Recently, it has been noted that white Americans seem to have all survived an ebola infection while black Africans, such as Thomas Eric Duncan, have not. Some have even implied that there is a racial aspect to the level of care rendered to victims of this deadly disease. If so, this would be an injustice that must be critically examined and rectified.
Let’s consider the situation in West Africa with regards to ebola. Ebola is currently raging in three West African countries: Liberia, Sierra Leone, and Guinea. These countries are poor even in good times, but the ebola epidemic has caused their economies to grind to a halt. Basic protective gear for health workers and burial teams is expensive and, at a grand scale, beyond the resources available to underdeveloped nations.
Hospitals are also less numerous in these countries, as are qualified medical professionals. There are 2 doctors per 100,000 people in Sierra Leone. Compare that to the United States, where there are 2.5 physicians per 1,000. It is well documented that hospitalization improves the survival rate of ebola patients, due to the supportive care that can be given there that couldn’t be provided in the average home.
At one point, there were 1,000 active ebola cases in Monrovia, the capitol of Liberia. Monrovia only has 240 beds at present that are available for ebola care. That means that the majority of ebola patients there were at home or on the streets. These people had no access to simple supportive care such as intravenous fluid hydration. Severe dehydration is one of the main causes of death from ebola.
Ebola has been particularly harsh on healthcare workers. With limited protective gear and poor training, the nurses in West Africa have borne the brunt of the contagion. We have seen the effects of inadequate education in infectious disease protocol in the U.S. when two nurses who treated Mr. Duncan came down with the disease despite protective gear. Imagine the situation in Liberia, where a greater percentage of health workers must, surely, get infected.
Every human must eat to survive. In the United States and other developed countries, we have assurances that our food will reliably be free of disease. In West Africa, the very animals that are reservoirs for the virus are part of the daily diet, including bats. These are often cooked over 55 gallon oil drums, leading to parts being undercooked. This means that West Africans are exposed to viral loads of ebola in their food, sometimes on a regular basis. Greater viral load equals a higher death rate.
Other factors involve the limited availability of experimental medications that could possibly speed the recovery of the ebola patient. Sera like Zmapp is hard to come by, even for some European health workers that were evacuated from the epidemic zone. Given too late, even an effective drug may not save the victim. Clearly, the ease of obtaining and delivering the proper medicines has implications for survival.
It appears that the hospital in Texas where Mr. Duncan was admitted had no access to Zmapp, the drug given to the infected American missionaries who were evacuated to high-level infectious disease centers in the United States. He received, instead, an alternate experimental drug that failed. If this was due to the fact that it was just a regular city hospital, the CDC must bear the responsibility for failing to demand that Mr. Duncan be transferred immediately to one of the four high-level infectious disease units in the nation. Anti-viral drugs work best early in the disease process, and any delay is cause for concern.
In all fairness, it should be noted that not all Caucasians evacuated and hospitalized have survived the disease. 2 Spanish missionaries and a German doctor perished from the disease after being transferred to hospitals in Europe. Some of these even received the experimental Zmapp, but too late.
The CDC should institute a national standard that must be followed by any hospital that admits an ebola patient, and that standard must include immediate transfer to facilities that can adequately protect the patient, the medical staff, and be uniform across the board. In this way, no victim, black or white, on our shores will receive treatment at any level but the absolute highest.
Joe Alton, M.D.
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