Ebola and homeopathy

A few months ago I wrote a fairly patronising summary of the ebola situation as was, and optimistically opined that perhaps the problem had been exaggerated by the media. Annoyingly, the disease has yet to burn itself out and the most current data from the WHO reports that there have now been at least 13,700 cases and 4,900 deaths.

In the UK there has been only one, imported, case of ebola. This was William Pooley, who contracted the disease in Sierra Leone and was transferred to London in August. He was treated with the new drug ZMapp, made a full recovery and has returned to Sierra Leone to continue his help.

The vast majority of cases remain in the West African countries Guinea, Liberia and Sierra Leone, and so it remains quite unlikely that infected people from these areas will reach the UK and transmit the virus here. The risk is certainly not zero however, and so Britain is currently continuing with preparations for this possibility. Most trusts have published protocols and guidance for dealing with suspected ebola cases.

Spotted in a Birmingham Hospital's ITU

I attended a lecture at my hospital on the subject, and learnt about the procedures to reduce the risk of infection, such as extra PPE and keeping such patients isolated in negative pressure rooms. Importantly, the staff were warned not to transfer suspected blood samples to the lab via the pneumatic tube system we would usually use, in case the blood vials were to break and effectively aerosol the blood and virus all around the hospital.

Ebola not welcome: A sign on the entrance to an Edgbaston GP Practice

Perhaps the most important intervention will be the use of homeopathy to combat the epidemic. Resources should clearly be diverted to the development and distribution of a homeopathic cure, you can help by signing a petition to urge the WHO to do just this. Sign it HERE*.

The good news is that a team of homeopaths have been mobilised to frontline West Africa to begin this important work.

A cynical person might suggest that sending homeopaths to ebola zones is evidence of natural selection at work. This is a cruel joke, and meaningless too because evolution doesn't exist.

Some homeopathic pills to treat Malaria

Anyway, you can already easily buy homeopathic treatment for most diseases online, including pills for dengue, meningitis and tuberculosis.

And of course mercifully there are several homeopathic clinics in Africa many of which offer cures for HIV and AIDS. Not sure if I've mentioned on this blog but I went to Tanzania earlier this year. I’ve seen a little of how devastating HIV can be to communities and individuals, but luckily charities exist that aim to help reduce this suffering. This is one of them, http://www.homeopathyforhealthinafrica.org/ and it has characteristically virtuous aims:

- To relieve the suffering of HIV/AIDS patients using classical homoeopathy
- To identify the homoeopathic remedies most successful in treating HIV/AIDS
- To spread this knowledge throughout Tanzania and Africa
- To produce formal, ethical research
- To prove to the world what homoeopathy can do

For the unenlightened, homeopathy involves taking an ingredient that causes harm and diluting it significantly, thereby releasing its healing power. The standard dilution (such as for the linked cures for dengue and meningitis above) is “30C”, meaning the original drop has been diluted by 1 drop in 100, 30 times. So 30C means one part in 1060.
This level of dilution, such that there are zero molecules of ingredient left in the treatment, is vital for the homeopathy to work.

Regrettably however, the benefits of homeopathy are denied by some groups – for example educated people and "scientists". For example, some of these “scientists” published a paper in the Lancet that compared 110 studies of homeopathy with 110 conventional medicine studies and concluded that the effects of homeopathic interventions are merely placebo effects. (1)

The 2009 official WHO statement is similarly closed minded:

“There is no place for homeopathy in treating serious illness such as HIV, TB, malaria and infant diarrhoea in developing countries.”

Quite clearly a needlessly obstructive and unhelpfully negative attitude.

In all seriousness I wish the homeopathy team in Africa the very best and sincerely hope that they manage to avoid infection,  and especially so to prevent the spread of the disease further.



*Please do not sign this stupid petition


The reference for the paper I mentioned is:
1. Shang A, Huwiler-Müntener K, NarteyL, Jüni P, Dörig S, Sterne JA, et al. Are the clinical effects of homoeopathyplacebo effects? Comparative study of placebo-controlled trials of homoeopathyand allopathy. Lancet. 2005;366(9487):726-32.

