Ebola is a tricky virus. After it transmits through bodily fluids, it targets crucial immune cells that typically would help fight off infections. Instead, this virus somehow manages to disable the very immune response that could eliminate it.
According to John Connor, a virologist at Boston University, this delay in the adaptive immune response can be quite significant. It gives the virus a head start to spread throughout the body. First, it goes to the lymph nodes, then the spleen, liver, and kidneys, causing damage along the way.
Connor explains that the body’s cleaning and waste disposal systems begin to fail, impacting the bloodstream, which has several negative consequences. Even though the immune system detects something is amiss, it’s not producing antibodies as one might hope. Instead, it triggers a more aggressive, albeit misguided, response. In many cases, this leads to a cytokine storm—a sort of inflammatory frenzy that can cause extensive collateral damage rather than efficiently clearing the virus. This results in multiple organ failures and severe symptoms like vomiting and diarrhea, causing patients to lose excessive fluids, often leading to death.
Despite this high mortality rate, it’s worth noting that it’s not a certainty—even without officially approved treatments.
Supportive care, which includes fluid replacement and managing blood pressure, can help keep patients alive long enough for their immune systems to catch up. Unfortunately, this care is challenging to deliver, particularly in outbreak epicenters like the Democratic Republic of Congo, where medical resources are stretched thin.
Basic support is hard to deliver
Krutika Kuppalli, now at UT Southwestern Medical Center, recalls her first day treating Ebola patients in Sierra Leone. Arriving during an outbreak that claimed over 11,000 lives, she faced intense challenges. “It was tough. I vividly remember seeing patients slumped over, unsure if they were alive,” she recalls.
Her primary responsibility was to help patients regain lost fluids. Kuppalli would try to encourage them to drink oral rehydration salts, akin to Pedialyte, although she admits, “It tastes really horrible.” If they couldn’t manage that, she would resort to IV fluids, which can be pretty difficult to administer during an outbreak.
“Putting on all the protective equipment to enter the treatment area takes time,” she notes, which complicates patient assessments. Working in such conditions is challenging; you can’t really evaluate patients thoroughly—it’s all visual.
Overheating in protective gear is another concern in tropical climates. Armand Sprecher, a physician with Doctors Without Borders, mentions, “You start sweating, but it doesn’t evaporate. You risk becoming dangerously overheated.” Once suited up, healthcare workers only have about 45 minutes to see as many patients as possible—an incredibly limited time frame.
“People often complain about 15 minutes with their doctor being too short. Just imagine having only five minutes when you’re dealing with Ebola,” reflects Craig Spencer, an emergency medicine physician who treated Ebola patients in Guinea. That’s the stark reality of inadequate providers and resources.
Disparities in care
When Spencer returned from Guinea with Ebola himself, his experience was vastly different. Upon developing symptoms, he was treated at Bellevue Hospital in New York. “I could count on one hand the number of patients under care. In the U.S., I had a whole team of providers just for me,” he recalls, emphasizing the comfort of air-conditioned rooms and immediate access to a range of tests that weren’t available in Guinea.
Those differences in available care are stark—of the very few cases treated in the U.S., most survived, significantly higher than in West Africa during the 2014 outbreak, where only about half walked out of treatment centers.
Since that time, new Ebola vaccines and treatments have emerged, making care management easier. However, the current outbreak in the Democratic Republic of Congo is concerning; the vaccines developed previously aren’t approved for the rarer strains now circulating. Plus, ongoing conflict in the region complicates the deployment of medical teams.
“The aim is to provide a higher standard of care than we did a decade ago,” Spencer states. Still, he acknowledges that initial efforts may lean towards basic triage due to resource limitations.
