Saturday, November 22, 2014

Why have the patients treated for Ebola in the U.S. done so well?

The truth is, we don't know.  There is a scarcity of quality information on this outbreak because the governments in the 3 hardest hit countries don't want negative publicity. The reporters from developed Western countries have returned to their countries after some of them contracted the disease, and I have not heard of any news crews returning to West Africa.

Recently, there was a study published in NEJM by Schieffelin et al, which reported observations made at the Kenema hospital in Sierra Leone. There, they found 57 percent mortality among those younger than 21, and 94 percent mortality among those aged 45 and older. Overall fatality from Ebola was 74 percent. These are some pretty scary numbers and they simply do not compare with what has been reported in the case updates provided by WHO and the CDC. In the latest situation update from WHO, Sierra Leone reports a total of 6190 cases, with 5150 of them being confirmed and only 1267 fatalities. If you calculate the mortality from this report, you get only 20% using total cases or 24% if you only use confirmed cases number. The most likely explanation is that the numbers reported in WHO and CDC surveys are bogus.

Here in USA, everyone who received treatment early during the course of their illness, including the 2 nurses from Texas and the irresponsible doctor treated in NYC, survived. So how do you square the remarkable survival rates we've seen in the few people treated here at the US, with the survival rates reported in that study cited above? One possibility is that the people who were treated at the Kenema hospital were much sicker than the typical person who contracts this strain of Ebola. Perhaps those with only mild symptoms never show up at treatment centers in Sierra Leone and are able to weather this disease at home. Another possibility is that the folks treated in the U.S. were given medications unavailable in West Africa, such as Zmapp, early during the course of their disease, and such medications proved very effective. To repeat what I said in my opening sentence, we just don't know.

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