The New England Journal of Medicine (N Engl J Med 2014; 371:2054-2057November 27, 2014DOI: 10.1056/NEJMp1413084) carries an article detailing the progress of Ebola in West Africa clinical patients and concludes that if patients can be kept alive for thirteen days from onset of symptoms they are likely to survive the infection. The data is based on 700 cases treated in Monrovia, Libria.
Progress of The Disease
A high fever running about 40 degrees C. concurrent with malaise, fatigue and body aches (similar to the flu) and by day three to five with the fever continuing, gastrointestinal problems including stomach main, nausea, vomiting, and diarrhea occur.
In Africa with limited communication and health care facilities, it is usually three days after these symptoms occur that patients first present at medical facilities – about the time families become overwhelmed.
At this point PCR (polymerase chain reaction) blood tests often show Ebola positive results but Ebola can’t be ruled out until another 72 hours have passed with additional clean test results.
This particular team reports that they had seen no evidence of people passing along the infection during the early febrile phase (before vomiting began.)
Frequent vomiting made it impossible to tolerate much fluid intake which is critical to survival.
Patients would normally go into shock after a few days’ loss of hydration. Bleeding from mouth or in stool was rare, only occurring in about five percent of patients.
Most deaths occurred between seven and 12 days after initial symptoms.
The most vulnerable were found to be children under five, the elderly, and pregnant women.
Due to the tropical conditions doctors only have two to three minutes to evaluate each patient because the full protective gear would lead to heatstroke in an hour or less.
Increased hydration along with medicine to stop diarrhea and vomiting is critical to survival, especially in West Africa where intravenous fluid replacement is difficult due to lack of supplies.
