August 22, 2014
News Review From Harvard Medical School -- 2 Americans Recover after Ebola Treatment
Two Americans treated for Ebola infection were released from Emory University Hospital this week. Kent Brantly, M.D., 33, and Nancy Writebol, 59, were infected while working at a hospital in Liberia. They were part of the mission groups Samaritan's Purse and SIM. Dr. Brantly and Writebol were flown home in a specially equipped plane in early August. Both were treated in an isolation unit at Emory. They were given an experimental drug, ZMapp. The drug is so new it has not been tested in humans. It's not known whether the drug helped them or if they would have recovered anyway. Standard treatment involves fluids, pain medicines and other supportive care. Emory doctors said the two are no longer infectious. Dr. Brantly appeared at a news conference August 21. He thanked and hugged members of the medical staff who cared for him. Writebol's husband released a statement. He said she was recuperating at an undisclosed location. Both should now have immunity to Ebola, an infectious disease specialist told HealthDay News. The Ebola outbreak in West Africa has killed at least 1,350 people so far. Cases have been reported in Guinea, Liberia, Sierra Leone and Nigeria.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
Two Americans involved in treatment of Ebola in Liberia became infected with the virus themselves -- and they have recovered. With celebration and speeches, Kent Brantley, M.D., and Nancy Writebol were both released from Emory University Hospital in Atlanta this week.
I listened to a newscast in which Dr. Brantley addressed well-wishers. His comments were not focused on his own recovery. Rather, his mind was still on the work to be done in West Africa.
According to the World Health Organization, more than 170 health-care workers have been infected. Most have been Africans. More than 80 have died.
Doctors and other health-care professionals who are willing to care for Ebola patients are my heroes. They are in short supply. In pivotal times of medical history, we have needed people who can put aside fears and work on the front lines.
Ebola makes me think of another time in history when people relied upon truly brave volunteer doctors to step into the midst of an epidemic. Just as West Africa is relying on "Ebola doctors" today, Europe relied on "plague doctors" during the late Middle Ages, in the time of bubonic plague. That epidemic (plague) was much more wide-scale than the current Ebola epidemic. Plague was less well understood than Ebola is, and it spread more easily. But it is interesting to me to compare the doctors and public health strategies now and then.
Ebola doctors and plague doctors gown themselves for work in similar ways. We have seen news images of white and yellow disposable paper gowns worn by medical professionals in West Africa. Ebola doctors wear hoods and goggles. Many of them wear masks shaped like duck bills. This shape makes it easier to breathe through the mask.
Artists' drawings show plague doctors who look strikingly similar, encumbered with protective clothing. The drawings also show a beak-shaped mask. In this case, the mask contained flowers and aromatic herbs, to help doctors cope with the terrible smells as they worked with the dying and dead.
Plague doctors coated their long robes with wax or lard. Some historians think this may have kept the gowns free of body fluid stains or contamination. They wore spectacles a lot like today's goggles, as well as leather pants and boots. They carried canes that allowed them to examine patients without so often touching them.
It is remarkable to consider how effectively these outfits might have protected doctors in those days, when so little was understood about exactly how illness was spread.
Plague was spread by fleas that carried bacteria. Ebola is spread differently, through body fluids. But just as in times of bubonic plague, public health measures for Ebola virus include quarantines.
Did you know that the word quarantine was invented during the time of bubonic plague? Ships that were thought to harbor potential plague infection were kept in harbors. They were not allowed to dock for 40 (in French, quarante) days.
In some cases, quarantines in plague time overruled civil rights. This is also a worry in our own time. In the time of plague, some houses were forcibly sealed up from the outside. Sick inhabitants were trapped inside. This week in Liberia, violence erupted in West Point, a slum district under quarantine. Protesters stoned security forces who were keeping residents from fleeing. Security forces fired bullets into the crowd and released tear gas.
What Changes Can I Make Now?
Dr. Brantley said, "I'm glad for any attention my sickness has attracted to the plight of West Africa in the midst of this epidemic."
This is a desperate time in West African nations involved in the Ebola outbreak. More than 1,300 people have died. Travel has been restricted, and it is challenging to preserve human freedoms in a time when we depend upon quarantines to prevent spread of disease.
Despite our celebratory hospital releases this week for two brave Americans, the Ebola outbreak remains geographically limited to West Africa. These nations need our empathy and the support of health care volunteers and provisions.
Some people who are not in West Africa are dismayed at protests against quarantines. Keep in mind that quarantines are socially complicated. Where there is uncertain trust toward government, motives behind quarantines can be confused. And if people in quarantine do not have health care and food supplies, we can't expect cooperation.
What Can I Expect Looking to the Future?
This is the largest outbreak of Ebola virus ever recorded. Our collective efforts to stop the spread of Ebola count even now more than they will as the epidemic enlarges. With unrest in West Africa now, we can expect to see further spread of Ebola before it is genuinely contained.
Most experts closely involved with Ebola do not expect this outbreak to become worldwide. Even if Ebola does affect some American travelers or health-care workers, it is not expected to expand into an epidemic in the United States. With adequate hospital resources and an educated community, cases here can be isolated soon after they are identified to help prevent spread.
As we watch this outbreak play out, let us appreciate the heroes who are willing to step into the center stage of the crisis in West Africa.