Alice Park

As the world waits for new treatments and a vaccine, doctors in Guinea have found the best way to help patients survive Ebola

With the number of cases topping 13,000 and deaths climbing close to 5,000, the current outbreak of Ebola in West Africa is the virus’s worst yet. But from the tragic illness and mortality emerge some important lessons from the region.

The latest, published in the New England Journal of Medicine, details the cases that first appeared in Guinea’s capital city of Conakry between March and April. Unlike in other parts of the region, where the mortality rate from Ebola averages around 60% to 70%, in Conakry it has remained around 43%.

MORE: Here’s What Scientists Know About Ebola in Sierra Leone

Why? As Dr. Robert Fowler, a clinician in pandemic and epidemic diseases with the World Health Organization (WHO) and physician at the University of Toronto, explains, Guinea’s first Ebola treatment center, established in the capital, took a very aggressive approach to handling patients. Working with the humanitarian aid group Medecins Sans Frontieres (MSF) or Doctors Without Borders, the WHO and the country’s Ministry of Health set up a facility where Ebola patients were immediately hooked up to IV fluids and treated for dehydration—often a complication of infection. They were also monitored regularly for changes in their blood chemicals, including the electrolytes that are a marker for whether the body’s cells are getting enough water and nutrients to function. While routine blood work is standard practice at every hospital in developed nations, such testing wasn’t at Conakry health facilities.

“At the beginning of the outbreak, there was no [Ebola] treatment center,” says Fowler. “It evolved from an old cholera treatment facility and the evolution of care went from having no beds to having IVs, IV fluids, antibiotics and antimalarial [drugs]. We were only able to do hand-held point-of-care testing [of blood samples] but that was quite novel for treatment centers anywhere in the outbreak, even though that’s expected and routine almost everywhere else in the world.”

MORE: This Map Will Show You Every Ebola Outbreak in History

The key to helping Ebola patients survive their infection, Fowler and his colleagues saw, was hydrating them with IV fluids, ensuring that their blood work remained stable and addressing any changes in their metabolites as quickly as possible. In the first month of Ebola cases, 37 patients tested positive for the virus, 28 were treated with IV fluids and 16 died. While the death rate remained high, it was lower than that typically seen in other parts of West Africa.

“Our hypothesis has always been that we wanted to establish a culture of very aggressive supportive care for patients who were coming in dehydrated with electrolyte and metabolic abnormalities and try to correct those very early on, so the complications of very severe depletion don’t compound the effects of Ebola virus infection,” Fowler says.

MORE: Why Cuba Is So Good at Fighting Ebola

Fowler is convinced that the key to improving Ebola survival rates is to think about it differently. Instead of thinking of Ebola as an almost-always fatal disease, see it instead as one that is survivable with the right treatments, he says. If people understood that survival is possible—and at higher rates than previously thought—then more people who might be exposed or infected would seek care sooner rather than later, when it’s too late. “I truly do think we can change the way people think about this illness if we evolve the thinking from needing to have isolation facilities…to saying we need rapidly mobilized treatment facilities that can help care for patients with aggressive supportive care as early as possible,” he says.

Even with the dozens of patients he and his team saw at the treatment facility in Conakry, “we just weren’t keeping up with their fluid needs as much as we needed to,” he says. “Collectively as a team, we were thinking we were failing miserably in terms of our goal of delivering optimal care.”

To succeed takes an enormous amount of resources, labor and personnel. Health workers need to routinely draw and measure patients’ blood to track any slight negative changes in their physical state. Fowler acknowledges the need for drug treatments and an effective vaccine, but for now, as thousands of patients struggle to fight off the virus, “we really, really need more health care workers so we can spend enough time with patients and deliver the kind of supportive care that will improve their outcomes,” he says.

MORE: Nurse Explains Why She Fought Ebola Quarantine

Fowler admits the challenges facing recruitment. For starters, working with Ebola patients requires health care personnel to suit up in personal protective equipment that leaves no skin exposed, making them uncomfortable in the equatorial heat of the region. “We are nowhere near hitting the mark that needs to be hit to improve outcomes,” he says. But as data like his starts to build, best practices and the most effective ways to treat Ebola patients are emerging. And hopefully they will start to make a difference.

Everything an expectant mother does can have an impact on her baby’s development—including the air she breathes

Research has long connected what a mom-to-be eats and drinks to the health of her baby, and recent studies have even linked behavioral experiences such as stress, sleep and mood to the growing fetus’s development.

