off record
Shaukat Ali Jawaid

Ebola Virus- a severe febrile
gastrointestinal illness


We are still battling to control the communicable diseases, have so far failed to control Polio while Non-Communicable Diseases like Hypertension and Diabetes have become also an epidemic. We need to be vigilant and the healthcare professionals must also keep themselves abreast of new viruses and how to manage them. Ebola virus which has created havoc in Africa taking many lives is just one example. Jinnah Postgraduate Medical Center in Karachi through an initiative of its Director Prof. Tasnim Ahsan had organized a meeting to update its staff and faculty on Ebola virus sometime back. No other institution in Pakistan seems to have followed that initiative.

According to Dr. Rob Fowler, a Canadian Critical Care Physician who has spent lot of time in Africa dealing with this virus, Ebola virus is a very different clinical syndrome. It predominantly is  a severe febrile gastrointestinal illness.  Infected people experience diarrhea, vomiting and usually very little respiratory illness. While for managing respiratory failure, mechanical ventilators and intensive care units are necessary, complications of Ebola can be treated with intravenous and rather simple supportive care. These are some of the measures and treatment strategies which can be made available in even resource constrained countries. Protection of mucus membranes –eyes, nose and mouth where Ebola typically gains entry is extremely important.

In an interview published by WHO recently, Dr. Fowler believes that early aggressive rehydration, anti biotic and antimalarial treatments and point-of-care laboratory directed treatment of metabolic and electrolyte abnormalities are quite good and rewarding and this has been generally adopted across West Africa. He has cautioned that the “World cannot be complacent about communicable diseases and health disparities focused in one part of the Globe.” First, it is globally immoral. Secondly we are too interconnected. There is no “Your problem” in 2015.  Global Health, Dr. Fowler believes is our collective responsibility.

Healthcare professionals treating the patients suffering from Ebola virus are required to use “Personal Protective Equipment” (PPE). The answer to control of Ebola virus is getting epidemiology right, contact tracing, social mobilization, infection prevention and control. These measures will play an important role in stopping the Ebola outbreak, he remarked. Ebola clinical syndromes can be easily managed with available treatments i.e. oral and intravenous fluids, electrolyte monitoring and replacements and antibiotics, antimalarial for co-existing illness. Even in the absence of Ebola specific medications, if we can ensure enough healthcare workers to spend time with patients, one can deliver excellent supportive care and thus reduce the mortality considerably. Treating healthcare professionals must concentrate on treating severe febrile, gastrointestinal illness with lots of diarrhea and vomiting with lots of dehydration.  Efforts should be made to prevent this dehydration, prevent and treat the organ failure and severe metabolic and electrolyte abnormalities which may develop. What Ebola has taught us, Dr. Fowler says, is that “to ignore it is at our collective peril.”

Note: Dr. Rob Fowler’s interview was published in January 2015 and it is accessible at the following:
Ref. http://www.who.int/features/2015/ebola-interview-fowler/en/

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