New England Journal of Medicine
October 23, 2014 Vol. 371 No. 17
Doing Today’s Work Superbly Well — Treating Ebola with Current Tools
François Lamontagne, M.D., Christophe Clément, M.D., Thomas Fletcher, M.R.C.P., Shevin T. Jacob, M.D., M.P.H., William A. Fischer, II, M.D., and Robert A. Fowler, M.D.C.M., M.S.(Epi)
N Engl J Med 2014; 371:1565-1566
October 23, 2014
The Ebola outbreak that is ravaging West Africa is a daily staple of the lay press and of scholarly medical publications. Ebola evokes fear among both the public and clinicians. It also evokes a sort of therapeutic nihilism — after all, if there is no treatment, what can be done? And without an Ebola-specific antiviral medication, of what use are infectious-disease clinicians? Without oxygen, let alone mechanical ventilators, how can acute and critical care clinicians possibly contribute?
We have traveled several times to West Africa and done primary patient care in treatment centers and hospitals in Guinea (Conakry and Guéckédou), Sierra Leone (Kenema, Bo, and Daru), and Liberia (Monrovia, Bong, and Foya). Before each trip, as we prepared to go to the front lines of Ebola medical care as part of World Health Organization and Médecins sans Frontières clinical teams, we, too, felt a certain unease about treating a highly transmissible infection for which there is no vaccine, no specific therapy, and a high mortality rate. Yet we also appreciated that most viral illnesses, and certainly most critical illnesses, have no specific therapy. And after spending much of the past 5 months treating patients with Ebola virus disease (EVD), we are convinced that it’s possible to save many more patients. Our optimism is fueled by the observation that supportive care is also specific care for EVD — and in all likelihood reduces mortality. Unfortunately, many patients in West Africa continue to die for lack of the opportunity to receive such basic care…