Ebola. It’s on everyone’s mind. As a handful of cases pop up in other parts of the world (ie United States, Great Britain, Spain), the severity of the crisis is becoming even more tangible. Adam Nossiter retells his experience in the touching article in the NY Times, “A Hospital From Hell, in a City Swamped by Ebola”. Nossiter is in a hospital in Makeni, Sierra Leone which has been ravaged by the virus, spreading quickly as “the risk of infection is high, the precautions minimal.” In over a month and a half, the district in which Makeni resides, Bombali, has gone from one confirmed case to almost two hundred. In the past few days, “at least six dozen new cases have been confirmed in the district.”
Right now, the top concern in West Africa is to isolate at least 70% of patients and put them in treatment centers so they do not infect their communities and that it does not become endemic (transmitted at low levels in humans all the time like chicken pox) creating a permanent presence in West Africa and increasing the possibility of spreading to other places.
But what is most frightening is that there is no proven medicine or vaccine for Ebola. A possible vaccine, ZMapp, was used earlier this year and was “credited as helping save lives, but it has not been subjected to a randomized clinical trial to prove its safety or its efficacy.” It has been tested on primates infected with variant of an Ebola virus different from the one in West Africa right now and was deemed successful, even stopping “replication of the Guinean strain of Ebola virus in cell cultures.” However, after being used on a few patients, the supply of ZMapp was exhausted.
Were the cases in which ZMapp is credited as having saved lives just mere chance? I mean it was only used on seven patients, maybe those seven patients were already getting over the virus, maybe they never contracted the full blown virus, just a weaker strain, so these could be Type 1 errors.
The United States just approved the experimental drug, Brincidofovir, to treat Ebola symptoms. Here, the soft points are being targeted, while the hard end points still remain a problem. I imagine because everyone is desperate that “the FDA extended Chimerix an Emergency Investigational New Drug Application, or EINDA, meaning the drug can be used in the event of an emergency without waiting for the results of more stringent agency testing” (RT News).
Another case has been in rural Liberia where a doctor has given “at least 15 Ebola patients lamivudine, which is considered a long-term and effective drug to treat HIV patients. All but two of them survived.” This again may only be treating the soft endpoints, so what about the hard endpoints?
It’s a tricky question: Is it ethical to “treat” patients with experimental drugs that may have bad, even life threatening, side effects? Or should we hold off and let patients suffer knowing that there is a drug that just might be the cure? As I discussed in the beginning of my post, cities like Makeni are in really bad shape, so why not test experimental drugs, who knows. Patients on their death-bed have very few options in West Africa, so resorting to experimental drugs like Brincidofovir couldn’t hurt. And even if they are only targeting the soft endpoints, it could buy patients more time. Unlike ZMapp, Brincidofovir is given in tablet form making it possible (or at least a lot easier) to perform a randomized control trial. Of course, the patients need to know explicitly what they are getting into. Still, it would be ethically questionable, but it would be the fastest way to know if it works and time is very important. Obviously because a patient’s life is at stake, but also, as I mentioned before, so that Ebola does not become endemic. A clinical test in the US is already in the works, but I think going ahead and doing a trial in West Africa among infected patients as well might be a good idea. Brincidofovir has been tested in more than 1,000 people for other viruses and “shows signs of effectiveness and proved relatively safe.” In Dallas, Ebola patient Thomas Eric Duncan is receiving Brincidofovir, but even if it does work, his case will remain an anecdote and be of no real help. Although so far there is definitely a lack of science, this might be our best bet.
Your article reminds me heavily of the powerpoint we looked at in class about how doctors can unintentionally kill us. Doctors would give the patients the vaccines and think that surviving patients can credit the treatment while dead patients are victims of the disease. In this case, it could be difficult to understand if the treatments actually helped since patients on their deathbeds since they could die despite the treatment. The treatment that could alleviate symptoms would be used at a point that’s much too late to do any good. Something to think about!
Dutt- Sorry, I shouldn’t have said “tested”… ZMapp has not been officially tested on humans, but it has been used on a handful of individuals and from those individuals, some concluded it saved their lives. Check out this article. It’s a good example of how two of the patients themselves credit their survival to God and not ZMapp. I concluded they were type 1 errors, because some of the doctors believed that the patients survived because they had been given ZMapp, but in actuality, nothing could be going on, they are simply surviving. Also, I understand that many people don’t realize they have Ebola until it’s too late, but still, many organizations and the CDC predict that the only way it will not become endemic is if 70% of infected patients are isolated and treated in medical facilities.
You mentioned that the ZMapp vaccine was tested and was credited as helping save lives. Yet it has only been tested on primates. Humans not only react differently just by gender, but also wealth, geography and race are also huge subcategories among humans when testing. So the correlation of the positive effect on ZMapp does not really make an impact on how it will test on humans. I don’t even think it could be tested on humans because as you said it would be unethical. And also you said it was a different variant of ebola on which the vaccine was tested upon. The old ebola virus which out-broke sometimes in the 70’s or 80’s was stopped just by using isolation and did not have the power that the current ebola virus has. The old ebola virus did not even make it on the list on the World Health Organization back then.
You also mentioned that the top concern in West Africa is to isolate the patients in order to put them in treatment centers, but the patients don’t know either that they have contracted this deadly virus either. And while their family is taking care of the sick individual, they are completely oblivious they they themselves have contracted the disease and the person they are taking care of has the disease. Just think about how ebola arrived in the United States.
Then you say “I mean it was only used on seven patients, maybe those seven patients were already getting over the virus, maybe they never contracted the full blown virus, just a weaker strain, so these could be Type 1 errors”, but how do you conclude that its a type one error, when you don’t even mention your null hypothesis.
You mentioned that the ZMapp vaccine was tested and was credited as helping save lives. Yet it has only been tested on primates. Humans not only react differently just by gender, but also wealth, geography and race are also huge subcategories among humans when testing. So the correlation of the positive effect on ZMapp does not really make an impact on how it will test on humans. I don’t even think it could be tested on humans because as you said it would be unethical. And also you said it was a different variant of ebola on which the vaccine was tested upon. The old ebola virus which out-broke sometimes in the 70’s or 80’s was stopped just by using isolation and did not have the power that the current ebola virus has. The old ebola virus did not even make it on the list on the World Health Organization back then.
You also mentioned that the top concern in West Africa is to isolate the patients in order to put them in treatment centers, but the patients don’t know either that they have contracted this deadly virus either. And while their family is taking care of the sick individual, they are completely oblivious they they themselves have contracted the disease and the person they are taking care of has the disease. Just think about how ebola arrived in the United States.
Then you say “I mean it was only used on seven patients, maybe those seven patients were already getting over the virus, maybe they never contracted the full blown virus, just a weaker strain, so these could be Type 1 errors”, but how do you conclude that its a type one error, when you don’t even mention you null hypothesis.
I agree with your point that it is unethical to give people medications that we do not know the side affects of . It is hard to say but I feel like any normal person when given the option between laying their waiting for a slow painful death or being given a medicine that might cure you, despite the risks, most people I feel would take that. It is in our human nature to fight especially for our lives. I don’t know many people that would just role over and not fight for their survival. All in all good post, keeps one thinking.