Ebola doctor reveals how infected Americans were cured


#1

I want to preface this by saying that I consider this article purely a news story. If I’m wrong in this thinking, and I end up with an infraction for posting medical advice, then I apologize in advance. Personally, I found the article fascinating, and I suspect other people will also.

nature.com/news/ebola-doctor-reveals-how-infected-americans-were-cured-1.15791

Last week two American aid workers who had contracted Ebola while working in west Africa were released from a US hospital and pronounced “recovered”. They had been flown to Emory University Hospital in Atlanta, Georgia, from Liberia earlier this month to receive care in the hospital’s specialized infectious disease unit. Kent Brantly, a physician with the humanitarian group Samaritan’s Purse, and missionary Nancy Writebol, of SIM USA, beat the strain of the disease they had contracted, which kills 52% of its victims.

Bruce Ribner, medical director of the hospital’s Infectious Disease Unit, sat down with Scientific American to explain how the two Americans were cared for, the lessons that could be applied to help patients across Africa and why the hysteria over flying the two individuals back to the US was unfounded.

Are Brantly and Writebol now immune to the Zaire strain of Ebola
In general, patients who have recovered from Ebola virus infection do develop a very robust immunity to the virus. They develop antibodies against the virus and they also develop cell-mediated immunity — the lymphocytes important to form viral control of pathogens. In general, the finding is it’s basically like being immunized — it would be unusual to get infection with the same strain.

Will that immunity afford them protection against other strains of Ebola?
We are still evaluating that in our two patients. Cross-protection is not quite as robust. There are five strains of Ebola viruses. Even though that data is not great, the feeling is there is potential for being infected if you go to a different part of Africa and get exposed to a different strain.

You said “still evaluating.” Are you still caring for Brantly and Writebol?
We are going to be following those two patients as outpatients, and as part of our evaluation they have agreed to undergo additional testing so we can better understand immunity to Ebola virus. We are meeting with them periodically.

What sort of lessons has Emory learned from caring for these two people that would be transferrable to patients in west Africa?
We are not being critical of our colleagues in west Africa. They suffer from a terrible lack of infrastructure and the sort of testing that everyone in our society takes for granted, such as the ability to do a complete blood count — measuring your red blood cells, your white blood cells and your platelets — which is done as part of any standard checkup here. The facility in Liberia where our two patients were didn’t even have this simple thing, which everyone assumes is done as part of your annual physical.

What we found in general is that among our Ebola patients, because of the amount of fluid they lost through diarrhea and vomiting, they had a lot of electrolyte abnormalities. And so replacing that with standard fluids [used in hospital settings] without monitoring will not do a very good job of replacing things like sodium and potassium. In both of our patients we found those levels to be very low. One of the messages we will be sending back to our colleagues is: Even if you don’t have the equipment to measure these levels, do be aware this is occurring when patients are having a lot of body fluid loss.

Our two patients also gained an enormous amount of fluid in their tissues, what we call edema. In Ebola virus disease there is damage to the liver and the liver no longer makes sufficient amount of protein; the proteins in the blood are very low and there is an enormous amount of fluid leakage out into the tissues. So one of the takeaway messages is to pay closer attention to that and perhaps early on try to replace some of these proteins that patients’ livers lack.

Considering how limited resources are in some of these facilities, could health care workers really act on this information?
I think the world is becoming aware that issues like this are not going to go away. The developed countries of the world will have to do our part to assist our colleagues with less-developed infrastructure to care for sick people. I think one of the messages that is going out from many sources is we really have to help countries such as the ones involved in this outbreak to develop their medical infrastructure. Hopefully in five years they will have this infrastructure.

You have said that you are helping to develop new Ebola care guidelines based on your experience. How will those be disseminated?
We have several articles that we have submitted to major medical journals, which are read overseas, where we will be pointing this out. We are working with several government agencies, including the US State Department, to help them come up with lessons learned — guidelines which they will distribute in turn to other countries. It is our goal to help our colleagues overseas.

