Transporting the patients
- The team including a physician will travel by ambulance to meet the patient’s plane. The ambulance is specially fitted with absorbent drapes covering the shelves on the walls, to catch any fluid drops. The ambulance driver’s compartment is pressurized so air from the patient compartment won’t come in.
- At the hospital, the isolation unit was built to house patients with the highest level of virulent infection, like Ebola, but this will be its first. It has housed a handful of less virulent cases, such as influenza.
- When in the room, doctors and nurses wear Tyvek suits with closed hoods and breathing apparatus.
- If family visits, they will communicate with the patient through a window.
Sources: Dr. Alexander Isakov, Dr. Bruce Ribner, Emory University.
How the decision was made
On Wednesday morning, Dr. Bruce Ribner, assistant professor of medicine at Emory University, got a phone call — from a specialized ambulance service, he thinks — saying the charity Samaritan’s Purse had heard about his containment unit at Emory University Hospital for patients with highly dangerous diseases. One of the organization’s health workers in Africa appeared to have Ebola. Could they come?
“Of course we said yes,” Ribner said, talking to the AJC after a press conference Friday. He hung up and informed the administration.
The decision has raised eyebrows and blood pressure across the metro area and beyond, but Ribner and Emory officials say the decision was perfectly in line with their well-thought-out procedures, drawn up long ago so that when this moment came no one would be brainstorming.
If the patients’ Ebola is confirmed, this is the first time in its 12 years that the unit will be put to its full use. Two previous patients thought to have similarly dangerous conditions turned out to have something different. “We’re excited,” Ribner said.
But that’s not why he said yes.
The unit was created for just this purpose. The care in Africa was so poor, and the care here so good, he believes it will substantially increase their chances of survival.
“It’s like any other sick patient,” he said. “We have two individuals who are critically ill and we feel that we owe them the right to receive the best medical care which is available for them.”
Mercer prof plans exit from Liberia
As two Americans stricken with the Ebola virus were being evacuated from Liberia for treatment in Atlanta, another American was planning his own departure from the country.
Rick Wilson, chairman of Mercer University’s Christianity department, is curtailing his work in the West African country and returning to Macon next week. Wilson, on loan from Mercer, has served as president of the Liberia Baptist Theological Seminary since January.
He talked with The Atlanta Journal-Constitution on Friday from the seminary compound about what it’s like living alongside a deadly virus.
“Calm, but grim,” Wilson said. Schools are closed indefinitely, government offices are shut down for sanitization, and traffic is as light as its been in six years, he said.
The elaborate handshake and hugs that constitute a Liberian greeting are gone. Now no one touches. Handshakes and hugs have been replaced by chlorine water baths placed at the entrance of many Liberian homes.
“When entering a room you wave at each other, you sit on opposite sides of the room,” Wilson said. “I haven’t touched anyone for a week. It’s weird but necessary.”
For Wilson, the isolation has been difficult. As part of his missionary and theological work, he has traveled to the West African country about a dozen times during the past decade. With the outbreak, most of his work is now conducted on the computer and through email.
“I’m not afraid. I understand my circumstances. I’m glad to be here and will be sad to leave,” he said. “I hurt for Liberia.”
The two Ebola virus patients coming to Emory University Hospital from Liberia — one is expected to arrive Saturday — pose no threat to the general public, federal health officials and infectious disease experts said Friday.
Even so, plans to treat the gravely ill American aid workers in Atlanta sparked concerns, and in some cases outrage, among many metro-area residents. Experts say people shouldn’t be concerned because Ebola is not transmitted through the air, as with other viruses like flu.
“Ebola, because it’s an exotic disease and something that’s rare – certainly unknown here in the United States – it can be frightening,” said Barbara Reynolds, a spokeswoman for the Atlanta-based U.S. Centers for Disease Control and Prevention. “It would take close personal contact of an exchange of body fluids for someone to become infected with Ebola.”
Officials also said that evacuating Dr. Kent Brantly and missionary Nancy Writebol to a U.S. facility is their best chance of survival.
The two remained in serious condition Friday, according to the North Carolina relief organization, Samaritan’s Purse, Brantly works for. They were expected to arrive at Dobbins Air Reserve Base in Cobb County. (Emory would not identify the two patients, citing privacy concerns.)
While there is no cure for Ebola, improving the patients’ level of care may markedly improve their chances, said Dr. Bruce Ribner, the infectious disease specialist at Emory who will be treating them.
“The body has to be given a chance to live long enough to kill the virus,” Ribner said.
Simply monitoring the patients’ level of hydration accurately and watching for bleeding are part of that effort, he said. The survival rate for the current Ebola outbreak has been around 40 percent.
