Emory’s Gavin Harris, MD, discusses how getting patients this type of treatment is essential to reducing the severity of disease, as well as adapting the four “I’s” algorithm in dealing with high-consequence infectious disease outbreaks.
This is part of a short series around high-consequence infectious diseases and the ongoing Hantavirus cluster associated with the cruise ship and the Ebola outbreak in Africa. The discussions with clinicians with experience in these areas will include dealing with quarantines, monitoring protocols, and the significance of biopreparedness in the face of these ongoing health crises and a reduced US infectious disease healthcare budget.
In updating the public on the Ebola outbreak in Africa, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, wrote on X that in the Democratic Republic of Congo (DRC) there were 82 cases confirmed with 7 confirmed deaths, and almost 750 suspected cases and 177 suspected deaths as of May 21.1 In Uganda, he reported there were 5 total cases and 1 death reported as of May 22.1
Gavin Harris, MD, associate medical director, Serious Communicable Diseases Program (SCDP), Emory University, has treated patients with Ebola in hot zones, which are areas where there are outbreaks of high-consequence infectious disease. He says there are a few challenges associated with this ongoing outbreak with the Bundibugyo virus disease (BVD) of Ebola.
“It's not typically picked up by traditional testing that looks for the more common species of Ebola, such as Zaire Ebola virus or Sudan virus. One of the challenges with this specific outbreak is it likely has been spreading for some time before it was detected, because testing may not have been for this specific area,” Harris said. “The other challenge with Bundibugyo is that we don't have licensed medical countermeasures like we do for the more common species that causes Ebola virus disease.”
Harris says aggressive supportive care for all patients with Ebola is essential. “People who unfortunately get ill with Ebola of any strain have profound electrolyte abnormalities, they lose a lot of fluids, and so things like sodium, potassium, calcium levels might be very out of the normal ranges, and so they need aggressive replenishment of the fluids that they might lose from gastrointestinal losses, such as vomiting or diarrhea,” he said.
Harris says when it comes to clinicians and support healthcare personnel taking care of people with Ebola, the need for personal protective equipment (PPE) is paramount and the level of PPE depends on what stage of disease the patient is in.
“Patients often present with non-specific symptoms, sudden high fevers, nausea, maybe some abdominal pain, bone aches, things of that nature. These are what we call a dry patient, so dry symptoms that can rapidly progress into the wet phase, which, as you might imagine, includes things like bleeding, vomiting, diarrhea, so that's when the loss of these fluids becomes more apparent—that changes our PPE posture,” Harris said. “So, for patients who are in the wet phase—that's the most dire phase of someone who may have Ebola—we plan on having full body protection, so several layers of gloves, coveralls, gowns on top of those coveralls, booties, also ideally, specific, powered air purifying respirators on your face, and face shields that are connected.”
Emory’s Jill Morgan, RN, BSN, provides an overview of putting on and taking off PPE, and the protocols for if a healthcare worker has an exposure to high-consequence infectious disease:
Donning and Doffing PPE for High-Consequence Infectious Disease Treatment
Harris says when dealing with these types of outbreaks, the 4 I’s need to be employed: identification, isolate, inform, and initiate care algorithm.
“The first thing to recognize with this specific outbreak is that it is occurring in a region that's very politically unstable with South Sudan, Uganda, Rwanda, and in that northeastern area of the DRC, so there's a lot of cross-border traffic. And that of course is concerning, because in situations such as this, where we don't yet fully understand the scale of the outbreak, we have to be able to identify potential patients, and so screening at these border crossings is incredibly important.”
This part of the algorithm is important to note because one of the most recent Ebola cases in the current outbreak was from a Congolese woman who traveled from the DRC to Uganda.
To prevent outbreak spread, Harris says people who are suspected of having Ebola need to be isolated.
“And that's why it's important that we are able to trace the movements of people and those that they may have come in contact with,” Harris said. “So that's the first piece to it. The next is to set up specific treatment units for people who might have symptoms or who are confirmed to have Ebola.”
In the inform portion of the outbreak strategy, public health officials and responders focus on risk communication and community engagement to build trust around what is being done to stop the outbreak.
For the initiate care part of the algorithm, the aforementioned supportive care is vital. And while this strain of the Ebola virus has no approved vaccines or treatments, Harris points to the prospective use of a non-approved therapy for this outbreak.
“We do have a monoclonal antibody that's under investigation right now that has pan Ebola virus activity, so against all species of Ebola, and my understanding is that it is planned to be deployed in this current outbreak,” he said.
Look for the next episode in the series where Harris discusses the Hantavirus including treatment and what the public should be aware of regarding this strain.
