Shots - Health Blog
2:04 am
Wed September 19, 2012

Ebola's Other Victims: Health Care Workers

Originally published on Wed September 19, 2012 7:51 am

The Ebola virus continues to strike people in the Democratic Republic of Congo. Since May, the World Health Organization has counted 72 confirmed, probable or suspected cases and 32 deaths.

As usual, a disproportionate share of those cases are health care workers — 23 of them, almost a third.

That's because, despite elaborate protective garb and other precautions, it's very hard for doctors, nurses and health aides to avoid virus-laden bodily fluids of Ebola patients or accidental needle sticks. That's especially true at the beginning of an outbreak, when Ebola symptoms might be mistaken for malaria or something else.

"The repeating story is always that here's incredible incidence among health care workers," says Peter Jahrling of the National Institute of Allergies and Infectious Diseases, an expert on Ebola and similarly lethal viruses. "It's usually the medical staff that bears the brunt of it."

Apart from the tragedy of caregiver deaths, this has a ripple effect that helps keep an outbreak going.

Dr. Armand Sprecher of Doctors Without Borders says that's because when health workers don moon suits and avoid all unnecessary contact with Ebola victims, that reinforces the community perception that the hospital is just the place people go to die.

"If you don't hang IV lines and do things that look medical, if you just put people in beds and walk around in protective gear and don't touch anybody, well, why would they want to come there?" Sprecher said in an interview with Shots from the Doctors Without Borders operations center in Brussels.

The perception is only fueled when people see health care workers die of Ebola in hospitals.

"We have a horrible time marketing our treatment unit because patients are not seeing a benefit to come in when we don't produce a lot of survivors," Sprecher says.

And if infected people stay away from hospitals, that just allows the virus to spread out in the community.

But the grim truth is doctors can't do anything for Ebola patients except give them fluids and other supportive care. What's needed, Sprecher says, is an effective treatment.

"If you had something in the refrigerator on standby, it might make it easier for the health care staff to engage with the patients," he says, "if they knew there was something that might help them in the event of something awful happening."

That might become possible. Fifty leading experts on Ebola and similar deadly viruses are gathering Wednesday and Thursday at the National Institutes of Health outside Washington, D.C., to assess several promising treatments for these diseases.

"This is really the first time we've ever all gotten together and addressed this problem," says Jahrling, who is running the meeting.

Meanwhile, the Food and Drug Administration has just granted so-called fast-track review to one company for two of its experimental drugs for Ebola and Marburg viruses.

Jahrling says this week's workshop will hash out what it would take to move one or more of the advanced treatments to the point where it could be tried in humans exposed to Ebola or its cousin Marburg virus.

One big challenge is to get the treatment — a vaccine, a cocktail of monoclonal antibodies or an antisense RNA-based drug — to where it would be needed.

That's possible when the exposed person is a U.S. laboratory worker who has an accidental needle stick during a monkey experiment. But it's a different story when Ebola pops up in a remote corner of Africa and no one can be sure when someone got exposed.

Animal experiments suggest that the Ebola antidotes will need to be given within 24 to 48 hours of exposure to the virus, before symptoms appear.

Another hurdle: Officials in the affected country would have to be convinced that giving a drug never used before in people was a safe and ethical experiment.

"These are the kinds of things that are going to come out in our workshop discussion," Jahrling says, "whether you're going to treat one occupational exposure or a village."

The goal is to see if the groundwork can be laid for trying an experimental treatment for Ebola before the next outbreak — or the one after that.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, HOST:

It's MORNING EDITION from NPR News. Good morning. I'm Renee Montagne.

STEVE INSKEEP, HOST:

And I'm Steve Inskeep.

An outbreak of the Ebola virus continues in the Democratic Republic of Congo. Since last May, the government says the virus has struck 72 people and killed almost half of them. Although other diseases kill far more people, none is more feared than Ebola. And as NPR's Richard Knox reports, nobody is more at risk than the health care workers who take care of the victims.

RICHARD KNOX, BYLINE: There was a poignant piece of good news the other day, in the midst of the Congo's Ebola outbreak. A woman suffering from the disease gave birth in the 20-bed ward set up to isolate and treat victims.

DR. ALFONSO VERDU: It was the first time a pregnant woman was having a baby in an Ebola treatment center.

KNOX: That's Dr. Alfonso Verdu of Doctors Without Borders. He's speaking by satellite phone from Isiro, the ramshackle town in northeast DRC that's the epicenter of the outbreak. Unfortunately, the mother died after giving birth. Her infant survives, but has Ebola. There've been five new confirmed cases of the disease this month. So Verdu says everybody in the surrounding area is still being urged to take precautions.

VERDU: We ask the people not to shake hands, not to touch them, not to hug each other. The authorities are respecting that. But also, the people in the shops is respecting that.

KNOX: Nobody is at higher risk of Ebola than the doctors and nurses and health aides who care for its victims. Despite elaborate precautions, Dr. Armand Sprecher says health workers often come into contact with infected bodily fluids or accidentally stick themselves with contaminated needles.

DR. ARMAND SPRECHER: The survival rate of exposure to Ebola is, you know, like a needle stick injury, it's 100 percent fatal. Nobody's ever survived one of those.

KNOX: Sprecher works in the operations center of Doctors Without Borders in Brussels. He says the dangers force health workers to don moon suits and avoid all unnecessary contact with Ebola patients. And that just reinforces the perception that hospitals are places where people with Ebola go to die.

SPRECHER: You know, if you don't hang IV lines and do things that look medical, if you just put people in beds and walk around in protective gear and don't touch anybody, well, why would they want come there?

KNOX: And if infected people stay away from hospitals, that just keeps the epidemic going because the virus spreads so readily out in the community. But the grim truth is doctors can't do anything for Ebola patients except give them fluids and other supportive care. What's needed, he says, is an effective treatment.

SPRECHER: If you had something in the refrigerator, on standby, it might make it easier for the health care staff to engage with the patients, if they knew that there was something that might help them in the event of something awful happening.

KNOX: That might become possible. Fifty leading experts on Ebola and similar deadly viruses are gathering today and tomorrow at the National Institutes of Health outside Washington to assess several promising treatments for these diseases.

PETER JAHRLING: You know, this is really the first time we've ever all gotten together and addressed this problem.

KNOX: That's Peter Jahrling of the N.I.H., who's running the meeting.

JAHRLING: Whenever there's an outbreak and we go rushing into the scene to document what's going on, we're concerned that we really don't have anything specific to offer. And if we did have something specific to offer and had reasonable expectation that it would work, I think it would probably be of mutual benefit to try to figure out how to get that material where it needs to be.

KNOX: It's a big challenge. Animal experiments suggest treatment has to be given within 24 to 48 hours after infection, before symptoms appear. That's possible when the victim is a U.S. lab worker who has an accidental needle stick during a monkey experiment. But it's a different story when Ebola pops up in a remote corner of Africa and no one can be sure when someone was exposed.

And if researchers wanted to try a drug that had never been used in people before, officials in the affected country would have to be persuaded it was a safe and ethical experiment.

JAHRLING: These are the kinds of things that are going to come out in our workshop discussion, I think, whether you're going to, you know, treat one occupational exposure, or a village.

KNOX: The goal is to see if the groundwork can be laid for trying an experimental treatment for Ebola before the next outbreak or the one after that.

Richard Knox, NPR News. Transcript provided by NPR, Copyright NPR.

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