is antibodies produced by tobacco plants and I suspect the limiting factor is growing the plants. There are some other potential drugs in the works, but I gathered from NPR this morning that none of those drugs are actually ready to be put in someone's arm.

[Griffon64]

From reports I've read on the spread of Ebola, it appears that one of the complicating factors in containing the epidemic is some the infected's lack of co-operation as far as going to medical facilities for treatment.

When you are trying out two of only a few doses of a highly experimental drug on a human guinea pig, wouldn't you want to observe the effects in a controlled environment and on a cooperative patient? Informed Westerners who, as River said, voluntarily put themselves at risk in order to render aid, seem to fit that bill. Not to mention that I agree with River that the drums would be beating to the tune of "experimenting on dying Africans" if this drug was given to African patients who didn't survive.

Perhaps Dr. Khan should have received a dose. He would have fit the "informed" part of the profile, too. But the risk there, as the article nerdanel link to stated, was that the drug is highly experimental, and if he died after receiving it, it would have stoked suspicion of Western medicine and in that way have been more likely to hinder efforts to help.

I lean towards the pragmatic. To me it seems that the development of ZMapp, and hopefully its future availability and efficiency, was helped most by this initial use. Two more doses, which apparently exhausted the supply for now, was sent to Liberia to be given to African doctors who had fallen ill.

Now that the WHO endorsed using untested drugs in the outbreak, I hope that at least the official responses to any drugs used would be tempered. I bet there will still be plenty of voices in the media using the tragedy to beat the drums for their own agendas, though. While I absolutely insist that any Western dealings in Africa be ethical, I am also absolutely not interested in looking for breaches under every rock. That is counterproductive at best, and deliberately undermining trust in Western assistance at worst. Unfortunately, the West does not have a great track record in Africa ( Nestle, for instance ) so vigilance is definitely called for, but it can be taken too far and it should not.

[Passdagas the Brown]

Just as an update, there are developed countries with world class medical establishments in the East and South now.

[Griffon64]

That is known, isn't it? No need to update me, I'm from Africa. There are world class medical establishments in Africa as well. I could and maybe should have said "developed" instead of "Western" but in this case I used "Western" because the drug in question was developed in America and hence the response to it was also framed in an Western context, and likewise my response to the response. For portions of my post not applying in particular to ZMapp, "developed" should be substituted as needed, but most of the post was really about ZMapp.

[Passdagas the Brown]

Just a joke. I understood exactly what you meant. But I apologize if I gave any offense!

[Frelga]

Well, unfortunately, many Westerners do need a reminder. Present company excluded.

[River]

Yeah, if that Spanish priest hadn't gotten a dose I would've stuck with "Americans" when describing who got the drug first.

ZMapp is the only Ebola drug out there that's ready for even a Phase I trial. There are a couple other contenders, one being made in Canada and the other in the US. If a pharma company outside North America is working on Ebola, they're being very quiet about it.