Two articles on Ebola and survival.

This can serve as a partial response to Dr. Acharya’s post on Toma Duncan. Today I read several CNN (ugh) articles on Ebola and one on the HuffingPost. One of the CNN articles discussed potential reasons why Tomas Duncan died and the other U.S. patients with Ebola lived. The article lists 4 reasons why some survived and he didn't:

1)   Early high quality treatment

2)   Quick re hydration

3)   Plasma transfusions

4)   Experimental drugs

In terms of TD, we know that he was sent home when first symptomatic. On this point, it appears that the health care system did fail TD. We don’t know how this interaction went, but it is clear that protocol was not followed.  On the second point, the article makes no mention of whether or not TD was properly hydrated within an appropriate time period. Regarding plasma transfusions, the article only mentions that TD did not receive a plasma donation from the doctor that provided donations to 3 of the other survivors. This was because he was not a match. TD did receive some experimental drugs… but not the same as the other. He also did not receive treatment at one of the four medical centers that have specifically planned for infections such as Ebola. On this point, I am not certain why he was not moved. I’m sure that information is out there.

Really, I found the article extremely unhelpful and the coverage shameful. I feel like they did not answer the question that presumably necessitated the writing of the article. Why did some survive and one did not? They did not go further on the first interaction with the health care system. It has been framed as a lapse in protocol or judgment, rather than an instance where the health system failed to take care of an individual. For instance, according to a HuffingPost article:

"After retracting its initial story placing blame on a "flaw" in its electronic health record system, Texas Health Presbyterian Hospital has yet to provide an explanation as to why Duncan's case was handled in the manner that it was"

Was it insurance? Again, what is/was the relationship between his insurance status and this interaction? According to Dallas county commissioner John Wiley Price,

"If you don't have insurance, you're not going to get treated. That's the elephant in the room."

The HuffPost article goes further and claims that TD’s treatment follows a disturbing pattern: “lack of insurance, black, foreign nationality and (likely) an accent.” Anyone who has had a basic course on sociology and health will be familiar with the idea that:  

"differential treatment of racial and ethnic minorities often results in delays in care, less aggressive treatment compared to whites with similar presentation of disease or symptoms, and worse health outcomes"

So, Dr. Acharya brings up great points about what really killed TD. An interesting aside, I went to the hospital today for an appointment. I was asked if I had left the country in the last 21 days. I also noticed an African-american male come up to the appointment counter while I was setting up my insurance. As I guessed, the secretary’s tone was harsher with this gentleman than how I was addressed. For me, it just hammered home the statistics stated above. 

CNN:  http://www.cnn.com/2014/10/20/health/ebola-how-do-some-survive/index.html?hpt=hp_t2

HuffPost: http://www.huffingtonpost.com/judy-lubin/unequal-treatment-race-eb_b_5955786.html