Unmeasured factors leave questions, authors note
A study retrospectively examining the role of intravenous fluids in preventing deaths of Ebola patients during the 2013-2016 West Africa Ebola crisis concludes the intervention, in itself, did not make a significant difference in chances of surviving during the 28 days following diagnosis.
Differences in survival rates during the crisis, between those in high-income countries and those with the severely constrained resources of the three countries that bore the brunt of the 2013-to-2016 West Africa Ebola outbreak, highlighted inequities in health outcomes and illustrated the consequence of an unconscionably delayed response. While about 40 percent of Ebola patients treated in West Africa died, mortality among those treated in high-resource settings was less than half that. And, as in-country responses gathered force and better quality care became available, death rates dropped.
While better quality care in higher income countries and improved in-country care supported by the belated international response likely played a role in that drop, the specific role of intravenous fluids, routine in high-income settings, uncommon across Sierra Leone, Guinea, and Liberia as the outbreak began, has not been determined, the authors of a report released this month in Clinical Infectious Diseases note.
They examined 28-day survival rates for 424 patients across five Ebola treatment centers in Sierra Leone and Liberia. Of the 354 who received intravenous fluids, 146 — a little more than 41 percent — were alive four weeks after being admitted for treatment. Of the 70 who did not receive intravenous fluids, 31 — nearly 45 percent — survived.
The authors note that some factors potentially affecting outcomes went unmeasured in Ebola treatment centers scrambling to provide care during the crisis. In addition, the impacts of differences in the administration of fluids in a setting without air-conditioning where the heat of wearing protective gear curtailed time spent with patients and necessitated the delivery of large volumes of fluids delivered rapidly, remains in question. The authors, led by Dr. Adam R. Aluisio of Brown University, call for ongoing research, including randomized controlled trials to better determine how to optimize care and improve survival rates for all Ebola patients.