Brantly and Writebol contracted Ebola while working in Liberia — one of three African nations stricken by the worst known outbreak of the disease. Identified in March, the virus has claimed 729 lives and shows no signs of abating, according to the World Health Organization. Another 1,323 confirmed or suspected cases have also been reported.
Leaders of the West African nations under siege by the virus were set to meet with WHO on Friday to discuss a $100 million plan to deploy hundreds more medical professionals to the ravaged region. Sierra Leone and Liberia have also announced emergency measures, including closing schools, conducting house-to-house searches for infected people and deploying the army and police.
‘This is supposed to make us feel better?’
The impending arrival of the two American aid workers has raised worries among residents about how officials plan to prevent the disease from spreading and why the Ebola patients are being brought here in the first place.
They will be treated in a special isolation unit built by Emory in collaboration with the CDC. The unit, one of only four of its kind in the country, is located away from other patients. (The other units are in Nebraska, Montana and Maryland.)
That doesn’t make Atlanta resident Mercy Wright feel any better, especially considering the recent safety lapses at the CDC in handling anthrax and a dangerous strain of flu.
“This is supposed to make us feel better?” Wright said. “The CDC, which already is mismanaging its supplies of dangerous diseases, is now entrusted with the most dangerous virus of them all?”
People have a right to be uncomfortable with the decision to bring the patients here, said Dr. Ford Vox, who works with brain injuries, not infectious diseases, but has ties to Emory.
“As a medical professional, I don’t have confidence in any hospital — even a unit run in collaboration with the CDC such as Emory’s — as having absolute safety,” he said.
Dr. Ribner, CDC officials and other infectious disease experts say there is little risk to the public of bringing the Ebola patients to Atlanta.
In fact, there is nothing about Ebola that necessarily requires the use of such a specialized treatment unit like the one at Emory, said Reynolds, the CDC spokeswoman, in an interview with The Atlanta Journal-Constitution Friday.
“Ebola is a viral disease that is not transmitted from person to person through the air,” Reynolds said. “We have other diseases that can be quite frightening and deadly that do transfer through the air.”
The virus is instead passed through bodily fluids. A person with Ebola, which is a type of hemorrhagic fever, can’t infect others until he is showing signs of the illness, such as vomiting or diarrhea, she said.
‘Under strict protocols for infectious diseases’
Flying Americans home after contracting diseases in foreign countries isn’t new.
Special resources were used in both the SARS outbreak of 2002 and the Marburg Viral Hemorrhagic Fever outbreak in Angola in 2009 to bring Americans back to the states while still protecting the community at large, according to the U.S. Department of State.
“The safety and security of U.S. citizens overseas is our highest priority,” the agency said in a statement. “These are U.S. citizens who are returning to the United States for medical care. They are being returned under strict medical protocols for infectious diseases.”
There have been at least five cases in the U.S. of people who suffered from other types of hemorrhagic fever, not Ebola, and were successfully treated without any secondary transmission, Reynolds said.
“The health care system worked,” she said.
Bringing the patients here is probably the right thing to do, said Richard Ebright, a biosafety expert at Rutgers who has been critical of the CDC’s safety lapses in handling dangerous disease samples. For one thing, Ebright said, it’s a humanitarian gesture that is also an opportunity to test out technologies developed for isolating and transporting these patients.
And though Atlanta residents may not be enthusiastic about the situation, they shouldn’t be overly concerned, he said. It’s a high-profile case and every precaution will be taken, Ebright said.
“None of the carelessness that has happened with the low-profile, routine, ongoing day-to-day laboratory operations at the CDC and CDC-regulated labs should be expected to occur in a case like this,” he said. “Management will be on top of this.”
‘Rest assured that all eyes are on the CDC’
The Emory doctors, Ribner and an emergency medical specialist, Alexander Isakov, said the patients were expected to arrive separately. When they do, Isakov will set out to meet the plane with a specially equipped ambulance.
Medical waste coming out of the unit will be sterilized, but the patients’ personal wastes will go into the county sewage system just like any other patient’s. That is safe and standard protocol even for viruses like this one, Ribner said, as the standard county sewage treatment is strong enough to eliminate any danger.
Ribner added that he is not concerned about being infected as a health care worker caring for an Ebola patient, as these patients themselves were.
It’s logical that the patients would be brought to Atlanta because the CDC is there, said U.S. Sen. Johnny Isakson, R-Ga. They’re also American citizens, he said. “If I got ill overseas and needed that care that was highly specialized, I would hope that my country wouldn’t not let me back in.”
Isakson added that he’s been in touch with CDC Director Tom Frieden and has full confidence in the CDC.
“I’m following this on a daily basis with the CDC,” he said. “People can rest assured that all eyes are on the CDC and all eyes are on these two patients to make sure everything is done properly.”