Thanks to Rachel Graham for tweeting the link to this excellent interview on NPR's Goats and Soda blog: Dr. Daniel Bausch Knows The Ebola Virus All Too Well. He is also highly articulate and realistic about what we're up against. Excerpt:
In Washington, D.C., last week for a round of meetings, Bausch visited NPR's headquarters and fielded questions from our reporters for 90 minutes. "As you can tell," he said wryly, "I talk about this a lot."
His answers touched on the essence of the virus, the search for treatments, the dilemmas facing medical caregivers — he once found himself one of two doctors looking after a ward of some 60 Ebola patients — and the Obama plan, which presents its own set of challenges. Finding volunteers to go to West Africa will not be easy, he notes. But without such an effort, he stresses, the only scenario is the worst-case scenario.
His comments were simply extraordinary, answering many of the burning questions about the disease with a very human touch. For those who want to dive in, here is his lengthy, freewheeling and fascinating conversation. The comments were condensed (just barely) and edited (very lightly) for clarity.
Is transfusing blood from an Ebola survivor a possible treatment? Wouldn't the blood need to be screened for many other diseases prevalent in West Africa, like Lassa fever? And we hear from Doctors Without Borders that there aren't enough staff just to put regular old IVs in patients to hydrate them.
That's a good question and perhaps a controversial one as well. First of all, on the science side, the jury is still out about convalescent plasma or convalescent blood.
It has, at least on the surface, an appealing element about it. It's low-tech: We take your blood, check it for a few things that people are used to checking for in that [part of the world], like hepatitis B and C and HIV and some of the other bloodborne pathogens.
So far, various people have been treated with convalescent blood. And some have survived, some of them have not. There's really no conclusion that can be drawn from that.
On the best-case scenario, if you can ensure that blood is safe, it's probably not going to hurt you very much. And you'll get what we call the colloid — the proteins — and things that come with a unit of blood, probably a reasonable therapy for [an Ebola patient]. It's not going to make a life-and-death difference, but it's probably a good thing.
The biggest challenge in this whole affair is the personnel to do things. If you look at Liberia, throughout the civil war, the medical school was closed. Since the civil war [it] has graduated something like an average of 10 medical doctors a year; probably half of them, I'll speculate, are drawn off by the brain drain and working outside the country.
So I was happy to see the announcement by Obama. But it's true that when you say we're going to train 500 people a week, who are those 500 people, right? In-country it's very hard, because there's just very few trained health care workers to begin with. And then, of course, they've been decimated by infections and deaths in Liberia and Sierra Leone.
I was in Sierra Leone last month trying to recruit health care workers to work in a ward. And they know, of course, that you're recruiting them because their predecessors died of Ebola? So how easy is it to get more health care workers involved?
And, of course, the money's not there. No one works for free, especially for a dangerous job. And so we need to get the money flowing, we need to get the right training for those people. But it's not like there's 500 workers [in Sierra Leone]. You probably could name all the nurses in the country and it might not get to 500.
And then the internationals, it's not that easy either. First of all, it's kind of just human nature, right, whether you're a doctor or a nurse. Who wants to go to West Africa and treat people with Ebola? There's 90 percent that are going to say, "No, I think I'm OK at home. Fine, thanks very much."
And then the 10 percent who say, "I might want to do that," their wife or husband's not real excited about that, or their job's not real excited about it. Who's going to cover you at the hospital for the next month when you're away?
But it's the right thing to do to try to find these people, both nationally and internationally, and that's what we have to do.
Also, this is not a sprint, it's a marathon; this [outbreak] is going to last many more months. I'm of the very firm conviction that I don't think the resources will be there for the long-term for outside countries to keep involvement. Ultimately, we need an African solution and we need to transfer that capacity to them. That's not an easy thing, but we have to start.