When magic substitutes medicine
Aug. 11th, 2014 04:01 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
nairiporterDr Kent Brantly may have accepted the prospect of imminent death at this point. He contracted ebola while in Liberia, where he was part of the international team that was combatting the deadly virus. Then his condition sharply deteriorated. He then received an experimental drug called Zmapp, which had only been tested on apes before that. It was administered to him by exception, since the US health authorities concluded that there was no viable alternative and he was otherwise already a dead man. An hour after he took the medicine, his condition abruptly improved. Last Saturday he was moved to a hospital in Atlanta, and was even able to walk out of the ambulance on his own. Cue panic outbursts throughout the Georgian populace...
Brantly's colleague Nancy Writebol, in a similar manner infected in Liberia and undergoing treatment in Atlanta, was also administered two doses of Zmapp, and displayed a positive reaction, although the effect was not as promising as in Brantly's case. The experts point out that it is unclear whether the improvement was exactly due to this treatment, or both doctors would have survived without the untested drug anyway.
There are three companies behind this Zmapp drug, plus the US government, and the Canadian public health agency. The medicine is giving some hope to the hundreds of ebola patients in West Africa. But the real solution goes a bit beyond that. Because the reasons for this epidemic are mostly related to the peculiarities of the affected countries, such as their cultural traditions. These factors have vastly helped spread the disease, and are blocking its adequate treatment and containment. Liberian president Ellen Johnson-Sirleaf has formulated the problem thus: "Ignorance and poverty, as well as entrenched religious and cultural practices, continue to exacerbate the spread of the disease". If we add the chronic lack of trust for the state, government, and outer world, we really have a truly deadly cocktail on our hands.
This has been the most serious ebola outbreak so far, with more than 900 death cases since February, the World Health Organisation already warning that the situation is getting out of control. There hasn't been an universally approved medicine or vaccine so far, but the victims do have a greater chance for survival if they detect the disease at an early stage, and get help.
For the first time, the disease which was named after a river in DR Congo, was encountered in 1976, and it took about 300 victims back then. The latest outbreak was in Uganda, with 400 victims. The three most affected countries now are Guinea, Liberia and Sierra Leone, and they are taking this very seriously: they have deployed their military to maintain quarantine in the affected regions, and restrict the free movement of people. In Sierra Leone and Liberia a state of emergency was declared, and these countries sealed their borders, or at least put them under increased control.
Help is coming from outside as well. The World Bank has granted a 200 million dollar emergency aid for the countries that are most seriously affected, and WHO has come up with a plan for coordinated actions, worth another 100 million. They have declared the epidemic a global threat, and called a meeting of experts in medical ethics to discuss the possibilities of using experimental treatment.
Many experts believe that the danger of epidemy spreading beyond Africa is still minute, and the risk for Europe and North America is very small. Obviously, the peoples of Africa are the most threatened, including people directly looking after the victims, or burying the dead, etc.
In fact, ebola is very difficult to contract, barring direct contact with bodily fluids from the infected patient. The reasons for the extremely high death rate in West Africa are cultural rather than purely medical. The epidemic broke out mainly in remote villages that are close to the tropical forest. And in Sierra Leone the situation was worsened by the deep distrust of the population to the central government. So when the government tells people that they need to impose a quarantine, and the bodies of the dead should be handed over, people simply refuse to comply.
The world media describes all sorts of absurd theories circulating among the local populace. Like the one that the authorities are trying to drain the blood of the dead and sell it, or that they need their organs for performing religious rituals, or that the ebola outbreak is the government's doing, a conspiracy aimed to get money from international aid. There is distrust to the international health workers as well, and accusations that they are deliberately spreading the virus, or that their disinfection medicines are what causes the disease. In Guinea, some of them are even forced to move around with armed convoys, and are being kicked out of the villages.
