Details of Ebola Victim's Arrival.

[RiffRandell]

Glad they took the driving precautions. Shit's getting real.

An ambulance from Atlanta's Grady Memorial Hospital left the base in Marietta, Georgia, shortly after the Gulfstream landed and drove the 15 miles or so toward Emory University Hospital where Brantly and another aid worker will be treated.

The ambulance with red markings was under light security, flanked by a few SUVs and a police car for the short trip to the hospital along a wide-open Interstate with no traffic.

Once at the hospital, one person in white protective clothing from head to toe climbed down from the back of the ambulance and a second person in the same type of hazmat-looking suit appeared to take his gloved hands and guide him toward a building at Emory. The hospital is located just down a hill from the Centers for Disease Control and Prevention.

Link: http://talkingpointsmemo.com/news/first-ebola-patient-us

[In_The_Wind]

1. Thanks for the update.

[RiffRandell]

2. You're welcome.

I'll keep you posted...not worried but strange it's pretty close.

[In_The_Wind]

3. Ah. You live in a beautiful area.

I remember Atlanta well.

[magical thyme]

4. it reads like he was dressed in a hazmat suit to contain his fluids

and that he is ambulatory. That is good to read.

I read elsewhere today that he and Writebol will be cared for by 4 infectious disease specialists, with 2 nurses in attendance at all times, plus subspecialists.

And that various caretakers forfeited scheduled vacations and volunteered to care for them.

These people have trained for containment in this sort of situation for 12 years.

I know it is impossible, but I keep wishing I could see his chemistries and cbc... Stating that his condition is "serious" or "grave" tells me nothing.

[RiffRandell]

5. Thought the same thing regarding him being ambulatory. nt

[ProdigalJunkMail]

6. i am sure there will be papers in time

and maybe then you can check them out...

sP

[magical thyme]

9. I doubt his chemistries, CBC or any other details will be published

HIPAA prevent it unless he specifically signs a release. He can't even see those himself; only attending medical staff.

[ProdigalJunkMail]

22. if he is saved and gets back to health

i would wager dollars to doughnuts he would gladly sign a release...

and if i am not mistaken, you have a right to see your own medical records. as a doctor, he might be interested.

sP

[magical thyme]

23. you have a right to see your own medical records, but you must first sign a release

If a patient asks for test results, we are not permitted to give them. We can give results only to their attending physician or nurse.

If they want specific test results they have to complete and sign a form with medical records.

He may or may not allow public release of test results. Doubtless they'll go to the CDC researchers.

[ProdigalJunkMail]

24. i bet he will

given his proclivities toward fighting this thing, if producing his medical record (related to this) will help anyone he would do it... but who knows? and yes, the attending can and indeed must provide if asked for *using the proper procedures.

sP

[jen63]

7. I know everything is speculation, but

do you think the fact that he has held out for a week is a good sign? Everything that I've read says that this virus typically kills in four to five days. I was hoping the fact that he was still alive and able to make the trip after a week was good news.

[magical thyme]

8. from what I've read, it kills very quickly once it reaches the hemorrhagic stage

but that it doesn't reach that stage until a week after the symptoms first appear. The time frames are probably different for somebody receiving supportive care and somebody in a remote village without immediate support with IV fluid replacement.

His symptoms first appeared just over a week ago, so he was approaching that critical point where he either turns it back or succombs.

I'm guessing that's why they brought him here first; iirc Writebol's symptoms appeared a day or two later than his. I was worried when the initial reports were that one patient would be transported early next week because by then he could already have gone into the final phase.

[jen63]

32. Thanks!

Guess I didn't realize that it lasted that long. Gawd, I hope he makes it! (and Writebol too!)

[pnwmom]

39. I read that the trip itself is a strain, so they were bringing the healthier person first. n/t

[RiffRandell]

40. I read the opposite because he gave meds to the other DR as there was only

on dose. Could be wrong.

[magical thyme]

43. she got the experimental serum

but one of his patient's who recovered gave him a unit of his blood so he would get the antibodies.

[pnwmom]

45. I read that, too. But the experimental med might not have been as helpful to her

as the donated blood was to him.

Or maybe he was in better condition in the first place.

[magical thyme]

44. I just read a short while ago that she was described as "responsive" so

clearly he is in better condition than she is. I hope hers improves enough to make and survive the trip.

