Treatment for Ebola: Dr. Dhanashri Singh

image_5_240x240dec16Dr. Dhanashri Atre Singh is a Consultant Intensivist/Physician at Vedant Superspeciality hospital. She has been a Visiting scholar to the University of Sydney and Research Fellow.

Apart from being a Consultant Intensivist, Dr. Dhanashri Atre Singh has also worked as a Cardiac physician at CIMS Hospital Ahmedabad.

Dr. Dhanashri Atre Singh answered Sify readers’ queries related to the above in an exclusive chat. Read the transcript below.

Why do most cough syrups make one feel drowsy/sleepy?
Most cough syrups contain antihistaminics and opiod derivatives (these medications act on your cough and allergy), but they make you feel sleepy.

Apart from staying away from the infected person are there other ways to prevent EBOLA?
Avoid contact with infected clothings, beddings, medical equipment. Practice good hand hygiene (alcohol based hand sanitiser) Avoid contact with bats, apes ,monkeys or eating raw meat from these animals. Avoid going to hospitals where patients of Ebola are treated. Monitor for symtoms of disease especially if you have travelled to the affected areas.

Does Ebola spread even with the touch of the infected person?
Ebola spreads by direct contact of BLOOD OR BODY FLUIDS of infected person. However if you need to take care of a person affected by Ebola (eg Health care workers), you must always wear PERSONAL PROTECTIVE EQUIPMENT (disposable full length gowns, masks, gloves..Droplet precautions need to be exercised) .

Is it normal to have body ache in winter when we wake up in the mornings? How to get rid of this?
Yes. Exercise everyday,avoid dehydration.

Do you also suggest some lifestyle changes for better winter health?
Avoid exposing in windy winter outdoors, wear protective warm layered clothing, drink plenty of oral fluids especially warm soups and warm water, avoid too much tea and coffee, no smoking, regularly moisturize your skin,dust and clean your house and woolen stuff and heated ducting systems periodically to prevent allergies. Lastly take your asthma puffs, BP and Heart medications extra vigilantly. Influenza vaccine in certain high risk people (consult physician to know who needs influenza vaccine)

Pl tell me about flu vaccine. Who should take it and when should it be taken?
Seasonal flu vaccines protect against the influenza virus that research indicates will be most common during the upcoming season.Traditional vaccines work against Influenza A (H1N1 virus), H3N2 (Infuenza A) virus and an Influenza B virus. These vaccines cause antibodies to develop about 2 weeks post vaccination which help in fighting against influenza caused by these strains of viruses. They decrease the severity of infection too. Certain group of individuals are more prone to developing complications of influenza. These include kids, elderly >65 years, diabetics, people with pre existing lung, kidney,heart diseases or pateints with cancers or those on hemodialysis. This susceptible population must definitely receive flu vaccine, after consultation with your local physician.

My daughter age-27yrs is pregnant.Her delivery is due in February 2015. She is under medical supervision but Doctor it would really helpful if you would give your suggestions on how can she take her care in this winter season?
Your pregnant daughter should keep herself warm by wearing protective layered clothing (long tees/woolen tank tops). In winter one doesnt feel thirsty, but dehydration can be harmful for the mother n the baby.So she has to religiously consume warm water or warm drinks like soups . Gentle pregnancy exercises (after consulting her gynaec) too help. Skin care by applying daily moisturiser. Care of feet by wearing right type of shoes/regular pedicures) Avoid too many caffeinated drinks. If she suffers from any medical or health related issues, it better to seek early attention.

How is Ebola treated?
There is NO ANTIVIRAL DRUG or VACCINE. Treatment is SUPPORTIVE. Aggressive rehyration therapy,blood and blood products.Maintain good oxygenation and blood pressure. Treat secondary infections if they arise.

Is there a permanent cure to Ebola?
No. It is said that if a person survives the first attack of Ebola he has protective antibodies for the next 10 YEARS. However it is unknown whether the immunity lasts life long or it also cross protects the person against a different strain of Ebola virus.

