Medpage Today 21:08:2014
Ebola patient Kent Brantly, MD -- saying "today is a miraculous day" -- has been discharged from an Atlanta hospital with a clean bill of health.
Brantly, a medical missionary working in Liberia, was airlifted to the U.S. and arrived at Emory University Hospital after coming down with the virus about 9 days earlier.
After a "rigorous course of treatment and thorough testing ... we have determined that Dr. Brantly has recovered from the Ebola virus infection," said Bruce Ribner, MD, medical director of the infectious disease unit at Emory.
"He can return to his family, to his community, and to his life, without public health concerns," Ribner told reporters.
Nancy Writepol, the other American missionary with Ebola airlifted to Emory, was discharged Tuesday, but at her request there was no announcement, Ribner said.
Brantly told reporters he was thankful to be alive and to be reunited with his family, who had returned to the U.S. from Liberia in late July as the Ebola outbreak worsened.
Two days after he put them on a homebound flight, he said, he woke up feeling "under the weather" as the first signs of Ebola infection made themselves known. As he grew weaker, he said, he and many others prayed for his survival.
"I serve a faithful God who answers prayers," Brantly said. "Through the care of the Samaritan's Purse and SIM missionary team in Liberia, the use of an experimental drug, and the expertise and resources of the healthcare team at Emory University Hospital, God saved my life."
Brantly was unable to pinpoint how he became infected, saying he and his colleagues in Liberia "took every precaution" while they were caring for Ebola patients.
Ribner said the Emory team, including five physicians and 21 nurses, is "tremendously pleased" with Brantly's and Writepol's recovery. Because there's very limited experience with treating Ebola in developed countries, he said, "we didn't know what to expect."
The recovery is "pretty gratifying."
He reiterated several times that neither patient now poses a public health threat, saying there's no evidence that recovered patients relapse, remain contagious, or can transmit the disease.
Among the criteria for pronouncing the two cured, he said, were absence of Ebola virus in the blood and symptomatic improvement for 2 or 3 days.
The two were cared for in Emory's Serious Communicable Disease Unit, which has been described as having an extraordinarily high level of clinical isolation.
But Ribner said that unit, set up in collaboration with the CDC, was only used because it was "convenient .... You don't need a special unit to take care of patients with Ebola."
In fact, he said, the choice of Emory, rather than some other U.S. hospital, was "semi-random" and largely because of its close ties with the CDC.
He said caregivers wore personal protective equipment that was consistent with CDC guidelines, including gowns and gloves. He added that workers found face shields and goggles difficult to use because of their tendency to fog up.
The key to the cures, he said, was "aggressive supportive care" at a level that is not commonly available in Africa but is widely available in the U.S.
Ribner added it's impossible to know if experimental therapies played a role. Both Brantly and Writepol were given a cocktail of Ebola antibodies, dubbed Zmapp, that had not previously been given to humans.
"We do not know whether it helped, whether it made no difference, or even theoretically if it delayed their recovery," Ribner said.
Brantly also reportedly got a transfusion of blood from a patient who survived the virus, but Ribner said the same cautions apply to that treatment.
The Zmapp antibody cocktail has also been given to two doctors and a nurse in Liberia, the World Health Organization said, and clinicians there are reporting a marked improvement in two of them.
The third patient, a physician, remains in serious condition, but has improved somewhat, the agency said in a statement. Supplies of the experimental drug are now exhausted, the WHO said.
Ribner said the Emory team learned some lessons about treating Ebola that might have an impact on the outbreak and is currently creating guidelines for care.
He noted that the West African healthcare systems "suffer a substantial lack of infrastructure" that hampers their efforts.
"We did learn a number of things ... in terms of fluid and electrolyte replacement, in terms of clotting abnormalities, and so on, which frankly our colleagues in Africa don't have the capability to detect."
However, simply knowing about those factors might help African doctors improve outcomes. "There are things you can do, even if you can't measure them," Ribner said.
The WHO says the outbreak, which began in late December, has now caused 2,473 known infections and 1,350 deaths in Guinea, Liberia, Sierra Leone, and Nigeria.
Medic-ALL.Inc 2014
