Ebola Update: Situation worsens in Africa, untested drug out of stock

The priest evacuated to Spain for medical treatment, Fr. Parajes, died of Ebola in a Madrid hospital.

He had been infected with Ebola while ministering in Liberia. He was supposed to have been given the experimental treatment, ZMapp at some point before he died, but there is some controversy as to whether he did. His body will be cremated tomorrow.

Several missionaries from SIM, who were in Liberia, have returned to the US. None has Ebola, but they will remain in quarantine at a location in North Carolina for 21 days. Their temperatures will be monitored 4 times/day. If anyone develops a fever, he will be removed to a hospital for isolation and treatment.

Kent Brantly and Nancy Writebol continue to improve in Emory Hospital’s isolation unit.

The number of Ebola patients in Nigeria varies, depending on the source. There may be 10 or 13. They are quarantined and being treated in Nigeria. So far, all of them have had direct contact with the Nigeria’s index case, Patrick Sawyer. They were healthcare professionals involved in his treatment.

A sign warns visitors that area is a Ebola infected. Signage informing visitors that it is a ebola infected area. September 27, 2013, Congo, Africa. Sergey Uryadnikov / Shutterstock.com

A sign warns visitors that area is a Ebola infected. Signage informing visitors that it is a ebola infected area. September 27, 2013, Congo, Africa. Sergey Uryadnikov / Shutterstock.com

The World Health Organization has approved the use of ZMapp, the monoclonal antibody drug that is currently untested in humans, for treatment of Ebola patients. Use of untested therapies can pose a risk to patients. Any patient who gets ZMapp will have to be informed of possible complications and other consequences of trying an unproven therapy. There has been an ethical debate about using the drug under these circumstances. In addition to the question of “should it be used,” bioethicists were also looking at which people should get it. Should it be only used for patients near death? Should it be used earlier, before the patient was in extremis? Should it be used only in the country (-ies) where it had been developed? Could it be given to pregnant women, knowing that there might be a risk to the fetus? These and other questions were considered. Some are still under study.

Unfortunately, the bioethicists will have some time to consider them because the manufacturer of ZMapp has exhausted its supply. Two doses of ZMapp have been sent to the affected area to treat two African physicians infected with Ebola. The company says that it will now take several months to produce even a small amount of additional drug.

One trial of an anti-Ebola vaccine may begin as early as next month. Other vaccines are in the drug development pipeline and could begin testing as early as next year. But even if drug tests go very well, it will still take some time for the vaccine to be produced in large quantities and made available for use.

The situation in the three most affected countries, Sierra Leone, Liberia and Guinea, continues to worsen. Some religious charities, like SIM, are evacuating most of their medical personnel. With the number of cases of Ebola increasing, decreasing medical personnel, the rainy season beginning, unwillingness of some healthcare personnel to treat patients, lack of funds and supplies, conditions will continue to get worse. These areas have very few of their own Western-trained physicians. Even at the best of times, without an outbreak such as this, medical care is stretched thin. In many cases it is totally unavailable.

Some physician-members or the nationwide medical organization on strike in Nigeria, voted to end the strike and return to work. Others refused stating that the Nigerian government is not even considering their demands. So the physicians’ strike in Nigeria continues.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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