I'm wondering if that unit of blood may have made a big difference for him. He had been described as "grave" and the day after they each received their transfusions, the Samaritan Purse's website said that they were "grateful they had both survived the night."

On the video, Dr. Gupta expresses surprise at his apparent improvement in his condition.

[LisaL]

46. They tried the blood transfusions in previous Ebola outbreaks and apparently

these blood transfusions are very effective.
So, that transfusion could have saved his life.
Apparently survivors developed antibodies against Ebola, so their blood is very effective treatment.
Maybe the experimental serum the woman got doesn't work so well as the blood transfusion.

[magical thyme]

48. I had posted a link to that elsewhere

There was a big outbreak 20 years ago where 7 out of 8 people with transfusions survived.

I had also read elsewhere that it had "mixed results" so possibly in other outbreaks it wasn't as successful. Otherwise you'd think they would obtain blood from survivors routinely with each outbreak. Although they may not have the infrastructure to do so.

It's possible that Writebol isn't doing as well because of her age. As we age, we don't produce antibodies as effectively and we also don't bounce back as quickly from any injuries or illnesses. Brantly is 33 whereas Writebol I think is in her 60s.

[RiffRandell]

10. I heard on the news he received a pint of blood from a healthy person in Africa

and no doubt fluids and meds during the flight.

[magical thyme]

12. he received a unit from a 14 year old patient who recovered thanks in large part

to his treatment. The boy who donated wanted to help the doctor who had saved him.

The hope is that the antibodies in the plasma of the recovered patient will help push back the virus.

[RiffRandell]

13. That was it...very heartwarming. nt

[In_The_Wind]

15. That would be awesome.

Maybe there is hope.

[magical thyme]

19. there is definitely hope

There is currently about a 45% survival rate in Africa. Note that includes people who don't seek immediate or any treatment.

Back here, he will receive more sophisticated care than is available over there. Whatever support they can provide will be immediately available, with no waiting, whether it's a unit of platelets or plasma or RBCs, or IV fluid. They can monitor his chemistries and respond immediately to signs of kidney or liver malfunction. If he can't breathe they can do that for him.They can monitor his CBC and be ready with a unit of blood should he need one.

He'll also be able to try experimental treatments that are in development, should he choose to.

His caretakers will not be exhausted or distracted; with 4 infectious doctors total, they will always have an infectious doctor in attendance, along with 2 nurses, dedicated to 2 patients.

[Squinch]

11. They say they started him very early on treatment which has made a difference in others who survived

I will relax when a month goes by and no one associated with Emory gets it. I was disturbed by the story of the people who showed symptoms after helping a guy into a wheelchair, but last I saw that story seems to be being dialed back, or squashed. Can't tell which.

[magical thyme]

14. he recognized his own symptoms immediately, and put himself into an isolation unit

Which does make a significant difference.

However, on the downside, he had been pushing himself to work 3 hour shifts in the hazmat suits. The work they are doing (I posted an interview with a doctor returned from a stint there) takes a tremendous toll on their bodies. They sweat so much in those suits that after a 1 hour shift (the normal in the suits) it takes them 2 hours to re-hydrate.

So he went into treatment exhausted and in an already weakened state.

[Squinch]

17. So it seems that if you survive, you do have an immunity. Do you know if that is definitely true?

Can't think why the blood of that boy who survived would be important otherwise, but I haven't seen anyone state it. And if it is true, wouldn't a vaccine be relatively easy to produce?

[magical thyme]

21. In the immediate aftermath of an illness you will have circulating antibodies

so at least temporary immunity, but I don't remember how long they last. It may depend on both the disease and the individual.

Also, with some diseases, your body is able to produce antibodies for years. With others, they don't. So, for example, the tetanus vaccine is good for 10 years. AFter that, it's questionable. With diseases like mumps and measles, you produce antibodies sometimes for decades. I was tested before doing my clinical training, and tested immune nearly 5 decades after illness.

There are vaccines in development, and I believe at least one of them may be very close to approval. I heard part of an interview this morning where they were talking about safety and efficacy approval as early as Jan '15 (although I only heard part, so am not sure if he was talking about safety approval, so ready to move on to efficacy trials, or if it was complete approval).