Is it true that Ebola has actually started from bats in Africa?
It most likely originated from non human primates (bats, monkeys or apes)

In what ways can common influenza be differentiated from influenza related to Ebola virus?
Influenza and Ebola infection both are viral, however Infuenza illness is much more common than Ebola virus. Influenza is a pandemic (i.e all parts of world are affected). Whereas Ebola is largely seen in West African countries,some cases have been reported in the US, Mali, Spain (lab confirmed).So influenza is much much more prevalent than the deadly Ebola. Ebola and Influenza in the initial stages cause a similar viral prodrome, however in the later stages of disease Ebola causes bleeding and multi organ failure, and so can swine flu. In Influenza (particularly H1N1 strain) ,early antiviral therapy reduces the disease severity and progression: But in Ebola there is NO ANTIVIRAL medication or approved vaccination.

Madam Dhanashri, Does Ebola generally start with Influenza?
No.These are two different viruses of different families. It can initially cause flu like symptoms (fever, severe bodyache,malaise, muscle pain and fatigue)..However a strong clinical index of suspicion is necessary in epidemics or when a patient has a recent history of travel to ebola affected high risk countries.This helps to detect Ebola infection in the early stage so that the patient can receive timely medical care.

Does Ebola virus act more harmful for certain organs in the body? Which organs are most targeted?
The entire body is prone to be affected. In advanced stages, bleeding from multiple sites of body, kidney failure, lung hemorrhage, liver failure and shock can occur.

Dr. Some essential tips from you to keep away infections and illnesses in winter. Regards
Winter related illness include: cough,cold, sore throat, allergies, painful joints, heart attacks,bronchitis, asthma,cold sores, cold hands,flu including stomach flu (norovirus). For allergy prevention:dust and clean and vaccum your home more frequently in winter, wash all blankets,woolen clothes, beddings periodically with hot water, service A/C or heating systems regularly. Avoid being too cosy with the pets. Hand hygiene,drinking plenty of oral fluids is important. Daily exercises prevent stiff joints. Moisturise your skin religiously. Wear warm clothing, stay warm in the house and a STICT NO TO SMOK ING and too many caffeinated drinks (these can worsen symptoms of heart disease) INFLUENZA Vaccine especially for the kids and elderly (pls contact your physcian for detailed information on this.)

How normal to fall sick for a couple of days with the change of every season?
Its very normal, especially when there are season related viral outbreaks.

How can one prepare in advance and overcome seasonal illnesses?
Winter related illness include: cough,cold, sore throat, allergies, painful joints, heart attacks,bronchitis, asthma,cold sores, cold hands,flu including stomach flu (norovirus).For allergy prevention:dust and clean and vaccum your home more frequently in winter, wash all blankets,woolen clothes, beddings periodically with hot water, service A/C or heating systems regularly. Hand hygiene,drinking plenty of oral fluids is important. Daily exercises prevent stiff joints. Moisturise your skin religiously. Wear warm clothing, stay warm in the house and a STICT NO TO SMOKING and too many caffeinated drinks (these can worsen symptoms of heart disease) INFLUENZA Vaccine especially in kids and elderly (pls contact your physcian for detailed information on this.)

Hello M’am, How does the Ebola virus actually harm one’s body?
It can cause a mild flu like illness to a deadly infection with bleeding and multi organ failure and shock.
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Female-age 39yrs. I usually feel very lethargic and sleepy in winters. Any particular reason for this doctor?
Because of slow metabolism. Winters are cosy anyways. Please check your thyroid and regular exercise in winter is a must.

What foods are best for children in winter?
All kinds of healthy foods are good for children in winter. Fruits, veggies, fish, eggs and milk products are advised.

My son aged 9yrs always falls sick in winter. I have been taking care of his diet, but what is your advice?
Allergies (pollen,dust mites,moulds), asthma, eczemas occur more commonly in winter. Vaccum and dust your house more in winter. Wash pillows,bedsheets, blankets weekly in hot water. Clean and service your air conditioning units frequently. Avoid close frequent contact with pet animals. Take your usual puffs more vigilantly if you are an asthmatic and keep rescue medicines at bay. Prevention of flu by influenza vaccine.

Is it true M’am that the body of the deceased person can also transmit Ebola?
Yes.