Ebola for Dummies

I don't want to brag, but I have access to the internet pretty much 100% of the time nowadays, and so very occasionally I glance at some of the news websites. There seems to be quite a lot of column inches dedicated to the ongoing West African Ebola Epidemic, and perhaps rightly so since if the news articles are to be believed this virus is proving to be a fairly destructive problem. Fear-mongers hypothesise that this is the beginning of the apocalypse. I’ve seen Outbreak and Contagion, so maybe they’ve got a point? Embarrassingly for a so-called medical student I knew almost nothing about this important disease, so I’ve now spent a few hours reading about it using my aforementioned internet access. And because I haven’t written anything on this blog since my elective I’ll write down what I found out here.

Ebola haemorrhagic fever is caused by the Ebola virus (EBOV) first isolated in 1976: usually an 800nm tubular protein mesh covered in a lipid bilayer and containing a single strand of RNA which codes for 288 amino acids as eight proteins. It is impressive that such a tiny and relatively simple bag of molecules is responsible for the miserable disease – as of the beginning of august over 1600 cases and 887 deaths have been reported to the WHO.

Electron micrograph of an ebola virion

Ebola haemorrhagic fever is also known as Ebola Virus Disease (EVD) and is one of the most virulent viral diseases in the world. It is named for the Ebola river in the Democratic republic of Congo (then Zaire), where the first cases were recorded. The virus is first acquired upon contact with bodily fluids from an infected animal, usually from handling infected wild animal carcasses – including primates hunted for bushmeat. Bats are thought to be the reservoir species for the ebola virus, from which apes and other wild and domestic animals can become infected – the virus is a zoonosis.

A CDC graphic from http://www.cdc.gov/vhf/ebola/resources/virus-ecology.html

Like seemingly every other disease in the world, the disease first presents as a “flu-like” stage due to the inflammatory reaction to viral particles and cell debris . These general symptoms appear about a week after contraction of the virus, and the early fever mimics other more common tropical fevers such as malaria or dengue. However, EVD becomes more severe as the virus produces a glycoprotein that binds to the interior surface of blood vessels and significant bleeding – seen as haematemesis (vomiting blood), petechiae and purpura (bleeding into the skin), as well as bleeding from elsewhere such as the eyes, nose, gums, GI tract etc.

The mortality rate can be as high as 90% as organs fail, though I imagine this number is highly variable depending on the strain of the pathogen, accuracy of diagnosis and promptness and effectiveness of (supportive) treatment. There is no specific treatment and no available vaccine but survival is increased with early interventions such as balancing fluids, electrolytes and coagulation and treating secondary infections.

Now

Since March 2014 in Guinea, West Africa, there has been an ongoing epidemic of this disease – and the most severe outbreak ever recorded, caused by the most dangerous strain, Zaire ebolavirus. The strain has since spread to neighbouring Sierra Leone and Liberia. As of today, August 4th, here have been no cases outside of Africa, though (worryingly?) two infected Americans have been flown to the states for treatment.

WHO epidemic figures up to August 1st

So far, the total number of deaths from the disease is still low, and whilst each case is individually horrific the overall disease burden is insignificant when compared with influenza or TB or HIV or malaria or any one of hundreds of others. Further, compared to other pandemic scares like SARS or bird flu, after five months the virus is fortunately yet to deliver the global chaos that some have predicted.

On Mosquitoes

More words than necessary about mosquitoes

I was recently pleased to pick up an English-language issue of the Guardian. I don’t think there is any relation to the UK newspaper as there are a number of differences in style and content – for example the puzzle page includes a join-the-dots and a picture to colour in. Mostly there is news of domestic affairs but there is an international section which included the important story, and large and pixelated picture, of people enjoying the weather at a beach in southern England, which I enviously read from monsoonesque Machame.

The front page story was more immediately relevant to me, reporting on a recent outbreak of Dengue fever in Dar es Salaam, a viral disease (also known as breakbone fever due to characteristic joint and muscle pain) that is mostly found around the equator and is spread by mosquitoes. The species of mosquito that carries the bug is endemic to Tanzania but the virus itself is not, so the outbreak is a fairly new problem for Tanzanians. As of 20^th May there were 400 confirmed cases of the disease in Dar, and 3 deaths.

