Buying Precious Time Through Supportive Care: How Two US Patients Survived Ebola
Isolated overseas for many decades, the deadly Ebola virus has claimed more than 1000 lives in Africa in a recent outbreak. Two American missionaries who contracted the Ebola virus while working in Liberia, became the first people ever to be treated for the virus in a US hospital when they were brought to recover in a special isolation facility at Emory University Hospital in Atlanta nearly two weeks ago. Today it was announced that both these patients–Mrs. Nancy Writebol and Dr. Kent Brantly–have been released, ending a public debate about whether they should have been brought back and highlighting the importance of the kind of supportive care (also known as palliative care) that they received.
Without a cure or an FDA approved treatment for Ebola, many people asked after their arrival: why risk bringing them into the United States? Two interesting reasons have been given. First, the likelihood of the virus spreading within the US is extremely small according to numerous experts, including the Director of the Center for Disease Control (CDC). Second, it has been suggested that the supportive care that is available in the United States can help prevent, control, and relieve the devastating symptoms that could otherwise have completely shut down Mrs. Writebol and Dr. Brantly’s immune systems.
At a press briefing in early August, Dr. Bruce Ribner of Emory University School of Medicine said: “The main reason we know we can help [Mrs. Writebol and Dr. Brantly] is because the primary care for someone with a hemorrhagic fever, and specifically with Ebola, is supportive care. We know that we can deliver a substantially higher level of care and support to optimize the likelihood that patients will survive the episode,” (See the full press briefing in the video below and here).
People don’t usually view supportive care as a lifesaving measure, but doctors attributed supportive care to the fact that Mrs. Writebol and Dr. Brantly continually improved. According to Dr. Ribner and the Center for Disease Control and Prevention, when patients experience complications of the illness, such as blood loss, low blood pressure, and dehydration, supportive measures enable the immune system to keep working and build its strength, since recovery relies on the immune system’s response without the availability of an immediate cure.
Some examples of supportive care Dr. Ribner and others cited include:
• Nutritional support
• Balancing fluids and electrolytes
• Supporting respiratory function
• Maintaining blood pressure and oxygen status
• Providing blood transfusions
• Treating complicating infections
This story raises the potential that supportive/palliative measures can buy precious time by giving the immune system the tools to maintain itself over a long enough period of time for the human body to eventually fight off the infection, which begins to happen after about two to three weeks with the virus.
With the outbreak still affecting thousands in Africa, it is critical that there be greater awareness of the role that supportive care can play in the struggle against Ebola and similar viruses and illnesses around the globe.