Ebola's Other Victims: Health Care Workers
by Richard Knox
NPR Morning Edition
September 19, 2012
A medical worker from the U.S. Centers for Disease Control and Prevention works at the laboratory where Ebola specimens from the Congo were tested at the start of the latest outbreak.
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.