What sort of lessons has Emory learned from caring for these two people that would be transferrable to patients in west Africa?

We are not being critical of our colleagues in west Africa. They suffer from a terrible lack of infrastructure and the sort of testing that everyone in our society takes for granted, such as the ability to do a complete blood count—measuring your red blood cells, your white blood cells and your platelets—which is done as part of any standard checkup here. The facility in Liberia where our two patients were didn’t even have this simple thing, which everyone assumes is done as part of your annual physical.

What we found in general is that among our Ebola patients, because of the amount of fluid they lost through diarrhea and vomiting, they had a lot of electrolyte abnormalities. And so replacing that with standard fluids [used in hospital settings] without monitoring will not do a very good job of replacing things like sodium and potassium. In both of our patients we found those levels to be very low. One of the messages we will be sending back to our colleagues is even if you don’t have the equipment to measure these levels, do be aware this is occurring when patients are having a lot of body fluid loss.

Our two patients also gained an enormous amount of fluid in their tissues, what we call edema. In Ebola virus disease there is damage to the liver and the liver no longer makes sufficient amount of protein; the proteins in the blood are very low and there is an enormous amount of fluid leakage out into the tissues. So one of the takeaway messages is to pay closer attention to that and perhaps early on try to replace some of these proteins that patients’ livers lack.

Is there anything you would like to add about insights you learned from your Ebola patient care?

The major thing I hope people have appreciated is there was a lot of anxiety, a lot of negative comment about our bringing these two patients back to our facility to care for them. Most of that we attribute to poor education, and I’m hoping that since we were successful in helping them resolve their infections it helps to dispel the idea that this is a disease that by nature has to be fatal. As we have been saying all along, we feel that the high fatality rates in developing parts of the world where this infection occurs are because of the lack of resources. We had always felt that the survival of patients with proper support would be a lot better than in developing countries.
 
The other thing I would hope we would get across to the public is this is a disease where we don’t have to have a lot of secondary infections—if we follow standard infection-control procedures. We had 26 people giving direct patient care to these patients and we did not have any secondary infections at all, and that’s as we expected.
 
We were using contact precautions and droplet precautions. Fortunately, we don’t have to go to that level of protection [wearing protective full-body suits like in west Africa]. You wear whatever you need so that the blood and body secretions don’t come into contact with you, depending on the quantity of fluids. We used gowns and gloves and foot coverings of the health care workers in order to prevent contact with the body materials of these individuals. Our approach was what CDC recommends: you wear a mask and goggles or a face shield to prevent that infection. Some of the nurses spending three to four hours in patients’ rooms were more comfortable wearing hoods than masks and face shields, though those would have been adequate. We can manage care with minimal chance for secondary spread. It’s not as though we brought the plague to American shores.

Read more: http://www.scientificamerican.com/article/ebola-doctor-reveals-how-infected-americans-were-cured/

hmmmmm

What lesson(s) has Nigeria learned from managing 15+ cases of EVD?

1) Show your preparedness: Assure Nigerians that you've stocked up Ebola vaccines in case of a possible outbreak, even when no such vaccine exists

2) Be the hero: Rush to national TV to announce containment of Ebola while a new outbreak takes form due to government negligence.

3) Bluster and talk tough: "We are on top of the situation" those words are soothing to Nigerians.

4) Divert Ebola Intervention Fund to other uses: Nigerians will soon forget; their memory is short as can be.

5) Dangle health insurance in front of Health workers and scam them as usual. They'll grin and bear it.

6) Be reactive as usual: only provide Ebola testing to Port Harcourt after an Ebola death is confirmed. No kobo must be wasted providing Ebola testing for Birnin Kebbi since Birnin Kebbi might not experience an outbreak.

7) Assure Nigerians that isolation is akin to a romantic getaway in the hope that the Dennis Akaghas will have no voice.

And many many more.

Afterall, ebola is not as deadly as assumed. It is not a death warrant. Unfortunately, some people ignorantly committee suicide trying to provent ebola with salt.

Emory Hospital! May God bless them and all the doctors within their walls... these are people that know what they are supposed to be doing, jare....when it comes to taking care of patients and nursing them back to full health. So far, they have recorded 100% success rate in treating their own victims of Ebola.

I doff my hat, jo!

Great research and achievements within the space of weeks. They should hiwever provide training workshops at least fly in for a week or two too.