Doctors Without Borders reports that the epidemic in Liberia has largely deteriorated because many people keep their infected relatives at home, rather than bringing them to the isolation centres. There are reports that some are dumping their infected relatives on the streets, to avoid having a quarantine imposed on their homes. On top of all that, the local burial traditions often include a direct contact with the body, like ritual washing, touching and kissing, and this is extremely dangerous. Liberia has already ordered the dead to be cremated, after some communities refused to accept burials on their territory.
Another problem is that in these countries many people are illiterate, so important information about the disease tends to be disseminated under the form of leaflets and large billboards with pictures on them. Another concern is the fact that the locals consider the meat of wild animals such as bats and monkeys to be a gastronomic specialty, and that could also be a source of ebola. But the biggest obstacle is the wide-spread belief in witchcraft. People do not seek medical aid because they blame various mages and witches for their predicament. They also believe that modern medicine cannot help them, so they rely on rituals, talismans and herbs instead.
In their work for the PLOS Neglected Tropical Diseases magazine, authors Daniel Bausch and Lara Schwarz write that large epidemics like this almost always break out in areas where the economy and the health-care system have been ravaged by years of civil conflict and failed development. They point out that biological and ecological factors could prompt the virus to "come out" from the tropical forest, but that always happens in result of some human activity. Economic misery pushes people further into the forest in search of means of survival, which sharpens the risk of infection. And then the health-care system cannot deliver adequate treatment. And the virus spreads from the hospitals into the villages and cities. Ultimately, all the fear and distrust is directed against the very health workers who try to contain the epidemic. And the vicious cycle rolls on.
This is why the experts are unanimous that, if there is a case of ebola in a New York hospital for example, the risk of spreading the disease is by orders of magnitude lower because of the high standards and strict procedures for infection control. And the best way to stop the spreading of the virus in Africa is through educating people about it, encouraging hygiene, and introducing effective methods for quarantine.
Ebola is extremely contagious in the wrong conditions, and could only be efficiently countered through strict infection control. The current outbreak shows that early medical intervention vastly improves the chances for survival, and prevention is the most effective way of dealing with the disease. Quarantine, improved hygiene, restricted contact with bodily fluids, and restricting people's movement across the affected regions, are all secondary measures, mostly dealing with the symptoms. As is the availability of adequate equipment and facilities, something West Africa is direly lacking. In North America or Europe, you would immediately rush the patient into isolation, use the respective isolation equipment, deploy the respective expert staff, and the risk of spreading would be brought almost to zero. So the challenge is West Africa, not the West.
But despite all assurances, in today's globalised world, where moving from point A to point B is easier than ever, the African ebola epidemic is causing serious concerns, and tightened control at international airports. The BA has already cancelled its flights to and from Liberia and Sierra Leone, and then two local air carriers followed suit as well. The fact that a US citizen of Liberian origin has managed to fly from Liberia to Nigeria without any obstacles, is also causing panic. The question is how a man whose sister had just died of ebola, himself already exhibiting symptoms of the disease, was so easily allowed to board several consecutive flights before eventually dying in Nigeria, and becoming the first ebola case outside of his country (the second was the nurse who treated him). He may have already transferred the virus to anyone who happened to be nearby, or who used the same toilet on the plane.
So, some countries in Europe and Asia, plus the US, are already taking measures against the spreading of the virus on their territory. Most of them are warning their citizens not to travel to West Africa. And Saudi Arabia has stopped issuing visas for citizens of Guinea, Liberia and Sierra Leone, after a Saudi national who had recently visited the latter, was treated with symptoms similar to ebola, and died at a hospital in Jeddah.
The British health authorities have issued a warning to all doctors, border control and airport staff to be vigilant for any signs of ebola. They're cautiously optimistic that it's "unlikely to see as many cases" of ebola as in West Africa, thanks to the established system of urgent response in such cases, including isolation of anyone who could spread the disease.
