The global Ebola outbreak touched American shores more definitively Monday, as Atlanta awaited the arrival of its second Ebola patient by morning, and a New York hospital announced it had isolated a man with possible symptoms who walked into its emergency room.
The bad news was leavened with good, as public health officials continued to say there was little risk here of a contagion like that seen in West Africa because of better health controls. And CNN reported that an experimental treatment administered to the two Ebola-infected health workers while in Liberia was followed by remarkable improvement.
The developments, including a wave of experts being sent to the outbreak by the Atlanta-based Centers for Disease Control and Prevention, all served to underscore the stakes. American and global health, plus the expertise of Atlanta’s Emory University Hospital and the CDC, were in the international spotlight for good or ill.
"We're back on track, doing what we do best," said William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University, alluding to recent troubles at the CDC.
Among the dramatic revelations Monday were that both Dr. Kent Brantly, who arrived at Emory on Saturday, and Nancy Writebol, who is expected Tuesday morning, received an experimental serum called ZMapp, and that they improved afterward. Brantly, CNN reported, thought he was dying and asked for the dose, then showed striking improvement right away.
It’s not clear how he has fared since. Brantly has elected under privacy laws not to allow Emory to talk about his condition.
Samples of ZMapp were given to Brantly’s charity, Samaritan’s Purse, said Erica Ollmann Saphire, a molecular biologist at the Scripps Research Institute, which is leading a global consortium attempting to coordinate research efforts on an Ebola treatment. ZMapp was developed by an international team including Americans and Canadians, and was largely funded, manufactured and tested in the United States, in spite of the fact that it will not be a money-maker, Saphire told The AJC in an interview.
There are many ways to build a medicine against a virus, Saphire said, either painting a target on the virus for a patient’s immune system to neutralize, or gumming up the works of the mechanism that a virus uses to attach itself to healthy cells and make them sick. ZMapp works by consolidating those tools into one.
“We’re doing great,” said Saphire, noting that monkeys treated within 24 hours of infection had all been cured, and clinical trials were scheduled for 2015. Saphire said she was not surprised at the reports that ZMapp antibodies may have worked.
“I would take them myself,” she said. “Wouldn’t you, if you’d been infected with Ebola? Wouldn’t you just go roll in it?”
The scientific excitement may be more tempered among the public. Only a few monkeys were treated with ZMapp. No one knows how the drug will fare in clinical trials, and even if it comes to market, that could be a long way off.
ZMapp is not the only drug under development for treatment of Ebola. A Canadian company, Tekmira, is actually further along, having begun clinical trials of its drug, TKM-Ebola, in healthy humans.
Those trials, which are designed to test how well humans tolerate the drug, were put on hold recently after the Food and Drug Administration asked the company to modify its protocol.
In earlier tests on monkeys or apes infected with Ebola, the drug was 100 percent effective in combating the virus, according to the company’s news release.
That said, you can’t give Ebola to someone in order to test the treatment, so Brantly’s and Writebol’s cases may be good news for drug development, nudging the process along.
Even without experimental treatment, Emory doctors have said they are highly optimistic about their patients’ chances here, where basic hospital protocols and patient care far exceed those of the outbreak areas — and that is not a coincidence, they said.
But where the two health workers are making use of science fiction-level containment in transport and treatment to and at Emory, one possible case in New York came in off the streets.
In New York City, Mount Sinai Hospital said a man came to its emergency room in the early morning hours Monday with a high fever and gastrointestinal trouble, classic Ebola symptoms. While he may not have Ebola, he is being tested for the virus.
He had recently been to one of the West African countries with Ebola. Some hospitals, such as Atlanta Medical Center, are now routinely screening patients for testing by asking those with flu-like symptoms about their recent travel.
Dr. Jeremy Boal, Mount Sinai Health System’s chief medical officer, told reporters in a news conference Monday that “likely it’s a much more common condition,” but they were taking no chances.
“The patient has been placed in strict isolation and is undergoing medical screenings to determine the cause of his symptoms,” the hospital wrote in a statement. “All necessary steps are being taken to ensure the safety of all patients, visitors and staff.”
Only Emory and three other facilities have the highest-level isolation units for the most dangerous class of pathogens, and Mount Sinai is not among them. That said, public health officials have said that measures such as Emory’s go well beyond what is needed to contain Ebola, which does not spread through the air. Boal said Monday they were not concerned about secondary infections, and hospital officials said they were in consultation with Emory doctors over the issue.
Infection requires direct contact with body fluids. Experts such as the CDC’s director have said that with meticulous attention to the basics of hygiene and patient care, the spread can be stopped.
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