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The Water Cooler
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How an Ebola Patient Dies
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<blockquote data-quote="JoLee1868" data-source="post: 2588690" data-attributes="member: 34169"><p>Thank you for the positive comment! I'm no expert by any means but i feel my fire department experience and current medical school training helps me convey it differently than the news does. In order for me to understand it I have to break it down simply. and as one of my favorite quotes i try to live by states "If you can't explain it simply, you dont know it well enough"- Albert Einstein. And if i can convey things im interested in, in a way that others can make more sense of it and mentally approach it from a different direction, then i'll be happy!</p><p></p><p></p><p></p><p>You can approach the "why bring them to the US with 2 very different thought processes to try and rationalize it however positive or negative you desire it to be. (personal opinion of course after research and my current understanding)</p><p></p><p><strong>-A) The "BRING THEM HOME" Argument: </strong></p><p>So the only treatment for Ebola currently is symptomatic supportive care. You give them fluids. Load them with platelets and blood. Try to maintain the fever at a minimal level, and be there to support them. And the BIGGIE that Africa has the problem with, is strict isolation and proper BSI (body substance isolation) precautions by healthcare workers. Currently in Africa the World Health Organization (WHO), the CDC, epidemiology/infectious disease experts, and other volunteer organisations have "swarmed" the area to try and do damage control. Still, you have the problems with the level of healthcare available. It's just not up to par for the patient load and presenting symptoms. SO, the organization that hosts the doctor there requested to have him transferred here to the US where the doctor has the very best chances of survival. Contrary to many peoples beliefs, the CDC didnt want him back necessarily, but when the request was made, it is their job to ensure the public health and safety and the methods used in transfer and isolation. Now that he is here, he can get the "special serum" which no one really knows much about, and get all the resources available dumped on him. Another benefit to being here in the US is the ability for local experts stateside to be able to observe and monitor the disease in a "safer" environment rather than a makeshift hospital isolation suite in Africa. There is the argument for that approach and the thought of giving him/her the best shot to live (and the selfish ability to observe the infection on our own turf by our own rules)</p><p></p><p><strong>B) The "No need to bring him here!" Argument</strong></p><p>The problems stated above of course apply here. But the different in thought comes to the treatment and the risk vs prognosis assessment. Ebola once it enters a humans blood stream is very capable of wrecking havoc and reproducing, so much so that with the most deadly species/strain "Zaire", you have a roughly 90% chance of fatality. You also have to appreciate where these numbers come from though. All the outbreaks of Ebola since its discovery in 1976 have been in Africa (western). Considering the problems already mentioned, it is no mystery that the survival rate is low. There hasnt been a large "1st world/modern country" outbreak where we can compare how the survival rates based on 'modern optimal medical care' vs '3rd world this is the best we got' medical care. And excluding the super secret special serum given to the doctor recently, there is no treatment but symptomatic/maintenance treatment. Is there anything here in a Level4 Biohazard safe room that the current docs cant do in a hospital in africa?? They can give fluids, blood, plasma, anti-pyretics (fever busters like tylenol, ect)...what else can do we besides our lab experiement serums? Is bringing someone over here and risking a local outbreak worth the risk when the patient statistically has a 90%-ish chance of dying??? the Risk vs probably outcome just doesnt make sense. If he is going to survive, then he would do it no matter whether he was in the US isolation room or a tarped off isolation room in Africa. </p><p></p><p>So to answer your question on <u>do they expect them to live</u>.....realistically no. BUT they get a chance to have CDC/infectious dz docs come observe stateside and do research only those in HOT zones could experience. I view it as a 'well since he is here, may as well make the best of it' situation by the CDC</p><p></p><p>Your question on <u>the test treatment and widespread use</u>: The way the FDA and drug companies, create, test, and then authorize the treatments for wide-spread use is a book by itself. However, in this type of situation, if the patient is coherent (or even if not the wife has the power of attorney and can authorize it) they can sign waiver forms that are probably longer than getting your Class III Weapons stamp or your first visit at a doctor's office. It would say the patient releases