Meanwhile, there is a ray of hope on the horizon. Dr Anthony Fauci , director of the American national institute of immunology and infections, promises that clinical testing of a new vaccine will be started in September, and by mid 2015 the vaccine would be a fact, and could be used at least for the health workers who are currently exposed to extreme danger while looking after affected patients. But the bottom-line is that while ignorance and poverty continue to hinder medicine, epidemics like these will keep lurking behind every corner.
Brantly's colleague Nancy Writebol, in a similar manner infected in Liberia and undergoing treatment in Atlanta, was also administered two doses of Zmapp, and displayed a positive reaction, although the effect was not as promising as in Brantly's case. The experts point out that it is unclear whether the improvement was exactly due to this treatment, or both doctors would have survived without the untested drug anyway.
There are three companies behind this Zmapp drug, plus the US government, and the Canadian public health agency. The medicine is giving some hope to the hundreds of ebola patients in West Africa. But the real solution goes a bit beyond that. Because the reasons for this epidemic are mostly related to the peculiarities of the affected countries, such as their cultural traditions. These factors have vastly helped spread the disease, and are blocking its adequate treatment and containment. Liberian president Ellen Johnson-Sirleaf has formulated the problem thus: "Ignorance and poverty, as well as entrenched religious and cultural practices, continue to exacerbate the spread of the disease". If we add the chronic lack of trust for the state, government, and outer world, we really have a truly deadly cocktail on our hands.
This has been the most serious ebola outbreak so far, with more than 900 death cases since February, the World Health Organisation already warning that the situation is getting out of control. There hasn't been an universally approved medicine or vaccine so far, but the victims do have a greater chance for survival if they detect the disease at an early stage, and get help.
For the first time, the disease which was named after a river in DR Congo, was encountered in 1976, and it took about 300 victims back then. The latest outbreak was in Uganda, with 400 victims. The three most affected countries now are Guinea, Liberia and Sierra Leone, and they are taking this very seriously: they have deployed their military to maintain quarantine in the affected regions, and restrict the free movement of people. In Sierra Leone and Liberia a state of emergency was declared, and these countries sealed their borders, or at least put them under increased control.
Help is coming from outside as well. The World Bank has granted a 200 million dollar emergency aid for the countries that are most seriously affected, and WHO has come up with a plan for coordinated actions, worth another 100 million. They have declared the epidemic a global threat, and called a meeting of experts in medical ethics to discuss the possibilities of using experimental treatment.
Many experts believe that the danger of epidemy spreading beyond Africa is still minute, and the risk for Europe and North America is very small. Obviously, the peoples of Africa are the most threatened, including people directly looking after the victims, or burying the dead, etc.
In fact, ebola is very difficult to contract, barring direct contact with bodily fluids from the infected patient. The reasons for the extremely high death rate in West Africa are cultural rather than purely medical. The epidemic broke out mainly in remote villages that are close to the tropical forest. And in Sierra Leone the situation was worsened by the deep distrust of the population to the central government. So when the government tells people that they need to impose a quarantine, and the bodies of the dead should be handed over, people simply refuse to comply.
The world media describes all sorts of absurd theories circulating among the local populace. Like the one that the authorities are trying to drain the blood of the dead and sell it, or that they need their organs for performing religious rituals, or that the ebola outbreak is the government's doing, a conspiracy aimed to get money from international aid. There is distrust to the international health workers as well, and accusations that they are deliberately spreading the virus, or that their disinfection medicines are what causes the disease. In Guinea, some of them are even forced to move around with armed convoys, and are being kicked out of the villages.
Doctors Without Borders reports that the epidemic in Liberia has largely deteriorated because many people keep their infected relatives at home, rather than bringing them to the isolation centres. There are reports that some are dumping their infected relatives on the streets, to avoid having a quarantine imposed on their homes. On top of all that, the local burial traditions often include a direct contact with the body, like ritual washing, touching and kissing, and this is extremely dangerous. Liberia has already ordered the dead to be cremated, after some communities refused to accept burials on their territory.