Alternatively, what lessons did you learn from those health care workers?
Mostly the clinical course of the patients — much like any physician sending a patient to a referral center. They admitted they knew they were kind of flying blind. They’d say, “This is what we observed, but we had no way to test it.”

The article continues online…


#2

The article continues online…

I’m glad you did. The part about the electrolyte imbalances was not at all surprising. Lots of diseases do that, and keeping a proper balance is a way to aid recovery. I was not aware of the protein deficiency. I’m not sure how they deal with that.

The varying strains is troubling. Also, it is still very troubling to me that they still don’t know what the animal or perhaps insect vectors of the disease are. There seems to be a strong suspicion that dogs can be carriers. If they can be, then likely other animals can be as well. If Ebola ever gets into a vector population in this country, we are in an enormous amount of trouble, no matter how careful they are in hospitals.


#3

The part about electrolyte imbalances was news to me, but it does make sense. You’re right about animal and insect vectors being troubling and disturbing. I haven’t read anything specifically discussing mosquito-borne transmission, but it certainly seems possible.:shrug:


#4

I’m so glad to see when people are able to survive this. That is encouraging. I hope we will see more of that in the future, too.


#5

I studied a month’s worth of infection control besides learning how to put on protective garb.

I am having the impression that when the patient is most symptomatic, that is when I wonder there are airborn droplets in the air…or the nurse when removing the garb accidentally touches a small spot on the outer cuff that was exposed…when removing gloves.

They are now finally saying the RN’s were not given adequate training for this particular disease. And one must practice over and over putting on and taking off protective clothing and gear.

I would also think it must be most stressful to care for a symptomatic Ebola patient, the concentration needed doing simple tasks…that I would think the nurse would need breaks for relief. But then just to take a break is exposing one’s self to possible contamination and exposure.

I don’t think the nurses were adequately trained to handle these cases. Many are now concerned in treating them. Some here in the States were wearing triple gloves…pulling off too hard to remove them can cause a sudden jar and then you accidentally touch contaminated area. You have to be so careful doing dialysis, inserting needles into veins, evacuating air ways…that I am likewise wondering when it is time to declare a person terminal and then to provide them comfort care.


#6

Yeah, that’s probably true.


#7

The hospital was not prepared and the careworkers were not properly trained.
Many careworkers died in africa.

All the CDC director can say is he is sorry she got sick.

I think the CDC director should step down.


#8

I am also wondering in severe cases, if by then the virus is air born…which makes it that much more contagious…and if the rooms they go into should have attendants observing each step…

That is why with the stress of concentration put on health care workers, when it may be necessary to decide when the case is terminal.

It is sounding to me that putting him on dialysis for one thing was extraordinary care.

I think the CDC and hospital administrators were operating on the idea that the system in itself can handle anything…but then it is another thing when they don’t know the parameters of this disease either.

You can only learn by trial and error…and this is already frightening the health care workers. They don’t feel safe or secure with their equipment either.


#9

The emboldened part is something I seriously believe:

“I was there when it broke out,” the former Premier League striker told BBC World Service’s Sportsworld programme .

"People didn’t take it that seriously at the time - it’s too late now."

The virus spreads between humans by direct contact with infected blood, bodily fluids or organs, or indirectly through contact with contaminated environments.

bbc.com/sport/0/football/29096286

Article on Soccer.


#10

This outbreak started early spring and despite numerous headlines about the death toll, no one wanted to address the ebola until late late summer.

Just like ISIS. The world watches the news and sees what is happening, but doesn’t act.


#11

They are now starting to discuss how far to go when to then define what is terminal.

With faith and prayer, we know that can be difficult.

But it also has to do with endangerment…because the stress of wearing these hot and sweaty suits and watching all your own movements is very hard as well and, it looks like mistakes will be part of this service.

The other issue is how to provide hospice for these ebola patients to make them most comfortable.


#12

Hospice? They are in isolation.


#13

Hospice is in essence comfort care for the dying.

