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Ebola special EUROPEAN HOSPITAL Vol 23 Issue 5/14 EBOLA continued from page 1 Biospleen blood cleansing excites experts blood cleansing at dialysis-like rates. Alternatively, a patient could under- go multiple rounds of the cleansing treatment. The next step is to test the device on large laboratory animals, starting with pigs. He anticipates that initial human clinical trials would be car- ried out with patients in ICUs with severe sepsis. Patients with earlier- stage disease would likely require confirmation of septicaemia before starting the biospleen. The device also might be able to reduce the spread of infectious agents to organs and additional- ly might lower levels of circulat- ing endotoxin and inflammatory cytokines. It also may be the only option to fight sepsis caused by antibiotic-resistant bacteria. ‘One of the huge advantages this device offers is that it is not neces- sary to perform a culture. Septic patients need treatment immediate- ly. An accurate pathogen diagnosis takes one day to a week. Culture followed by antibiotic susceptibil- ity testing (AST) takes two to seven days. Today, doctors are forced to make a decision on how to treat a patient without ever getting the lab data. We are working to change that paradigm,’ Dr Super said. Dr Super added: ‘We see this technology being used as a ‘front- end’ technology for pathogen collec- tion and concentration before doing molecular diagnostic tests such as Mass-Spectrometry, PCR and Next Generation Sequencing (NGS). The pathogen capture can be used to ‘clean up’ the sample, removing human proteins and DNA that inter- team confirms that the ‘secret sauce’ MBL protein does bind to Ebola. Dr Super did not know if a dialysis-like technology would work in view of the scale of the disease. ‘But we could imagine having this technol- ogy available as a safety net for medical staff treating Ebola patients. ‘What is so powerful about this technology is the ability to remove pathogens from a person’s blood even before having the time to identify it.’ * See 14/9/2016 article in Nature Magazine online: (www.nature.com/nm/journal/vaop/ ncurrent/full/nm.3640.htmlhttp:/www. nature.com/nm/journal/vaop/ncurrent/full/ nm.3640.html fere with molecular diagnostic tests. ‘For example, when human DNA contaminates a bacterial DNA sam- ple, a polymerase chain reaction (PCR) for bacterial DNA will not work reliably. We are focusing on how to clean up the sample so that we can do PCR.’ He anticipates that the biospleen device will be a platform technology with the ability to remove proteins like cytokines or autoantibodies as well as other types of cells, e.g. cancer cells from the whole blood volume of patients by coating the magnetic beads with appropriate cell- or protein-specific ligands. Could such a device help curtail a future Ebola-like epidemic? The Michael Super, PhD, Senior Staff Scientist at the renowned Wyss Institute for Biologically Inspired Eng- ineering Report: Lisa Chamoff Unlike some news reports the Ebola virus is not as easily transmitted as influenza or other infections. Still, healthcare and laboratory workers must take precautions to quickly identify those infected and prevent an outbreak. In an October webinar, hosted by the American Association for Clinical Chemistry, Dr Nancy Cornish, a medical officer at the Centers for Disease Control, emphasised that Ebola is transmitted by direct con- tact with blood and body fluids, and not spread by air or water. However, research laboratories making viral cultures so that pathogens achieve high concentrations, must increase safety precautions. Anyone testing specimens from a possibly infected patient should wear gloves, water-resistant gowns, and full-face shields, or goggles and masks. Certified class II Biosafety cabinets or Plexiglass splashguards should be used to protect workers’ skin and mucous membranes. Anyway, medics should anyway ensure minimum infection preven- tion practices in patient care, includ- ing hand washing, using gloves, gowns and masks, safe injection practices and cough etiquette, Cornish said, also stressing that African facilities dealing with Ebola specimens have a different set of challenges, including no reliable running water and limited access to disinfectants. Dr Sheldon Campbell, Director of laboratories at VA Connecticut Healthcare and Professor of lab- oratory medicine at Yale School of Medicine, said facilities should come up with plans to include assessing the route and risk of transmission of certain organisms, and determine how common the pathogen is. When developing poli- cies, Campbell said it’s important to balance laboratory staff risk with the possibility of compromising care for 100 or more patients. ‘When planning, plan for what’s reasonable now, and that’s really small numbers of at-risk patients to rule out for Ebola,’ Campbell said. ‘Don’t try to plan yet for 100 patients with Ebola, or even for five. Plan for one and get that in place and watch what happens over the next few months. You might have to plan for more, but start with small numbers of cases and then reassess as time goes by.’ The CDC has also developed interim guidance for specimen collection, transport, testing, and submission for patients suspected of Ebola infection, which can be accessed at www.cdc.gov/vhf/eb ola/ hcp/interim-guidance-specimen-col- lection-submission-patients-suspect- ed-infection-ebola.html. Dressing up for Ebola’s unlikely EU epidemic The welcome logic of a World Bank expert Report: Michael Krassnitzer ‘Ebola does not present a direct epi- demiological danger for Europe,’ according to Dr Armin Fidler, Lead Advisor on Policy and Strategy at the World Bank, but, he added, ‘Inevitably some Europeans will become infected with Ebola, such as those in the healthcare professions or aid workers.’ Dr Fidler made that statement when interviewed by European Hospital during the European Health Forum Gastein, in very early October – well before the first known case of an Ebola infection in Spain emerged. ‘Numerous current analyses and commentaries assume that Ebola could be quickly and effectively brought under control if the dis- ease had not started in three West African states but for instance in a European country,’ he explained. In countries with highly developed healthcare systems, people with sus- pected infections can be quickly and consistently isolated. Health service providers are adequately equipped to minimise the risk of contagion. Doctors and nurses can offer the best possible treatment, such as treatment for dehydration, impaired liver and kidney function, bleeding and impaired electrolyte metabolism. ‘Contaminated materi- als can be appropriately disposed of and there is extensive informa- tion available to the public on the disease, its transmission and the correct behaviour during an Ebola epi- demic.’ However, Ebola does indeed pose an indirect danger for Europe, as Fidler explained: The disease has a desta- bilising effect on those countries already known as fragile states: ‘If these countries experience politi- cal unrest or waves of refugees this would obviously also have politi- cal or economic consequences for Europe.’ ‘The problem around Ebola is an indication of the fact that there Could the virus endanger Europe? Armin Fidler MD MPH MSc, who joined the World Bank in 1993, is Lead Adviser on its Health Policy and Strategy, based in Washington D.C. A medical graduate from Innsbruck University, he also holds Masters in Public Health (MPH) and Science (MSc) in Health Policy and Management, both from Harvard University’s School of Public Health. Dr Fidler studied management at Harvard Business School and Public Finance and Welfare Economics at the London School of Economics and Political Science. ©EHFG ©WHO/StéphaneSaporito has not been enough long-term and sustainable investment into the healthcare systems in these coun- tries over the last few decades,’ he stressed. ‘The main investment has been into quick wins, i.e. areas where it’s easy to quickly achieve positive results.’ Development aids in the h e a l t h c a r e sector, he said, are often earmarked for projects and measures that are comparatively easy to implement and effective in the short term, such as against HIV/ AIDS. ‘In vaccination programmes, for instance, results are easy to measure. It’s easy to estimate how many lives have been saved. These pro- jects are important, but there is also a need for systematic, long-term and strategic investments into the healthcare system.’ Some damaging effects ‘Many of these funds develop par- allel structures, with doctors and nurses enticed away from the public sector because pay is better.’ Long- term investment in healthcare sys- tems is not as ‘sexy’ and harder to evaluate. In human resources invest- ment, it takes a decade to train a doctor, which covers two legislative periods – ‘so no politician would be interested,’ he said. Furthermore, health also depends on structures that appear to have nothing to do with a healthcare system. Fidler mentioned contain- ers filled with medical supplies decaying in a harbour because the authorities are inefficient or corrupt: ‘People in highly developed coun- tries find it hard to perceive that investments into harbour and cus- toms administration are also impor- tant their healthcare system.’ The agenda for Ebola is obvious to Fidler. There is an urgent need for additional healthcare providers who need to be adequately sup- ported. The affected countries also need more mobile laboratories, hos- pitals and rapid tests, but also more communication about the disease, spread and treatment. ‘Theoretically, it should not be difficult to stop the epidemic – if we succeed in isolat- ing people with suspected infec- tions or those who have been in contact with people who have had the disease diagnosed.’ However, the situation will become critical if the disease reach- es the slums of a large African city with millions of inhabitants: ‘The worst-case scenario assumes a potential 1.4 million cases by the end of the year. We all hope this will not happen.’ ©Harvard’sWyssInstitute 2

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