Another problem is that in these countries many people are illiterate, so important information about the disease tends to be disseminated under the form of leaflets and large billboards with pictures on them. Another concern is the fact that the locals consider the meat of wild animals such as bats and monkeys to be a gastronomic specialty, and that could also be a source of ebola. But the biggest obstacle is the wide-spread belief in witchcraft. People do not seek medical aid because they blame various mages and witches for their predicament. They also believe that modern medicine cannot help them, so they rely on rituals, talismans and herbs instead.
In their work for the PLOS Neglected Tropical Diseases magazine, authors Daniel Bausch and Lara Schwarz write that large epidemics like this almost always break out in areas where the economy and the health-care system have been ravaged by years of civil conflict and failed development. They point out that biological and ecological factors could prompt the virus to "come out" from the tropical forest, but that always happens in result of some human activity. Economic misery pushes people further into the forest in search of means of survival, which sharpens the risk of infection. And then the health-care system cannot deliver adequate treatment. And the virus spreads from the hospitals into the villages and cities. Ultimately, all the fear and distrust is directed against the very health workers who try to contain the epidemic. And the vicious cycle rolls on.
This is why the experts are unanimous that, if there is a case of ebola in a New York hospital for example, the risk of spreading the disease is by orders of magnitude lower because of the high standards and strict procedures for infection control. And the best way to stop the spreading of the virus in Africa is through educating people about it, encouraging hygiene, and introducing effective methods for quarantine.
Ebola is extremely contagious in the wrong conditions, and could only be efficiently countered through strict infection control. The current outbreak shows that early medical intervention vastly improves the chances for survival, and prevention is the most effective way of dealing with the disease. Quarantine, improved hygiene, restricted contact with bodily fluids, and restricting people's movement across the affected regions, are all secondary measures, mostly dealing with the symptoms. As is the availability of adequate equipment and facilities, something West Africa is direly lacking. In North America or Europe, you would immediately rush the patient into isolation, use the respective isolation equipment, deploy the respective expert staff, and the risk of spreading would be brought almost to zero. So the challenge is West Africa, not the West.
But despite all assurances, in today's globalised world, where moving from point A to point B is easier than ever, the African ebola epidemic is causing serious concerns, and tightened control at international airports. The BA has already cancelled its flights to and from Liberia and Sierra Leone, and then two local air carriers followed suit as well. The fact that a US citizen of Liberian origin has managed to fly from Liberia to Nigeria without any obstacles, is also causing panic. The question is how a man whose sister had just died of ebola, himself already exhibiting symptoms of the disease, was so easily allowed to board several consecutive flights before eventually dying in Nigeria, and becoming the first ebola case outside of his country (the second was the nurse who treated him). He may have already transferred the virus to anyone who happened to be nearby, or who used the same toilet on the plane.
So, some countries in Europe and Asia, plus the US, are already taking measures against the spreading of the virus on their territory. Most of them are warning their citizens not to travel to West Africa. And Saudi Arabia has stopped issuing visas for citizens of Guinea, Liberia and Sierra Leone, after a Saudi national who had recently visited the latter, was treated with symptoms similar to ebola, and died at a hospital in Jeddah.
The British health authorities have issued a warning to all doctors, border control and airport staff to be vigilant for any signs of ebola. They're cautiously optimistic that it's "unlikely to see as many cases" of ebola as in West Africa, thanks to the established system of urgent response in such cases, including isolation of anyone who could spread the disease.
Meanwhile, there is a ray of hope on the horizon. Dr Anthony Fauci , director of the American national institute of immunology and infections, promises that clinical testing of a new vaccine will be started in September, and by mid 2015 the vaccine would be a fact, and could be used at least for the health workers who are currently exposed to extreme danger while looking after affected patients. But the bottom-line is that while ignorance and poverty continue to hinder medicine, epidemics like these will keep lurking behind every corner.