[DhhD]

29. NIH To Launch Early Ebola Vaccine Trials in September. Results due January 2015.

http://www.democraticunderground.com/10025316867

[magical thyme]

33. awesome. thanks!

[deurbano]

27. Do you mean he was wearing a hazmat suit when he contracted it?

[magical thyme]

28. no. They don't know yet how he contracted it.

What I mean is that when his symptoms started he immediately suspected ebola and put himself into isolation.

I don't know what he was doing when his symptoms started. He may have awakened with a sore throat. Or he may have been working and started to feel aches and pains. Or he may have started to feel sick during the 2-hour rehydration period after working. Or he may have been monitoring his own temperature as a precaution and shown a fever one day.

[deurbano]

30. I was wondering how he contracted the virus if he was being so cautious as to wear a hazmat suit.

(But, as you replied, they don't know yet.) I have so much respect for those putting themselves on the line like this.

[Avalux]

31. Ebola is transmitted through body fluids of living or dead, can live on surfaces for several days.

It is not transmitted through casual contact or air. Even if a worst case scenario were to happen in this country - an infected person coming into the US and spreading Ebola to others through close contact, it would be contained and wouldn't get very far.

The current outbreak is happening in the three poorest countries in the world; they don't have the infrastructure to assist the afflicted and are easily overwhelmed. Employing infection control practices in hospitals, clinics and among the people will be effective in stopping the spread of Ebola, just may take awhile.

[Baitball Blogger]

16. I presume that a survivor develops antibodies, and those antibodies can be

reproduced to protect others?

How long before we know his chances of surviving this thing?

[RiffRandell]

18. Hey, I'm no doctor.

I only know my pharmaceuticals.

Seriously, I have no idea and I don't think anyone else does, but one of the reasons for bringing him here is that he'd have a better survival rate.

If he survives that would be awesome, same with the other victim.

[Louisiana1976]

20. Yes. He and the other victim will be better cared for here in the States.

[magical thyme]

25. somebody had asked a couple days ago who is paying for the evac and treatment

I had read in a couple place, and today read in the NYT that the 2 charity organizations are paying for the entire thing.

[RiffRandell]

26. You're right.

I read that as well.

[magical thyme]

34. His wife had a 45 minute visit; says he's in great spirits and so grateful

American aid worker stricken with Ebola now in U.S. hospital and 'in great spirits' after walking into facility

Brantly's wife, Amber, later visited him from behind a glass wall for about 45 minutes, according to a statement given to CNN. She described her husband as being "in great spirits and so grateful." "I spoke with him, and he is glad to be back in the U.S.," she said. "I am thankful to God for his safe transport and for giving him the strength to walk into the hospital."

Brantly's wife, parents and sister wept while watching news footage of him entering the medical center.

http://www.nydailynews.com/news/national/american-doctor-ebola-virus-headed-home-article-1.1889491

[RiffRandell]

35. Yay!

I just got chills. Thanks!

[magical thyme]

36. Dr. Sanjay Gupta surprised at his condition, ability to walk off ambulance, showered before

leaving Liberia.

http://www.cnn.com/2014/08/02/health/ebola-outbreak/

Looking at the timeline, I wonder if the transfusion made a big difference. He had worsened immediately after it, but that could be attributed to the procedure itself. Since then has apparently improved.

[MohRokTah]

37. Yeah, my initial concern was they were being brought back by their church.

Once I found out the typical CDC protocols were in place, I had no problem with it. The initial stories I heard on television made it sound like the church they were affiliated with was chartering a flight etc.

Just goes to show, you've got to discount anything and everything reported as "breaking" on television until you've got wide confirmation and explanations. I forget that from time to time.

[RiffRandell]

38. I hear you.

Their transports are paid for by charities. No problem with that.

[WinkyDink]

41. I don't care about the reasons given; he should have been carried on a stretcher.

[RiffRandell]

42. Maybe he wanted to walk as he was lying down during most of the

flight? Or maybe it was orders that it was best for him?

[WinkyDink]

47. See: Opening part of my sentence.

[magical thyme]

49. well thank you Dr. WinkyDink!

Why do you think he should have been carried on a stretcher?

Sitting or lying for extended periods is not necessarily the healthiest thing to do. Sometimes walking is therapeutic.