all liability from the company if anythign bad happens and understands they dont know what the hell the serum actually does. At this point, the risk of trying it is worth it when you are shaking hands with the Grim Reaper. The why just them in the US probably is due to the availabilyt of the serum and also the 'we have no idea what this does and if it works" factor. Ebola is hardly understood and so the serum being made is most likely just shots in the dark and literally a trial and error process. Sure it would be great to distribute it all across Africa as is, but here are the problems</p><p></p><p> 1) if it doesnt work then you lose public trust especially in Africa where they are already iffy on the legitimacy of the doctors and if Ebola is even real in the first place. Now you are faced with even less reporting cases because the "treatment" killed them</p><p> 2) what if there are awful side effects that end up being a second problem you now have to fix, instead of just 2 people now you have a large number being affected with again, less than optimal care available and a higher chance of bad outcomes</p><p> 3) Cost: the amount of man-hours and research done to create the stuff has to be astronomical. And this is only done in very small labs in small amounts. To take it to a full scale production would cost more time/money ect. </p><p></p><p>in the future as more is learned about Ebola and the Filoviridae Virus Family, more potent and specific serum can be made in larger quantities and then allows a larger test cohort. Still, it will take a long time before it is dumped out to every patient who has it. It would progress from these 2 docs.....then to a small group a say 1 hospital.....to now a region....slowly and methotically expanding. And after every trial long hours of data crunching on if it was successful, was it not. side effects? compare age, sex, what symptoms did the patient have when it was given, how long did it take to die or recover, if they did survive what is their functional abilities? Are they brain dead, are they back to 100%, yada yada. NOW, they go back and and tweak the chemical structure. and back at it. If things are going real well, then maybe you have Serum A, B, C, D. You do the same as above with each. Then compare to see which is best and worst, the compare and find out why. You can see the trend on how just the pharmacology and biochemistry of this process could take years. In the meanwhile the world is upset it's not being fixed right NOW. </p><p></p><p>THAT is why the official CDC report released a few days ago stated that the best prevention for a US outbreak, is to stop it at the source. </p><p></p><p>Kind of a long rant, and if you got this far hopefully it wasnt too awful of a read.</p></blockquote><p></p>
[QUOTE="JoLee1868, post: 2588690, member: 34169"] Thank you for the positive comment! I'm no expert by any means but i feel my fire department experience and current medical school training helps me convey it differently than the news does. In order for me to understand it I have to break it down simply. and as one of my favorite quotes i try to live by states "If you can't explain it simply, you dont know it well enough"- Albert Einstein. And if i can convey things im interested in, in a way that others can make more sense of it and mentally approach it from a different direction, then i'll be happy! You can approach the "why bring them to the US with 2 very different thought processes to try and rationalize it however positive or negative you desire it to be. (personal opinion of course after research and my current understanding) [B]-A) The "BRING THEM HOME" Argument: [/B] So the only treatment for Ebola currently is symptomatic supportive care. You give them fluids. Load them with platelets and blood. Try to maintain the fever at a minimal level, and be there to support them. And the BIGGIE that Africa has the problem with, is strict isolation and proper BSI (body substance isolation) precautions by healthcare workers. Currently in Africa the World Health Organization (WHO), the CDC, epidemiology/infectious disease experts, and other volunteer organisations have "swarmed" the area to try and do damage control. Still, you have the problems with the level of healthcare available. It's just not up to par for the patient load and presenting symptoms. SO, the organization that hosts the doctor there requested to have him transferred here to the US where the doctor has the very best chances of survival. Contrary to many peoples beliefs, the CDC didnt want him back necessarily, but when the request was made, it is their job to ensure the public health and safety and the methods used in transfer and isolation. Now that he is here, he can get the "special serum" which no one really knows much about, and get all the resources available dumped on him. Another benefit to being here in the US is the ability for local experts stateside to be able to observe and monitor the disease in a "safer" environment rather than a makeshift hospital isolation suite in Africa. There is the argument for that approach and the thought of giving him/her the best shot to live (and the