Now, scientists reporting in the journal PLOS ONE have pinpointed one exposure that could contribute to a baby’s higher risk of developing attention deficit hyperactivity disorders (ADHD), which the latest data from the Centers for Disease Control show affects around 11% of children aged four to 17 years.

MORE: Early Exposure to Air Pollution Tied to Higher Risk of Hyperactivity in Children

Frederica Perera, director of the center for environmental health sciences at the Mailman School of Public Health at Columbia University, and her colleagues focused in on how the pollutants in the air that pregnant women breathe can affect their babies’ cognitive development. Perera previously found a correlation between polycyclic aromatic hydrocarbons (PAHs) emitted by burning fossil fuels (such as in car exhaust and some forms of residential heating) to developmental delays by age three, reduced IQ in kindergartners and attentional problems by age six. So the team looked specifically at symptoms associated with concentration and evaluated how these effects connected to PAHs might be contributing to ADHD.

The scientists measured the level of PAHs in both the cord blood retrieved when the mothers gave birth and the mothers’ blood following delivery. They also collected urine samples from the children at age three or five years and analyzed them for PAH levels. The children born to mothers with higher levels of PAH during pregnancy had five-fold increased odds of showing symptoms of ADHD than those who were born to mothers with lower levels. The effect remained strong even after the researchers adjusted for the babies’ exposure to air pollution and smoking after birth.

“This is a new finding, and if the PAHs are identified as a contributor to ADHD, that opens up new avenues for preventing ADHD,” says Perera.

MORE: Study Links Exposure to Pollution with Lower IQ

PAHs, says Perera, circulate in the body for a long time, so even brief exposures could contribute to changes in the body. And each person processes the chemicals differently. Some may be more prone to breaking down the compounds into their potentially toxic elements, while others are less affected by the exposure.

While mothers may not be able to control some exposures, such as those from traffic and heating sources, there are some ways that expectant women can reduce their risk. Pushing local legislators to adopt clean air laws is one way to improve air quality, and on a more personal level, families can make sure that cooking areas have proper ventilation, avoid burning candles and incense and other sources of PAHs, and most importantly, ensure that they aren’t exposed to tobacco smoke. “Air quality is a policy problem, but individuals can be empowered to take steps,” Perera says.

MORE: Mom’s Exposure to Air Pollution Can Increase Kids’ Behavior Problems

Women who are pregnant can also eat more antioxidants from sources like fresh fruits and vegetables, since these can counteract some of the oxidative damage that PAHs wreak on fetal cells.

Perera stresses that limiting exposure to PAHs isn’t the only answer to reducing the increasing rate of ADHD in the country. Genetic and other environmental factors all contribute to the disorder, but identifying as many potential factors as possible could start to reduce the effect that the chemicals have not just on mothers, but on their developing babies as well.

The latest research shows that moms and dads use baby talk in different ways, and that boys and girls respond to them differently too

In the latest research on how babies first pick up language, it turns out that gender makes a difference.

Reporting in the journal Pediatrics, Dr. Betty Vohr and her colleagues decided to look at how both moms and dads talk to their young babies. Much research has focused on how mothers engage infants, even before they can speak, but fewer studies have focused on the male side of the equation.

Taking advantage of a small recording device called LENA, which they attached to the babies on a vest for 16 hours, Vohr’s team analyzed all of the verbal interactions a group of 33 babies had (none of the babies were born premature). The recordings occurred just after they were born, while the infants were still in the hospital, and again at 44 weeks and seven months. The last two sessions were recorded on days when both the babies’ parents were home.

MORE: How to Improve a Baby’s Language Skills Before They Start to Talk

From more than 3, 000 hours of recordings, the scientists got a good snapshot of the babies’ verbal environments. And the results were both expected and surprising. When babies made sounds, moms were more likely to respond to them verbally than fathers were — “Oooo, sweetie pie, you’re talking this morning.” Mothers responded 88% to 94% of the time to the babies vocalizations, while dads responded only 27% to 33% of the time.

Perhaps because of the increased responsiveness, or because of other reasons, both boys and girls were also more likely to respond to their mothers’ or female voices than they were to male voices.

Vohr says it’s possible that mothers may use more mother-ese — the higher pitched, sing song-y conversational tone that women, more than men, tend to adopt with infants. Mothers may also pair their vocal interactions with more eye contact with the baby, encouraging them to respond more when they hear their mothers’ voices.

“It seems to me that adults talking to children is absolutely the most cost effective intervention a family could do to improve children’s language,” says Vohr, professor of pediatrics at Alpert Medical School at Brown University.

