U.S doctor with Ebola improving, says Expert

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In Nigeria
Aug 4th, 2014
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The condition of American Dr. Kent Brantly stricken with Ebola seems to have improved, the director of the Centre for Disease Control and Prevention said yesterday.

Dr. Thomas Frieden said it was encouraging to see Dr. Brantly walk out of the ambulance unassisted when he arrived at Atlanta’s Emory University Hospital from Liberia at the weekend.

Frieden said he understands the public’s concerns about Ebola, and the public health role is to ensure that the infection is not spread.

The CDC chief said old-fashioned practices were required to stop the spread of Ebola in West Africa. These include finding the patients and their contacts, making sure they’re treated, educating the public and doing rigorous infection control in hospitals.

Ebola is only spread through direct contact of bodily fluids.

This current Ebola outbreak is the worst on record and has killed more than 700 in three countries in West African and infected more than 1,300.

Before Brantly arrived in Atlanta, not much about his condition had been made public. According to Samaritan’s Purse, the aid organisation he was working for, Brantly was in “serious but stable” condition before being flown to the U.S.

When the doctor was able to walk into the hospital, at least two experts said they were surprised but pleased that the doctor seemed to be doing well.

This strain of the Ebola virus has a fatality rate of approximately 60 per cent and past outbreaks had fatality rates as high as 90 percent.

Dr. William Schaffner, an infectious disease specialist at Vanderbilt University School of Medicine, said he felt “guardedly optimistic”, since Ebola usually advances quickly and Brantly had shown signs of the disease for at least a week.

“The first thing we all said ‘Whao, he’s not on a vent,’” Schaffner said of realising that Brantly did not need a ventilator to help him breathe. “In general [with] Ebola is … you progress on a downhill course. If you’re at this point and you’re holding your own you’re entitled to be optimistic.”

When the doctor was able to walk into the hospital, at least two experts said they were surprised but pleased that the doctor seemed to be doing well.

This strain of the Ebola virus has a fatality rate of approximately 60 percent and past outbreaks had fatality rates as high as 90 percent.

Morse said that Brantly was obviously not out of the woods and that he would be under constant monitoring to ensure his blood pressure, lung function, kidney function and other vitals remained steady.

“If he really does get better, we want to know his secret,” Morse said.

Doctors yesterday also spoke on how their infected colleague would be treated amid fears that  the outbreak killing more than 700 people in Africa could spread in the United States has generated considerable anxiety among some Americans.

But infectious-disease experts said the public faces zero risk as Emory University Hospital treats a critically ill missionary doctor and a charity worker who were infected in Liberia.

The U.S. Centers for Disease Control and Prevention has received “nasty emails” and at least 100 calls from people saying “How dare you bring Ebola into the country!?” CDC Director Tom Frieden said Saturday.

“I hope that our understandable fear of the unfamiliar does not trump our compassion when ill Americans return to the U.S. for care,” Frieden said.

Dr. Kent Brantly and Nancy Writebol, who will arrive in this week, will be treated in Emory’s isolation unit for infectious diseases, created 12 years ago to handle doctors who get sick at the CDC, just up the hill. It is one of about four in the country, equipped with everything necessary to test and treat people exposed to very dangerous viruses.

In 2005, it handled patients with SARS, which unlike Ebola can spread like the flu when an infected person coughs or sneezes.

In fact, the nature of Ebola — which is spread by close contact with bodily fluids and blood — means that any modern hospital using standard, rigorous, infection-control measures should be able to handle it.

Still, Emory won’t be taking any chances.

“Nothing comes out of this unit until it is non-infectious,” said Dr. Bruce Ribner, who will be treating the patients. “The bottom line is: we have an inordinate amount of safety associated with the care of this patient. And we do not believe that any health-care worker, any other patient or any visitor to our facility is in any way at risk of acquiring this infection.”

Brantly was flown from Africa to Dobbins Air Reserve base outside Atlanta in a small plane equipped to contain infectious diseases. The plane had briefly stopped in Maine to refuel.

Bangor Mayor Ben Sprague confirmed that the plane landed Saturday morning at Bangor International Airport.

He said airport staff, law enforcement and public health personnel were on alert in case anything went wrong, but it was a straightforward landing and refuel.

At the Dobbins air base, a small police escort followed his ambulance to the hospital. He climbed out dressed head to toe in white protective clothing, and another person in an identical hazardous materials suit held both of his gloved hands as they walked gingerly inside.

“It was a relief to welcome Kent home today. I spoke with him, and he is glad to be back in the U.S.,” said his wife, Amber Brantly, who left Africa with their two young children for a wedding in the United States days before the doctor fell ill.

“I am thankful to God for his safe transport and for giving him the strength to walk into the hospital,” her statement said.

Inside the unit, patients are sealed off from anyone who doesn’t wear protective gear.

“Negative air pressure” means air flows in, but can’t escape until filters scrub any germs from patients. All laboratory testing is conducted within the unit, and workers are highly trained in infection control. Glass walls enable staff outside to safely observe patients, and there’s a vestibule where workers suit up before entering. Any gear is safely disposed of or decontaminated.

Family members will be kept outside for now.

The unit “has a plate glass window and communication system, so they’ll be as close as 1-2 inches from each other,” Ribner said.

Dr. Jay Varkey, an infectious disease specialist who will be treating Brantly and Writebol, gave no word Saturday about their condition. Both were described as critically ill after treating Ebola patients at a missionary hospital in Liberia, one of three West African countries hit by the largest outbreak of the virus in history.

There is no proven cure for the virus. It kills an estimated 60 per cent to 80 per cent of the people it infects, but American doctors in Africa say the mortality rate would be much lower in a functioning health-care system.

The virus causes hemorrhagic fever, headaches and weakness that can escalate to vomiting, diarrhea and kidney and liver problems. Some patients bleed internally and externally.

There are experimental treatments, but Brantly had only enough for one person, and insisted that his colleague receive it. His best hope in Africa was a transfusion of blood including antibodies from one of his patients, a 14-year-old boy who survived thanks to the doctor.

There was also only room on the plane for one patient at a time. Writebol will follow this week.

Dr. Philip Brachman, an Emory public health specialist who led the CDC’s disease detectives programme for many years, said since there is no cure, medical workers will try any modern therapy that can be done, such as better monitoring of fluids, electrolytes and vital signs.

“We depend on the body’s defenses to control the virus,” Ribner said. “We just have to keep the patient alive long enough in order for the body to control this infection.”

The plane carrying the second American patient left the U.S. for Liberia yesterday.

The private air ambulance is scheduled to arrive in Liberia after one stopover. The plane will then bring aid worker Nancy Writebol to Dobbins Air Reserve Base in Marietta, Ga., and is expected to land midday tomorrow.

The same plane brought Dr. Brantly to Georgia on Saturday

 


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