A health worker outside Connaught Hospital, in Freetown, Sierra Leone. (AP Photo/ Youssouf Bah)
As the Ebola epidemic continues to spiral out of control, MICHELE BARRY, MD, director of Stanford’s Center for Innovation in Global Health, has launched a fundraising campaign to help combat the outbreak in Liberia. On Friday, the World Health Organization (WHO) declared the situation a Public Health Emergency of International Concern – the worst outbreak of the disease ever recorded.
The disease claimed the life of SAMUEL BRISBANE, MD, a colleague who mentored residents in the Yale/Stanford Johnson & Johnson Scholars Program. Brisbane was the first Liberian doctor to die in the outbreak, which the WHO says is responsible for more than 900 deaths in West Africa.
Brisbane was an internist who treated patients at the John F. Kennedy Memorial Hospital, the country’s largest, in the capital city of Monrovia. A second medical officer has become ill at the hospital, one of the sites for the scholars’ program, Barry said.
Through the program, Brisbane mentored physicians from Stanford and other institutions who volunteer for six-week stints in resource-limited countries. He quarantined himself after showing signs of illness but died on July 26 after being transferred to a treatment center, said Barry, a professor of medicine and senior associate dean for global health at the School of Medicine.
She said Liberia is in desperate need of personal protective equipment for health care workers, such as masks, gowns and gloves, as well as trained personnel who can do contact tracing and isolation of infected individuals. The Ebola virus has a 21-day incubation period, during which time an infected individual can transmit the virus to someone with whom they have very close contact with bodily fluids.
Barry joined an informal fundraising campaign with her colleagues on July 29 to help Liberian health care workers contain the spread of the disease, raising $11,000 in 48 hours. Two days later, she broadened the appeal in an email sent to all Stanford medical school faculty. The first shipment of medical supplies was delivered shortly after that, she said.
Barry has had experience fighting Ebola in Uganda, where she said outbreaks have been limited by isolating patients in outdoor tented hospitals and where physicians and nurses have had access to good protective gear. In the past, she said the disease typically has had “hot spots” that last a month and then subside.
But the latest epidemic, which has affected patients in Guinea, Sierra Leone and Nigeria, as well as Liberia, has followed a different path.
“I think we are doing a better job of taking care of patients and keeping them alive longer, so they become more viremic [in which the virus has spread through the bloodstream] and more infectious,” she said. “And with globalization, there is more traffic across borders so spillover to other countries occurs.”
The first American, Patrick Sawyer, fell victim to the disease on July 25 after contracting the virus during a visit to Liberia. He became seriously ill on the flight home to Minnesota and made a stop in Nigeria, where he died.
The disease, also known as Ebola hemorrhagic fever, is initially difficult to spot because the first symptoms – sudden fever, intense weakness, muscle pain, headache and sore throat – resemble a common flu. Patients then develop more serious problems, including vomiting and diarrhea and impaired kidney and liver function, according to the federal Centers for Disease Control and Prevention.
The disease has no cure, with fatality rates in the latest outbreak approaching 90 percent, according to the WHO. However, some patients are able to mount a significant enough immune response to recover from the infection.
Like HIV, the disease is spread through direct contact with blood or bodily fluids from an infected individual. Health care workers typically becoming infected through needle sticks or blood splashes, Barry said. She said the best protection for health care workers is to apply universal precautions – a practice begun in the early days of the AIDS epidemic – in which caregivers treat all patients as potentially infectious and use masks, gloves and other preventive measures.
“The difference is that HIV patients don’t bleed profusely, while at the end of a life of an Ebola patient, patients bleed everywhere,” she said.
She said she does not see the disease as a major threat to the United States, where effective infection control methods are widespread.
“I think we need to be vigilant, but I don’t think there needs to be any true concern that this is going to spread to the United States,” she said. “There’s always a risk of a patient coming in unknown to the hospital, but we practice good universal precautions because we have the equipment and we’ve been trained to treat HIV.”
Donations to the health care project can be made online at https://www.indiegogo.com/projects/save-healthcare-worker-lives-fight-against-ebola–2.
—RUTHANN RICHTER, Stanford School of Medicine