She also found other intriguing gender-based differences. When she compared mothers of girls to mothers of boys, she found that mothers of girls responded more frequently to their babies’ sounds than mothers of boys did to theirs. The same trend occurred for dads; those who had boys tended to respond more frequently to their infants than those who had girls.

“We’re not certain why that is, but the important thing here is knowing that of critical importance in early language development is the need to encourage both parents,” says Vohr. “The more we learn about it, the more we can inform parents of the power they have in just talking and interacting with their infants to improve the long term outcomes for their child and their school readiness.”

Previous studies have documented that the amount of verbal interaction, or “conversations” babies are exposed to even before they can speak, can predict their later language skills and even academic performance in school.

Some people may get a new flu shot that’s made with dog cells instead of chicken eggs

Rare, reliable data about Ebola from inside a treatment center in Sierra Leone

Everything we know about Ebola since the disease’s two dozen or so outbreaks since 1976 comes not from a rich, deep database of scientific evidence that’s been carefully collected and recorded. With few formal health care systems in the areas hardest hit by the disease, there were no medical records, no charts and no standardized ways to document patients’ symptoms, vital signs, treatment regimens and whether or not they survived. Instead, much of our knowledge comes from the haphazard scrawl of doctors’ notes and their recollections about treatment and survival rates.

But for the past 10 years at Kenema Government Hospital in Sierra Leone, the country’s Ministry of Health has been working with a group of international researchers to establish a meticulous medical records system—originally for patients with Lassa fever, another common infection in the region. So when the first Ebola patient walked through the door on May 25, the same procedures for documenting vital signs and treatment information stayed in place. Now, for the first time, doctors have a robust record of the first Ebola patients in the current outbreak treated at Kenema beginning in May—and the results of that record-keeping appear in the New England Journal of Medicine.

MORE: Ebola Tests Fast Tracked By FDA

The new records were a challenge to collect, since infection control rules meant that the paper charts could not be transferred back and forth between the ward where patients were treated and other areas of the hospital. “The nurses’ station was separated from the patient rooms by essentially a chicken wire window, so the nurses would talk to each other through the chicken wire—the nurse inside, in personal protective equipment, would tell the nurse outside what to write down,” says paper co-author Dr. John Schieffelin, an assistant professor of clinical pediatrics and internal medicine at Tulane University who has been serving stints at the hospital for the last four and a half years. Even that rudimentary system was state of the art for the region, where most health clinics do not keep medical records. “In most of Sierra Leone, the hospital chart is one of those little composition books that we used to write essays in during high school,” says Schieffelin. “There was no structure to it; the physician would just write daily notes and most hospitals don’t have a charting system.”

MORE: See How Ebola Drugs Grow In Tobacco Leaves

The new documents confirm what previous health workers knew about Ebola from experience. Of 106 patients with Ebola, 44 had complete medical charts in paper form (the rest were destroyed because health officials feared they had been contaminated with the virus), and the findings supported some basic tenets of Ebola infection: that the incubation period for Ebola virus is about six to 12 days, that 74% of those infected died, that younger patients were more likely to survive infection than those over age 45, and that people with less virus in their blood when diagnosed were more likely to survive.

“It affirms our understanding of how to treat Ebola patients,” says Schieffelin. “We need to treat them aggressively with IV fluids and monitor their blood chemistries. The study also gives us a good solid baseline for understanding the disease, so we can build on it in a lot of different ways. It’s a foundation for doing further studies for optimizing treatment. It provides a great foundation for studies looking at novel treatment methods. Now that we understand how Ebola affects patients, can we improve symptoms and outcomes with novel therapies? We can start to ask and answer those questions.”

MORE: 12 Answers to Ebola’s Hard Questions

Turning those answers into new treatment strategies, however, might be a daunting task—especially in the context of the current outbreak. On most days, the Kenema hospital would see about 90 Ebola-related patients, some of whom were suspected to have the disease but still needed to be tested, and others with confirmed infections who needed to be immediately assigned to a bed and given IV fluids. “There are a lot of confused Ebola patients,” says Schieffelin. “These people are wandering around the ward, often going from one bed to the next, and they are scared so often not very cooperative. To top that off, a lot of people didn’t speak English, so that made it even more challenging.”

He admits to often tossing patient confidentiality concerns aside by asking other patients who were feeling well to translate critical information to their peers, who either didn’t need to be in the hospital any longer because they tested negative, or needed to be immediately transferred to another ward if they were infected.

