The Ebola Epidemic in West Africa

So many issues come into play with regards to the West African Ebola epidemic. I touch on two here that have caught my attention.

728 have lost their lives in Guinea, Liberia, and Sierra Leone. The current mortality rate is 55%. Is the outbreak out of control? Can it be stemmed and isolated within these countries? The U.S. has sent 50 public health experts to help control the epidemic in the region, but it is absolutely crucial that these public health experts work to educate and partner with in-country health workers. First, the virus is very hard to transmit; a healthy individual must be in complete contact with bodily fluids of an infected individual in order to contract the virus. Second, the maximum incubation period of the virus is 21 days. Third, the NIH is scheduled to begin testing a potential Ebola vaccine this September. The casualty numbers may be daunting, but the virus does not pose a global threat if West African clinics are educated on basic infection control measures. This “partnership” system can work to reduce similar epidemics in the future. We cannot create sustainable change in developing nations by providing medical aid without education and collaboration.

An American physician, Dr. Kent Brantly, who was infected by the virus was flown to Emory in Atlanta, GA for isolation and treatment. Brantly had been suffering for nine days prior to arriving to the U.S., and at one point while he was in Liberia, he told the doctors that he thought he was dying. They administered an experimental drug, ZMapp, which was developed by a biotech company called Mapp Biopharmaceutical. The drug had only been tested on monkeys with limited success. Miraculously, Brantly’s condition improved tremendously after he received the drug, and he was even able to take a shower on his own before being flown to the U.S. Startlingly, this drug has not endured the intense phase of clinical trials in the U.S. It was approved in this situation under the FDA’s “compassionate use” clause, allowing investigational drugs to be administered outside clinical trials in trying circumstances. Fortunately, Brantly’s case avoided the extensive bureaucratic measures associated with this regulation, and he received the medication in only a few days. How justified is the FDA’s “compassionate use” clause? Was it justified in this case or used “under desperate circumstances”? As an aspiring physician, my first thought is to “do no harm.” The drug had not undergone proper testing in humans, so the result easily could have panned out in a different way. However, the patient’s condition was deteriorating by the second, and his outlook for survival was very minimal because no successful cure exists for Ebola. In difficult cases such as this one, my course of action would fall on the patient’s consent for the investigational treatment. Only after he is sufficiently informed of and has consented to the procedure would I administer the drug under the FDA’s regulation. Of course, this act wouldn’t be without qualms, but no controversial situation is free of uncertainties.

Sources:
1. http://www.cnn.com/2014/08/04/health/experimental-ebola-serum/index.html
2. http://www.bbc.com/news/world-us-canada-28631777
3. http://www.nature.com/news/largest-ever-ebola-outbreak-is-not-a-global-threat-1.15640?WT.ec_id=NEWS-20140805

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