"The most important is the compliance with the quarantine."

An interview with Prof. Dr. Thomas Löscher, specialist in infectious diseases

by Lina Koch,  2014/09/26

Prof. Dr. Thomas Löscher is the director of the department for infectious and tropical diseases at the university hospital in Munich. In an interview he talks about the current Ebola epidemic in West Africa and explains why this disease can spread so quickly and which measures must be taken.

Dear Dr. Löscher, the Ebola epidemic in West Africa continues spreading. However, there is neither a causal therapy nor a vaccination against this disease. So, Ebola cannot be treated. What are the reasons for this?

Up to now, there has been very little research done concerning Ebola. Before the current epidemic and since the discovery of the virus in 1976, there have been only about 2,500 people infected with Ebola during smaller outbreaks. All these outbreaks had been much smaller and had generally happened in very isolated regions like South Sudan or in Congo. Thus the economic and scientific interest in it had been very limited. Ebola hasn’t been attractive enough for research.

Another reason why, up to now, Ebola has been studied only in few facilities and why this cannot be changed suddenly is the fact that the virus can only be researched in high security laboratories. Worldwide there are only about 25 of them and it is very expensive and complex to build up and maintain such facilities.

Is it possible at all to help infected persons?

Yes, a symptomatic treatment is possible. Not all Ebola patients die. Old people or persons with chronic diseases show a very high mortality rate of up to 90 percent. According to current assumptions, those who survive Ebola are immune to another infection. According to current data, the mortality rate is of about 50 percent. But as many people have fallen ill only in the last days, the actual mortality rate will probably increase up to 70 percent.

The UN Security Council has meanwhile classified the Ebola epidemic in West Africa as “a threat to the world peace and to the international security”. Why is Ebola more dangerous than other infectious diseases?

Well of course, the definition “more dangerous” must be put into quotation marks. In terms of the number of cases Ebola cannot be compared to HIV, malaria or tuberculosis, of which millions of persons fall ill every year. But with Ebola we have to deal with a disease causing a very high mortality rate and against which we don’t have any treatment nor vaccination at our disposal, at the moment.

Why could and still can Ebola spread so fast?

Like many other specialist in infectious diseases I haven’t expected Ebola to cause an epidemic like this one, one day. Actually, the virus is not highly transmittable and you don’t get infected by the air, like it happens with the flue, but only by direct contact with an ill person.

The problem with the current epidemic is the sociopolitical situation of the concerned countries. The civil wars in Sierra Leone and Liberia, which have lasted for decades, have extremely weakened the public and social structures and have destroyed the people’s confidence into their state and its facilities.

These countries haven’t been and still are not at all able to treat all patients separately and to control all contact persons. If in Liberia ill people flee from the hospital because of the hunger, that’s saying a lot. What’s more, there is much ignorance and superstition which hampers the information about Ebola.

Thus, this breeding ground has made it possible for a disease, which is actually easy to contain by simple quarantine measures, to spread so massively. But not only the national forces have failed; also the international organizations have completely underestimated the situation. That’s why the current situation needs quick and comprehensive international help.

How can further spreading of the epidemic be contained?

The most important is to identify all patients, if possible, and to treat them separately and, most important, that the quarantine is respected. The local community must make sure that all contact persons of infected persons are put under official supervision. Besides that, we must continue to inform the people in the concerned countries about the danger of Ebola.

Has Ebola meanwhile become a tangible danger for Europe, too?

I don’t think that is a problem. The first persons infected with Ebola have already been brought to Europe and we have seen that the protective measures in German and European facilities are so safe that there is no danger of spreading. If at all, most likely there could be a certain remaining risk for medical staff, especially if the possibility of an infection hasn’t been considered and no appropriate safety measures have been taken.

And what happens, if a patient with suspected Ebola appears in your institute?

Patients with a reasonable suspicion are interviewed and examined by an adequately protected doctor in a special quarantine room in our location. If the suspicion is confirmed, we call the competence center in Munich, which will send us a special ambulance which can be completely disinfected.

Then, the patient is transported in this ambulance to the special isolation ward in the clinic Schwabing, where he is transferred and is examined further under the adequate staff protection measures. The patient’s blood is then sent by special mail to Hamburg or Marburg, where are the only high security laboratories in Germany. If the suspicion is confirmed, the patient stays in isolation treatment until he recovers from the disease or until he dies, in the worst case. Afterwards, the treatment wards are completely disinfected.

Thank you very much for these interesting insights. We wish you all the best for your work and your further achievements.

The humedica help in Liberia is being supported by The German Ministry of Foreign Affairs, action medeor e.V., “Ein Herz für Kinder”, Medical Teams International (MTI), Flughafen München. We thank all institutional and private supporters very much.
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