MORE: Learning From Past Viral Epidemics, Asia Readies for Possible Ebola Outbreak

At Kenema, the health care workers did not use the full-coverage hazmat suits that Medecins Sans Frontieres uses in its clinics. Instead, they wore Tyvek suits that covered their front and back, a mask, face shield, double gloves and a head covering. That left some skin in the front and back of the neck exposed. The reason was partly for practical reasons—Schieffelin was often the only health care worker on his part of the ward where patients were triaged, and frequently had to spend four to four and a half hours at a time suited up. The full coverage suits become uncomfortable and unbearable after about 45 minutes.

“But I was personally okay with our equipment,” he says. “Because my biggest concern was getting a needle stick. My mucous membranes—my eyes, nose and mouth—were pretty well covered.”

After about four hours, he and whoever else was working on the wards with the infected patients would get sprayed with a bleach solution from the shoulders down, in order to avoid splashing any potentially contaminated material onto their face and neck. Then they would take each piece of equipment off and wash their hands in bleach after each step. After a break of an hour or so, they would suit up again.

MORE: Ebola Quarantines ‘Not Grounded on Science,’ Say Leading Health Groups

When Schieffelin returned from his work in Sierra Leone in August, he was told by the World Health Organization, U.S. Centers for Disease Control and the Louisiana state health department (he lives in the state) to monitor his temperature twice a day for 21 days, which he did. He was also told not to use mass transportation. He worked at home for a couple days, only because he was exhausted after his trip, and when he returned to work he didn’t see patients for a few weeks—mostly out of a scheduling coincidence, not intentionally.

Given public concerns about Ebola potentially coming to the U.S. and spreading here, however, he says, “Perhaps we should say that in terms of physicians and nurses, maybe direct patient care for a couple of weeks would not be in anyone’s best interest.”

But while he recognizes that hospital organizations and the general pubic have legitimate concerns about being protected against an agent as deadly as Ebola, Schieffelin is against mandatory self-isolation or quarantine, measures the states of New York and New Jersey recently decided to require for all health care workers returning from the three countries affected by Ebola. “I think self-isolation is completely unnecessary if you are not symptomatic. In my mind, that enhances hysteria. I have young children. If their dad were in self isolation away from everybody for three weeks, that would adversely affect them and would be telling the community and the schools the wrong message: that I need to be a pariah and an outcast for three weeks,” he says. “In my mind, that’s not the right message. If I have no symptoms, I am not a threat to anybody—I’m not a threat to my children, nor are my children a threat to other children at their school.” Such mandatory quarantines could also deter health workers from contributing to the effort to control the epidemic, and that will only prolong it, he says.

Schieffelin says that if he had recorded a fever at any point during this 21 day monitoring period, he would have immediately reported to the Louisiana health department and gone into isolation. He knows how deadly Ebola can be from personal and professional experience: seven of Schieffelin’s co-authors on the paper have died of Ebola infection since the data were collected over the summer.

A screening combo may be worth it for women with dense breasts

More hospitals are offering women the latest technology in mammography: machines that can recreate breast tissue in 3D to help doctors better detect the earliest cancers. But it’s still not clear whether these screens, which cost more than digital mammograms, are worth the money.

In a study published in the journal Radiology, researchers led by Dr. Christoph Lee at the University of Washington found that for women with dense breasts, who often need repeat mammograms, adding on 3D screening—called tomosynthesis—to a traditional digital mammogram actually costs less in the long run.

MORE: High-Tech 3D Mammograms Probably Saved This Woman’s Life

Women with dense breasts are at moderate to high risk of developing breast cancer because of the volume of breast cells in their tissue, and Lee’s team created a model for these patients to compare the cost effectiveness of digital mammography every other year to digital mammography with 3D screening every other year. Using data from the National Cancer Institute’s Breast Cancer Surveillance Consortium, the researchers calculated breast cancer rates and deaths using both screening methods, and found that for every 2,000 women with dense tissue who were screened, the 3D and digital test avoided one additional death from breast cancer compared to the digital mammography alone.

Just as importantly, says Lee, the model predicted that the two screening methods together averted 810 false positive readings. Fewer false positives means that women won’t get as many repeat scans and will be less likely to have biopsies and other procedures to learn more about any suspicious growths.

“The savings represented by 810 fewer false positives are a huge savings in anxiety, diagnostic workup and resource utilization in the health care system,” says Lee. “The decrease in false positives is what is driving cost effectiveness and showing that the benefits of adding tomosynthesis outweigh the added costs of the technology.”

The findings support a study published earlier this year that showed for the first time that 3D mammography detected more cancers, while reducing the false positive rate in a broader group of women even without dense breast tissue.