selfish ability to observe the infection on our own turf by our own rules) [B]B) The "No need to bring him here!" Argument[/B] The problems stated above of course apply here. But the different in thought comes to the treatment and the risk vs prognosis assessment. Ebola once it enters a humans blood stream is very capable of wrecking havoc and reproducing, so much so that with the most deadly species/strain "Zaire", you have a roughly 90% chance of fatality. You also have to appreciate where these numbers come from though. All the outbreaks of Ebola since its discovery in 1976 have been in Africa (western). Considering the problems already mentioned, it is no mystery that the survival rate is low. There hasnt been a large "1st world/modern country" outbreak where we can compare how the survival rates based on 'modern optimal medical care' vs '3rd world this is the best we got' medical care. And excluding the super secret special serum given to the doctor recently, there is no treatment but symptomatic/maintenance treatment. Is there anything here in a Level4 Biohazard safe room that the current docs cant do in a hospital in africa?? They can give fluids, blood, plasma, anti-pyretics (fever busters like tylenol, ect)...what else can do we besides our lab experiement serums? Is bringing someone over here and risking a local outbreak worth the risk when the patient statistically has a 90%-ish chance of dying??? the Risk vs probably outcome just doesnt make sense. If he is going to survive, then he would do it no matter whether he was in the US isolation room or a tarped off isolation room in Africa. So to answer your question on [U]do they expect them to live[/U].....realistically no. BUT they get a chance to have CDC/infectious dz docs come observe stateside and do research only those in HOT zones could experience. I view it as a 'well since he is here, may as well make the best of it' situation by the CDC Your question on [U]the test treatment and widespread use[/U]: The way the FDA and drug companies, create, test, and then authorize the treatments for wide-spread use is a book by itself. However, in this type of situation, if the patient is coherent (or even if not the wife has the power of attorney and can authorize it) they can sign waiver forms that are probably longer than getting your Class III Weapons stamp or your first visit at a doctor's office. It would say the patient releases all liability from the company if anythign bad happens and understands they dont know what the hell the serum actually does. At this point, the risk of trying it is worth it when you are shaking hands with the Grim Reaper. The why just them in the US probably is due to the availabilyt of the serum and also the 'we have no idea what this does and if it works" factor. Ebola is hardly understood and so the serum being made is most likely just shots in the dark and literally a trial and error process. Sure it would be great to distribute it all across Africa as is, but here are the problems 1) if it doesnt work then you lose public trust especially in Africa where they are already iffy on the legitimacy of the doctors and if Ebola is even real in the first place. Now you are faced with even less reporting cases because the "treatment" killed them 2) what if there are awful side effects that end up being a second problem you now have to fix, instead of just 2 people now you have a large number being affected with again, less than optimal care available and a higher chance of bad outcomes 3) Cost: the amount of man-hours and research done to create the stuff has to be astronomical. And this is only done in very small labs in small amounts. To take it to a full scale production would cost more time/money ect. in the future as more is learned about Ebola and the Filoviridae Virus Family, more potent and specific serum can be made in larger quantities and then allows a larger test cohort. Still, it will take a long time before it is dumped out to every patient who has it. It would progress from these 2 docs.....then to a small group a say 1 hospital.....to now a region....slowly and methotically expanding. And after every trial long hours of data crunching on if it was successful, was it not. side effects? compare age, sex, what symptoms did the patient have when it was given, how long did it take to die or recover, if they did survive what is their functional abilities? Are they brain dead, are they back to 100%, yada yada. NOW, they go back and and tweak the chemical structure. and back at it. If things are going real well, then maybe you have Serum A, B, C, D. You do the same as above with each. Then compare to see which is best and worst, the compare and find out why. You can see the trend on how just the pharmacology and biochemistry of this process could take years. In the meanwhile the world is upset it's not being fixed right NOW. THAT is why the official CDC report released a few days ago stated that the best prevention for a US outbreak, is to stop it at the source. Kind of a long rant, and if you got this far hopefully it wasnt too awful of a read. [/QUOTE]
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