The majority of infections are mild or asymptomatic, so good odds for the individual but this also means that the disease can spread swiftly and silently from unwitting carriers. The outbreak has caused an uneasy atmosphere about the hospital as there have now been a number of cases reported nearby. Most of the staff have no experience with the virus and so it became the topic of a heated discussion in church on Wednesday – bizarrely I was asked to stand up and report what I knew about the disease to the assembly as if I was some wise foreign visiting professor, rather than a bewildered foreign visiting hindrance. I managed to articulate the basics that I could remember – that the disease usually causes a rash and high fever but in severe cases can cause haemorrhage, shock, and (rarely) death, and that since there is no vaccine or effective anti-viral drug treatment is supportive.

I learnt afterwards that my exceedingly English public speaking accent is nearly incomprehensible for the local people so my platitudes largely went unheard. I did manage to communicate that dengue is not present in England and I that I didn’t know how it is diagnosed in English laboratories. I get the feeling that I did nothing to assuage the worry of the congregation, and actually I merely scaremongered with a notion of an unknown and sometimes fatal disease with neither a simple diagnostic test nor a definitive treatment.  Dengue sharply contrasts with that other, commoner, mosquito-borne scourge that the hospital is so familiar and comfortable with - patients with almost any presentation are often labelled “clinical malaria” and started on anti-malarials. The doctors like diagnosing malaria because they know how to treat it, and the placebo effect is pretty effective too.

So now, in addition to trypanosomiasis from abundant tsetse flies, I have another reason to keep my blood safe from vicious hungry little arthropods; a task that I have never been able to accomplish with any degree of success. I’m a fraction too big for my bunk in the guest house so either my feet stick out of the end of mosquito net or I inadvertently collapse it onto myself with my somnolent kicking. This isn’t the main problem (the net is full of holes anyway), as in the daytime I rarely remember to use sufficient insect repellent and I am apparently oblivious to the presence of mosquitoes even when they are enjoying feeding on me,  I am usually surprised later to discover a large red itchy swelling.  So the combination of my ineptitude and my delicious delicious blood means that I am getting quite a number of bites and good size dose of mosquito saliva; right now I have a fairly large swelling on my left tricep (making me look uncommonly muscular, though in an asymmetrical unnatural and inflamed manner) and a troublesome lesion on my left little finger – it hurts a bit to bend or use so the alert reader will notice that due to the discomfort of typing I have used the letter Q significantly less frekwently than usual. Fittingly, as I write these last words I have been bitten, again.

Aedes aegypti - as stolen from the internet

Cool ways to prevent dengue – memories from an essay I wrote during my undergrad
No vaccine yet, so we need to control the disease vector:  for dengue these are Aedes aegypti mosquitoes.

Obvious/don’t get bit:

-          Wear long sleeves and long trousers (an advantage of wearing a burkha.) Bonus: no sunburn.

-          Use insect repellent (unpleasant, expensive, health risks)

-          Sleep under an insecticide treated net (But mosquitoes still bite in the day)

Common/low tech:

-          Spray urban areas with insecticide, fairly ineffective but makes a government look proactive.

-          Tanzania are fumigating buses to avoid transmission of mosquitoes around the country – but asymptomatic humans can easily travel and spread the disease

-          Drain pools that are mosquito habitat – often impractical

-          Add larvacide to mosquito habitat – might involve poisoning water supplies

Biological control:

-          Introduce fishes that eat mosquito larvae – disruption of ecosystem

-          Introduce bacteria that infect mosquitoes, reducing their lifespan and viral transmissibility

Add more mosquitoes/cool high tech science fiction stuff:

-          Release sterilised male mosquitoes, causing a population crash

-          Release self-destructing mosquitoes, males which carry a lethal gene, causing a population crash

-          Release female-incapacitating male mosquitoes, modified genes when expressed in female offspring cause development without wings, and so these mosquitoes rubbish at living or transmitting disease

-          Add genetically modified virus-resistant mosquitoes to outcompete and replace the existing harmful population