Sunday, October 19, 2014

Ebola Update: What is it like to survive Ebola?

Dr. Kent Brantly and his wife Amber and their children in Liberia before Dr. Brantly was infected with Ebola Samaritan's Purse
Angela Mulholland | CTV

The Ebola outbreak in West Africa has a notoriously high mortality rate, with close to 70 per cent of patients eventually dying of the disease. But there are hundreds of others who are surviving, and some are describing what it's like to have the virus and live.

Liberian Salome Karwah was diagnosed in August, along with six other members of her family. She was treated at a Doctors Without Borders/MSF clinic in Monrovia and survived, although her mother and father died.

In an essay posted on the MSF website, Karwah says she was left completely weakened by the illness and remembers experiencing "overpowering" pain that lasted several days.

"Ebola is like a sickness from a different planet. It comes with so much pain. It causes so much pain that you can feel it in your bones. I’d never felt pain like this in my lifetime," she writes.

Ebola begins much like the flu, with fever and fatigue. It then becomes more like a gastrointestinal infection or food poisoning, causing severe vomiting and diarrhea. The infection eventually affects every organ in the body and patients typically die from septic shock or organ failure.

The virus attacks immune cells which send out proteins that lead to inflammation. That inflammation damages blood vessels, causing them to leak, which can trigger the bleeding seen in some -- but not all -- Ebola patients.

Treatment involves replacing fluids and electrolytes, transfusions to replace lost blood, and interventions to maintain blood pressure and breathing. The earlier these treatments begin the better, as doctors have found that by the time the disease progresses to hemorrhaging, it's usually too late to save the patient's life.

Future for survivors uncertain
Many who survive an Ebola infection have few lasting effects. But others are weakened by the infection and live with lasting kidney or liver damage. There have also been reports of patients who endure long-lasting joint inflammation, hair loss, and chronic eye and ear problems.

The virus can sometimes still be found in the system of survivors for several weeks, even after they begin to test negative for Ebola. The World Health Organization says it has noted cases in which the virus has remained in the semen of Ebola survivors for up to seven weeks after recovery.

Female Ebola patients can also retain the virus in their breast milk, but because the issue has not been well-studied, the U.S. CDC says there is not enough evidence to provide guidance on when it is safe for women to resume breastfeeding after recovery.

As for whether those who survive Ebola become immune to the virus, this too remains unclear. It's assumed that survivors can not become infected again by the strain of Ebola they contracted, but it remains unclear how long that immunity lasts. Nor is it certain whether patients will have immunity against other Ebola strains.

Some develop no symptoms
Then there are patients who become infected with Ebola, who test positive for the virus, but never develop any actual symptoms. Researchers have noted this phenomenon in many of the smaller, previous outbreaks.

Last month, MSF described the case of an 11-year-old boy who came to one of their clinics in August complaining of nausea and fever. Blood tests revealed he had Ebola, but just three days later, he was back on his feet again. Though he tested positive for the virus twice more, he never became fully ill. His older sister, meanwhile, also became infected with Ebola and died within days.

It's not known how many people have been infected with Ebola but not gotten ill. Just this past week, a team of researchers including one from McMaster University in Hamilton, Ont., published a letter in The Lancet, proposing that there should be further study into asymptomatic patients, in hopes of identifying why some people may be naturally immune.

As well, they suggest that the current epidemic may be "silently immunizing large numbers of people" and that the WHO's current forecasts of how this epidemic could progress may be wrong because they ignore "naturally acquired immunity."

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