But I am realizing that in these poor peoples’ last stages, they pretty much expel anything put in them, and violently so.


#14

Yes I know what hospice is. But with ebola they are trying to save their lives until they die and I am sure they are caring for them the best they can considering the circumstances.


#15

Yes…the problem is providing care without causing death to yourself as well as finding a comfort that they can retain.

The RN is now in best hospital where they do scientific research and so I believe they will come to good care as well as more protection for the public.

But I do think Ebola is most contagious in that it is appearing to be also air born through minute droplets. And people caring for them…I just saw something on tv where the teams must practice continually and have observers…triple glove, shoes, decontamination chamber…really something.

I also think we need to place ban on these African countries. The fellow who got into America attempted to camouflage his departure by going to another country, as well as the admittance desk not communicating the man came from Africa. Nigeria and Senegal had bans and now disease is gone.


#16

Mosquito-borne transmission seems unlikely. A mosquito-borne virus like West Nile or Dengue virus has to successfully infect the insect, replicate to high enough level to make its way into the saliva glands, and then be injected in high enough dose into the next host, where it has to amplify to high enough level to continue the cycle. This dual-host requirement places a strong constraint on how the virus can evolve. Even for West Nile virus, humans are a dead-end host, because the virus doesn’t amplify up enough in us - the real cycle is between the mosquito and birds, which West Nile absolutely rips through. Anyway, Ebola certainly amplifies to high levels in humans, but it is unlikely to do the same in a mosquito.

I suppose the prospect could be that a mosquito bites an Ebola victim, and then immediately goes and and bites someone else, while still having traces of live virus on their proboscis. However they don’t tend to do that. Once they get their blood meal they tend to go hang out and rest. The blood sits there in the midgut and coagulates. By the time they get around to biting someone else a few days later, most likely the virus (without successfully infecting the insect) has decayed away.

I remember in the early days of HIV people were very concerned that mosquitoes could transmit it, what with it being a blood-borne pathogen. Presumably the same could be true of any other bloodborne virus like hepatitis B, hepatitis C, and what not, based on the mechanism of a mosquito biting two people in a row. But you don’t tend to see transmission of viruses this way. And these human viruses don’t easily adapt to become insect viruses. If any of them did, I would expect to have seen it with HepC because it is more closely related to West Nile, Dengue, Yellow Fever, and a bunch of others. Ebola is way out there.

The natural animal reservoir of Ebola by the way appears to be bats. Thing about bats is they are highly mobile, and they defecate wherever. I don’t know if Ebola ends up coming from bat guano, or from bat bites (like rabies in the US). I do know that Nipah virus which is another highly lethal one in SE Asia, appears to be transmitted to people via fruit bats defectating on fruit which people then consume un-washed.


#17

Yes. I agree. Our government is doing everything wrong!

Now I hear the lab worker who did the blood test on one of the infected is on board a Carnival Cruise ship and Belize is refusing to let the lab worker off the ship or any passrngers. Belize wants to protect its citizens. I wish our government felt the same way!


#18

Here is an interesting show about ebola. This episode of NOVA aired earlier this month.

pbs.org/wgbh/nova/body/surviving-ebola.html

Peace

Tim


#19

I saw it. It was very good.


#20

If I can get the time, I would like to watch this.

I am hearing they don’t think it is airborne. I somehow think it is at a particular stage…and this is the stage I am wondering that could be terminal as well, considering how the patient is expelling so much from the body, the lungs hemorrhaging.

Case in point, I came down with a cold and am also caring for my 14 month old grandchild with my husband. I washed my hands frequently, my cold was mild, more with fatigue, very little sneezing. I opened the window, had fan on, and sprayed the room, where the grandchild would nap so many hours later.

I work on the computer here downstairs next to my son’s room. He uses this computer on the side and has his windows open. We keep our windows open slightly year round anyway. But he got sick with this as well, but he is getting over it faster than me. He was using this computer while i was sick. My grandchild also got this cold.

So I still am not convinced this ebola is not airborne.


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