York global health law expert helps inform international Ebola care guidelines

Steven J. Hoffman, a professor in the Faculty of Health and Osgoode Hall Law School at York University and the scientific director of the Institute of Population & Public Health, part of the Canadian Institutes of Health Research (CIHR), was among 30 world experts who informed newly released medical guidelines for the care of patients with Ebola virus disease.

Steven Hoffman
Steven Hoffman

Hoffman served as a member of the Ebola clinical management guidelines development panel, an international group that worked with the World Health Organization (WHO). Hoffman was asked to bring ethical, legal and social perspectives to the guidelines.

Hoffman and his colleagues on the panel were tasked with developing clear global guidance for health professionals on how to manage patients presenting with Ebola virus disease, whether those patients are in Canada or in a poorer country where such outbreaks are more likely.

“The world is seeing increasing numbers of infectious disease outbreaks, so it’s important that our health professionals are ready to respond to them,” said Hoffman. “These evidence-based guidelines summarize the best available research on how health professionals should manage patients with Ebola virus disease. Their development and publication means that health professionals won’t be scrambling the next time Ebola hits – but will know immediately how to care for patients with the disease.”

The group consisted of critical care physicians, nurses, emergency medicine physicians, general practice physicians, infectious diseases physicians, public health experts, health research methodologists, one survivor of Ebola and WHO staff observers. Hoffman is co-author on the resulting manuscript published in The Lancet medical journal. The article recommends several interventions to care for patients presenting with Ebola, including: administration of hydration; monitoring of vital signs; biochemical testing; adequate staffing ratios; and access to analgesics for pain relief. The guidelines also recommend measures to support the psychological and social well-being of patients and their families, both for its intrinsic value and for building trust among communities for the responding health professionals.

Hoffman’s work was key to ensuring that future medical care for patients with Ebola is informed by population-level issues, including ethics, law and social policy.

The Ebola virus

From 2013 to 2016, the outbreak of the Ebola virus disease in West Africa resulted in more than 70 per cent fatality rates and unprecedented challenges in providing care to patients with the disease. This rate, however, was decreased when patients with Ebola received supportive care. As a result, an international multidisciplinary panel of experts was convened to help inform optimal care for any future outbreak of the Ebola virus disease.

“As a global health law scholar, it was an honour to be able to inform the Ebola clinical guidelines with a population and social perspective,” said Hoffman. “Ebola outbreaks do not occur in controlled labs, but rather in complex social, legal and regulatory contexts. The imperative of having broad perspectives informing these guidelines is even greater when we consider that most Ebola outbreaks will unfortunately occur in some of the poorest communities, meaning that health professionals will not have the benefit of all of the core capacities and health-care technologies that we have become used to in wealthier countries like Canada.”

Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, this multidisciplinary panel has now published the first evidence-based international guidelines on the delivery of supportive care for patients admitted to Ebola treatment units.

“The increasing emergence of widespread epidemics and various infectious diseases, like that of the Ebola virus, poses significant challenges to the health and safety of people worldwide,” said Marc Ouellette, scientific director, CIHR Institute of Infection & Immunity. “The Canadian Institutes of Health Research recognizes the need for continued research to develop tangible, real-world solutions to global health threats. On behalf of CIHR, I congratulate all involved in the work creating these guidelines. They are an important tool to manage the risks associated with treating patients who have contracted the Ebola virus. Through adoption of these guidelines and through research, we can help stop the spread of this virus.”