Ebola update: 2 Americans seriously ill

Here’s the latest on the Ebola outbreak that’s threatening west Africa, and has already infected several Americans in the region.

The two Americans in Liberia infected with Ebola, Dr. Kent Brantley and Nancy Writebol, are still seriously ill with the disease. Plans are being made to bring them out of Liberia and back to the US.  A long-range commercial jet, equipped with an isolation pod, has been sent to Africa to transport them.  The CDC, US State Department and the Liberian Government have been working together to coordinate the transfer.  The patients will be housed in biocontainment transfer units that will keep them sealed off from others.  The patients will be placed in the units, sealed inside, and the external surfaces will be decontaminated before they are loaded into the plane.

This is the kind of biocontainment unit they use to transport the patients:

Patient isoliation unit, courtesy of Gentex.

Patient isolation unit, courtesy of Gentex.

Upon arrival, at least one of the patients will be transferred to Emory Hospital in Atlanta, close to the CDC.  Emory is one of the few hospitals that has a high-level containment unit to house patients who are infectious.  The unit is separate from the main parts of the hospital where other patients are housed.  The hope is that these two patients will do better in facilities that are better equipped to deal with serious medical illnesses. (Dr. Brantley’s wife and children, who were in Liberia with him but returned to the US before he broke with Ebola, are still healthy but they are under “fever watch” precautions at their home in Texas. “Fever watch” means they monitor oral temperatures (one assumes) several times per day, and the patients are told to immediately report any symptoms like fever, headache, nausea, vomiting, diarrhea, muscle aches, etc. to the doctors/agency who is supervising them so that they can get assessed for Ebola immediately.)

If you look at the pictures from the Samaritan’s Purse site you can see that the hospital there is not very well equipped.  The chapel, shown in one of the photos, has been converted to an isolation ward.  This hospital, and others, are sadly lacking in equipment, supplies, medicines, laboratory facilities, etc.

[The US Army Medical Research Institute of Infectious Diseases (USAMRIID) used to have a unit that could be used to isolate patients with dangerous infections.  It was a high-level containment unit, virtually a mini hospital. However that was closed down. The Department of Defense had a similar facility, the Aeromedical Isolation Unit, that has also been closed down.]

Mrs. Writebol was also given an experimental serum.  The details of the serum are unknown, but usually when the term “serum” is used in an article about an infectious disease, it implies that the serum contains antibodies that may help the patient fight off the virus. Apparently, the serum has not been tested in other patients and there was some controversy as to whether it should be used at all.  If the patient has a serious reaction to the serum itself, it could make her even more ill or, possibly, cause death. Reportedly, there was some controversy among experts as to whether the serum should be used in such a seriously ill patient because of such possible side effects.

Dr. Brantley was given a transfusion of blood from a young boy who survived Ebola.  The boy, cared for by Dr. Brantley, wanted to show his gratitude for recovering from the virus.  The medical personnel on site may be hoping that the boy’s blood contains anti-Ebola antibodies that might help the doctor. Theoretically, if the serum and/or plasma in the transfused blood has anti-Ebola antibodies, it can decease the amount of virus circulating in the patient. And maybe buy him more time to stay alive till he can produce antibodies on his own.

Some of the medical missionary groups are now withdrawing their personnel from the stricken areas.  Other groups have stopped sending people into the area all together.  And the CDC has upgraded its travel alert for the area.  It now recommends that, unless someone has a pressing need to travel to Guinea, Sierra Leone or Liberia, that they avoid going there at all.

Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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