Thursday, February 22, 2018

Ebola warriors: a race against death

There is no cure for the Ebola virus ravaging West Africa, and it kills most of those it infects. But when Bruce Ribner got the call that two Americans stricken with Ebola were headed to his Atlanta hospital, he did not hesitate.

"I said, 'Hey, we've been practicing for this for 12 years,' " he said.

Ribner is an infectious disease specialist who oversees the isolation ward at Emory University Hospital, which is designed to house people suffering from highly lethal illnesses that could decimate a population if not contained.

Two nurses who form part of the team trained to work in the ward canceled vacations to treat the patients.

And on Saturday, team members in hazmat suits stood by as a convoy accompanying the ambulance carrying patient Kent Brantly arrived at Emory after an overnight air ambulance flight from Liberia.

The driver of one vehicle flashed a victory sign as the convoy turned onto the hospital grounds. A medical worker, whose hazmat suit included a protective hood and mask, clambered out of the rear of the ambulance. Then Brantly, also wearing a special suit, carefully lowered himself to the ground. He leaned on the medical worker as they walked slowly through a door into the isolation ward.

Nancy Writebol was expected to arrive from Liberia Tuesday on the same air ambulance that carried Brantly. Brantly, a doctor, and Writebol, a missionary, became sick last week while working in Liberia and treating others infected with Ebola.

Although Brantly was able to walk, albeit with assistance, he remains seriously ill with a virus that has no cure and a mortality rate is as high as 90 percent, depending on the strain.

Ribner said the high-stakes mission to bring Brantly and Writebol home was born as much out of medical duty as humanitarian obligations. Their chances of survival were lower in Africa than in this country, where they will receive the kind of care that could enable their bodies to recover enough to fight off the virus.

"The critical component ... is supportive care," Ribner said. "We're talking about maintaining blood pressure. We're talking about supporting respiration up to and including a respirator if the condition becomes that severe. People with Ebola virus infection may have kidney failure, so we are potentially talking about dialysis."

There is no other treatment for Ebola. Until Saturday, the virus had never entered the United States.

But opposition to its importation via the ailing patients has been minimal, limited mainly to right-wing pundits and individuals griping on social media. "KEEP THEM OUT OF HERE," Donald Trump tweeted.

But there was no sign of fear or anxiety around Emory. "Everybody at Emory is extremely supportive of this mission," Ribner said. "We realize it's an important part of being an advanced health care facility."

Rep. Adam B. Schiff, D-Calif., speaking on CNN, said the fact that Brantly and Writebol had a potentially deadly illness should not bar them from entering the country. "I don't think we should be so spooked because of the novelty of this terrible virus that we turn our back on Americans who are troubled," he said.

Ribner agreed. "We have two individuals who are critically ill, and we feel we owe them the right to receive the best medical care which is available to them," he said.

The ward where the pair will receive care is one of a few such facilities in the United States and was built with assistance from the CDC. Because it is designed for only the rarest of serious communicable diseases, it has been used only a handful of times.

Staff must follow proper protocols when entering and leaving the room while also showing compassion for their patients, who cannot have any direct human contact. Visitors are confined behind glass and speak to them via phone or intercom.

Each patient will be cared for by two nurses as well as infectious disease doctors and other specialists. All medical staffers who treat them will wear masks, hoods, gloves and an outer shell over their clothing to protect them from vomit, saliva, mucus and other fluids that can spread the virus.

The isolation required for treatment can add stress to patients, especially when their prognoses are unclear. Ribner said he could not say how long either patient might be kept in the special room, but Emory officials were confident they could save them.

As Jay B. Varkey, an infectious disease specialist at Emory who will help treat the pair, said after Brantly's arrival: "We are ready."

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