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Outbreak in the Congo

September 12, 2007

131908576_0291be0adb An item came across my desk yesterday about a developing situation in Africa.  It seems that there is a chance that an outbreak in a remote region of the Congo might be Ebola.  The movie buffs among us will remember this is the very scary virus from the 1995 movie, Outbreak.  Scary, scary infection with a super high death rate and very easily transmissible.  The symptoms are terrifying, and one’s mind quickly jumps to ebola virus when one hears about uncontrolled bleeding from bodily orifices.

The problem with this all is that there are many other diseases where similar bleeding occurs.  When two diseases, one associated with high mortality and the other not, with similar symptoms occur in the same space and time, confusion reigns.

Unfortunately, this might just be the case here.  There are reports that some of the sick have responded well to ciprofloxacin (Cipro), an antibiotic that should have no effect on the ebola virus.  One disease that presents with very high fever, cramping and rectal bleeding (due to very serious diarrhea) is shigellosis (shigella).  So, why not just give everyone Cipro and help the folks that don’t respond?  Because of the quick progression of the disease, there just might not be enough time to wait and see.  Beyond that, because of the infectiousness of the disease, an amazing amount of contact tracing must occur, and frankly, there just aren’t enough people to deal with both diseases.

Distinguishing between the two infections and meting out appropriate care by an overwhelmed medical staff is of paramount importance, and interestingly enough, a sort of case study for pandemic influenza planning.  I’ll be the first to admit that the cases are wildly different, but the difficulties faced will be similar.  Think about it – in a pandemic flu situation, you will have a relatively small number of very ill people (relatively small because it will be a minority of the populace, but definitely not small in actual numbers) presenting at the same time as a larger number of folks whose symptoms, while mimicking those of the very ill, are not life-threatening (not only those with seasonal flu and other relatively innocuous infections, but also the worried well).  This influx will quickly overwhelm the health care system (instead of two dozen WHO doctors and ICPs being flown into a remote region of the world, you have a full health care workforce overwhelmed by way too many people).

I don’t have a solution to either problem, but I think that it’s important to look for potential solutions in dissimilar situations.  A pinch of this plan, a dash of that plan, and voila – we might just be onto something.

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