Via Macleans.ca, an excellent interview: Frontline physician Tim Jagatic on the worst Ebola outbreak in history. Click through to read the whole long article. Excerpt:
Few diseases inspire more terror than Ebola. The deadly virus causes rapidly worsening fever and pain, internal hemorrhages and, usually, death. Most patients spend their last days in isolation, sometimes bleeding from their eyes and nose, surrounded by people in Hazmat-style suits and goggles. Some suspect the current outbreak originated among bat hunters near Guéckédougou, Guinea. Since February, it has spread to 1,093 people and killed 660 in the West African countries of Liberia, Guinea and Sierra Leone.
Family doctor and native of Windsor, Ont., Tim Jagatic is on the ground in Kailahun, Sierra Leone, helping Doctors Without Borders fight the worst Ebola outbreak in history.
Q: How does this illness present? What is actually happening?
A: When the virus enters the body, it attacks the immune system and the blood vessels. It releases an immune cascade at the same time as your blood vessels are being weakened. On the outside, you see fever, headache, nausea, vomiting, diarrhea, joint pain, muscle pain—a lot of things people associate with the common cold. With the progression of the disease, you might see the hemorrhagic signs. We see that in fewer than 50 per cent of cases.
Q: What are the hemorrhagic signs?
A: We see people with nosebleeds. They have bloody vomit, bloody diarrhea, internal bleeding and conjunctivitis [bloodshot eyes].
Q: What’s the usual cause of death?
A: There are many, and because it’s such a large outbreak, we’re starting to see some signs that we didn’t associate with Ebola before. We saw some patients with elevated blood sugar. We’ve seen people dying from what seemed to be a heart attack. We’ve seen people dying from blood loss. We’ve seen people just being overwhelmed by the disease.
We don’t have much diagnostic material to work with, so we’re not able to do an EKG to see if it was a heart attack or not.
Q: You were in the outbreak zone back in March and April, in Guinea. What has changed?
A: I was there for about three weeks. I saw an epidemiologist, and he said, “We’re seeing the tip of the iceberg.” Plain and simple: The virus has gotten to a point where it’s able to spread itself, just because it’s a capital city, and within a population with a cultural practice that lets this virus spread around.
Q: How is it spreading within communities?
A: Funerals are the biggest point of infection. When one person dies, people from all over will come and practise their behaviour rituals [touching and kissing the unembalmed body without washing their hands after]. A dead body is the most infectious thing, and that’s when the majority of people come into contact with it.
Another one is being exposed to sick people. The whole family is taking care of them, being exposed constantly.
Q: What would you be doing in an ideal situation to respond to Ebola?
A: We need twice as many people. We simply don’t have the numbers to delegate all the things that have to be done when we’re in the isolation ward. Because we’re wearing personal protective equipment, it limits the amount of time that we spend inside the isolation unit. We would like to keep a visit between 45 minutes and one hour, but now, we’re stretching it to almost two hours.
We put ourselves through a very strong physiological stress when we’re using personal protection gear, because it’s impermeable. So we sweat, we’re losing water, we’re getting hotter and it wreaks havoc on the body. Our own endurance starts to wear down.