Is there an age group which is more prone to Ebola?
No, all the exposed groups are prone to Ebola.

Hello dr. …Why is that some people survive whereas some people don’t after the Ebola infection?
Its not clear why Ebola runs a different course in some people, but it depends on how rapidly the symptoms develop and partly how much virus load a patient was initially exposed to. It also depends on how rapidly a person receives care for his disease. It partly depends how the immune system reacts..this factor is beyond anyone’s control. The EBO-R (Reston) strain of Ebola is less pathogenic than the rest. So many factors,some of which are not completely understood cause a variable course of Ebola infection in different people…some survive,some dont.

Is it right to eat refrigerated stuffs like ice-creams at places with cold temperatures? Some say this normalizes our body temperature according to the weather temperature. Is this true?
Not really.

Why is it that infants, children and older people are most hit by winter illnesses?
Due to lower immunity in the extremes of age groups.

I am a male-36yrs, my wife is 33yrs and our kid is 5yrs, we all sleep in air-conditioned room every day. Some of friends tell me that sleeping every day in an air-conditioned room is bad for health. Advice?
Ducts in the A/C circulate fine dust throughout the house, they also may harbour moulds which can perpetuate allergic symptoms like frequent sneezing or allergic colds. They also keep the rooms completely closed and natural light and ventilation in such rooms is a problem. It is necessary to service A/C on a regular basis and also ensure that when A/C is not in use, the rooms are well lit and well ventilated.

How to avoid allergies that occur in winter?
Allergies (pollen,dust mites,moulds), asthma, eczema occur more commonly in winter. Vacuum and dust your house more in winter. Wash pillows,bed sheets, blankets weekly in hot water. Clean and service your air conditioning units frequently. Avoid close frequent contact with pet animals. Take your usual puffs more vigilantly if you are an asthmatic and keep rescue medicines at bay.

Also I feel less thirsty in winter. Anything I can do increase my thirst?
You must remind yourself to drink water at regular intervals, even though you may not feel thirsty.

I am a 38yrs working female. Medium built. I usually feel bloated after meals in winter. What should I do?
You can try having warm water after meals, also suggest to walk after meals. Avoid going to bed immediately post meals. If these symptoms persist, please seek further advise from your doctor.

I have this strong craving for fried foods in winter. Feel like having fried foods everyday. And I know that more oil and ghee are bad for heart. How can I overcome this? Pl help. Thank you.
Its a natural craving, however you must limit the ingestion of high fat containing foods. Drink more water, daily exercise must be a routine. Establish health goals (may be you can write this on a piece of paper), Prepare a list of healthy foods and enjoy foods which have a nutritive value, other forms of cooking like light saute or boiled or grilled food must be consumed .Its all about emotional awareness and mindful eating at the end of the day.

Should we always visit a doctor for seasonal related common cold, cough, fever? I usually try to sip in cough syrups, crocin or tabs for common cold.
Most of the winter related illness are viral, so symptomatic home remedies like steam inhalation, warm water salt gargles, drinking of warm water and over the counter medications help. However if these symptoms do not get controlled OR if you have health related risk factors like : Diabetes, Previous lung disease, kidney disease or heart disease or cancer you must visit your physician at the first go.

How to get rid of body aches in winter, especially in early mornings when I wake up?
Wear warm clothing, drink plenty of warm fluids,and MOST IMPORTANT is daily exercise.

Is Ebola fatal in most cases?
Ebola runs a varied course, in some people its a mild disease whereas in some it runs a fulminant course with very high death rates.

Please tell some common symptoms of Ebola?
Mild symptoms:fever, severe headache, body ache,muscle pain, fatigue, vomiting, diarrhea,abdominal pain, unexplained bleeding. In severe cases it causes kidney and liver failure and death due to multi -organ dysfunction and shock.

Is Ebola very contagious?
Yes.

Hello Dr. Dhanashri, how would you explain the disease called Ebola?
Ebola is a rare,deadly,hemorrhagic viral fever caused by virus EBOLA.

Hello, researchers say that there are no known treatments for Ebola yet then, there have been cases where Ebola infected patients have recovered from the infection. How has that happened?
Its not clear why Ebola runs a different course in some people, but it depends on how rapidly the symptoms develop and partly how much virus load a patient was initially exposed to. It also depends on how rapidly a person receives care for his disease. It partly depends how the immune system reacts..this factor is beyond anyones control. The EBO-R (Reston) strain of Ebola is less pathogenic than the rest. So many factors,some of which are not completely understood cause a variable course of Ebola infection in different people…some survive,some don’t.

Ma’m, Hospitals and clinics usually check all our family health history before any treatment,how should we check and find out about the hospital/clinic, whether they are maintaining hygiene, opting for right techniques and equipments for treatment, etc.?
In India, most of NABH/NABL OR JCI accredited hospitals follow standardized norms of health care practices. So you must find out such a hospital in your vicinity,usually it is available on the hospitals website.

I am 26yrs pregnant woman who has to go for regular check-ups. What precautions should I take doctor if I have to go for blood or any other tests, as I have heard that serious diseases like Ebola also spread through needles ?
Use single time disposable syringes and needles. Also avoid visiting hospitals where Ebola patients in high numbers are admitted and treated.(especially in west African countries)

Hi Doctor, Our family usually travel for holidays in the winter season. Sometimes the holiday destinations are the ones with real low temperatures/snow. How can we adapt to such cold temperatures without falling sick?
Influenza, colds, bronchitis, sore throat,asthma, painful joints are the common winter related illness. When you travel to destinations with low temperatures you need to wear layered clothing to keep yourself warm, have hot drinks frequently, be extra vigilant about taking your regular medications and keep rescue medications especially if you suffer from previous asthma or heart problem.Also ensure that your vaccinations are up to date.

Does Ebola also spread through surgeries?
If contaminated syringes or needles or instruments are accidentally used, this is a possibility. However in most of the hospitals single time disposable equipment are used during surgery.

Are there any vaccinations available for Ebola prevention doctor?
NO FDA approved vaccines exist till date.

There are many facts that Ebola has actually erupted from animals. But has it been due to the contact with infected animals or by eating the infected animal’s meat?
Both modes either EATING raw meat of these animals or though DIRECT CONTACT of infected animals.

Can Ebola virus also be transmitted through one’s genes?
Ebola is spread from through DIRECT CONTACT with blood or body fluids of infected persons.Infected body fluids could be secretions of respiratory tract, blood, saliva or semen.

Are children also prone to Ebola?
Yes.

I am a male aged 29 yrs. I do travel out of India most of the times in a year. How should I prevent myself from Ebola M’am? Please guide.
Hello..When you travel to areas where there is a high prevalence of Ebola infection, especially in West African countries you must take following measures: hand hygiene with soap and alcohol based hand rubs, avoid contact with blood or body fluids. Do NOT handle items that have been contaminated by infected persons blood or body fluids (clothes,bedding, needles). Avoid burial rituals that need handling of body which was infected with Ebola. Avoid contact with bats, monkeys or apes AND avoid ingestion of meat from these animals. AVOID hospital visits to areas which are treating Ebola cases.

Is there a way to detect that a particular animal is infected with Ebola?
The natural reservoir of Ebola are bats, apes and monkeys in all most all epidemics that have occurred till today. By autopsy of these animals and performing PCR/ELISA tests on the infected tissues, it is possible to know which animal is infected.

Is Ebola disease basically found in animals?
The natural reservoir of EBOLA is still a mystery. However based on research the most likely natural reservoir of EBOLA is non human primates ..that is FRUIT BATS, APES OR MONKEYS. In all previous epidemics, these animals were found to be the natural reservoirs of Ebola virus.

Good afternoon M’am, I wanted to know that is EBOLA spread by mere contact of the infected person?
good morning..Person to person transmission of Ebola occurs via Direct contact (through skin or mucous membranes of eyes,nose etc) with BLOOD OR BODY FLUIDS of infected person.It can also occur if there is a DIRECT CONTACT with infected needles,syringes or infected tissues. This mode is common in health care workers. The first human patient gets infected after DIRECT contact or INGESTION of infected primates (apes, monkeys, bats).This is called the SPILL OVER EVENT. Subsequently person to person transmission occurs.

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