Duncan is only receiving supportive care.

[cali]

I don't buy that it's because docs fear that it will worsen his condition. That goes against what's been reported. I realize that zmapp is reportedly not available, but what about blood from recovered ebola patients and other experimental procedures/drugs? His condition is worsening. He's critical. What is there to lose?


Thomas Eric Duncan, the first person to be diagnosed with Ebola in the U.S., is not being treated with experimental medication, officials with the Centers for Disease Control and Prevention said today.

Doctors treating Duncan fear that the experimental medication may worsen his condition, CDC Director Tom Frieden said. Duncan is instead only receiving supportive care.

David Lakey, commissioner of the Texas Department of State Health Services, also said that Duncan's medical condition had worsened. Doctors downgraded his condition from serious to critical on Saturday.

<snip>
http://abcnews.go.com/US/texas-authorities-man-made-contact-ebola-patient/story?id=25976338

[TwilightGardener]

1. How much available blood IS there from recovered patients, and would it match his

blood type, or would it have some other issue that would cause a bad reaction? I don't know how they process it, or even where they have this sort of blood--is it in the US?

[LisaL]

10. Sacra and Branly had the same blood type.

Which is why Brantly's blood could be used for Sacra.
Duncan potentially has a different blood type. Also, Sacra is in the hospital again sick, so his blood obviously can not be used for transfusion.

[magical thyme]

16. the donor would have to be either the same ABO type or type O (universal donor), or

the recipient would have to be type AB (universal recipient).

Writebol has been in slow recovery. You can end up with permanent kidney, liver and other damage, and your immune system is severely damaged as well. So she is not likely recovered enough to donate.

Sacra is sick again, so can't donate.

[ChisolmTrailDem]

2. "zmapp is reportedly not available" ... my ass! It was

available for those doctors. They fear it will worsen his condition? As opposed to what? He's going to die anyway, right?

[TwilightGardener]

3. Actually, they didn't have enough for both Nancy Writebol AND that Brantly guy, IIRC.

I thought he gave her his dose. I don't know how much they have available, but I don't think they're holding out on this guy. And no, he might not die. Ebola isn't always fatal, especially with good supportive care.

[ChisolmTrailDem]

4. "Ebola isn't always fatal, especially with good supportive care." I probably knew that, there's

been so much said about it in the past week. But it is good to hear it again.

My hopes are that Mr. Duncan lives to enjoy the rest of his life.

[magical thyme]

15. they had enough for Brantly, Writebol, a Nigerian doctor, and one other, but ran out in August

it is in production and more will be available in about 2 months.

(They had one vial thawing when Brantly said to give it to Writebol. But later that same day he took a serious turn for the worst, said he thought he was dying and asked for it after all. Each of them got 2 doses.)

[kestrel91316]

6. There were only 6 or 7 doses of zMAPP in existence.

They all got used. Deal with it.

[Wella]

12. How difficult is it to manufacture zMAPP?

I don't know much about it.

[kestrel91316]

13. Difficult and complicated and time-consuming in the extreme. And REALLY REALLY expensive.

And it is strictly experimental.

They have to genetically engineer tobacco plants to produce a monoclonal antibody, then grow the tobacco plants, harvest, extract, purify those monoclonal antibodies. Boggles the mind.

They are racing like crazy to make more, and I heard that in several months they MIGHT have 20 more doses.

People are smoking crack if they think zMAPP is going to be the solution. We need a vaccine for the medical workers, and then the tried and true contact tracing and isolation.

But I think the whole system is getting overwhelmed by the sheer numbers of cases and contacts and is falling apart. Ebola may become endemic in humans because of this, and that's a bad thing.

[Wella]

14. Thank you for explaining it

Are there any vaccines in development?

One of the big problems we have seems to be funding for this sort of thing: development of experimental cures, vaccines. I suppose if Ebola becomes endemic, it will be worth Pfizer's time to develop a vaccine they can sell for top dollar. Right now, our public health system seems to have been overburdened with other issues and with a lack of funding.

[magical thyme]

17. yes, there are vaccines in development. they will be online by next year as well. nt

[kestrel91316]

20. I was happy to hear that the most promising vaccine is a genetically engineered

one like our newer rabies and feline leukemia vaccines, which rely on a live canarypox vector. Extremely safe and extremely effective.

I was also happy to hear that they are ramping up production of vaccines in advance of results of the clinical trials, so as to hit the ground running with them the very minute the numbers look good on paper and they are shown to be somewhat effective in addition to safe.

[AngryAmish]

25. GMO vaccine?

That is gonna make a certain class of anti-vax, anti-GMO nutter go berserk.

[kestrel91316]

26. I hate GMO crops and the lack of product labeling, but I'm no fool.

Our GMO vaccines are groundbreaking and not scary. Quite clever, actually.

[SickOfTheOnePct]

8. Yes, it was available for those doctors

And they used it on those doctors.

As to the other experimental drugs, it could be that they've never been used on humans, I don't know.

But the Zmapp is gone; has been for awhile.

[LisaL]

9. ZMapp is gone.

It was only available for two Americans. Was not available for Dr. Sacra.

[pnwmom]

23. They said at the time that they only had the two doses. Why do you think they were lying back then

when this patient was still in Liberia?

[tblue37]

35. If a patient's condition is too far gone for there to be any real hope that a

treatment will help, and if the treatment is in very short supply, then doctors probably would decide to save the available treatment for those who could benefit from it.

I have read that treatment must begin very early after symptoms manifest to have any hope of helping, so those two days lost after he was sent home with a prescription for antibiotics might have sealed his doom.

[kestrel91316]

5. There is no treatment other than supportive care.

All the zMAPP got used up. It takes months to manufacture even miniscule amounts.

His supportive care is undoubtedly extremely complex, involving electrolyte and metabolic tweaking and delicate fluid balancing.

It is the way it is. Whining and crazy conspiracy theory speculation won't change biology.

[LisaL]

11. There is another experimental drug called tekmira, that they used on Sacra.

But maybe there are side affects they are afraid of?

[magical thyme]

18. yes. I found an article from before this mess that said at one point its trials were put on hold

due to flu-like symptoms in recipients. In somebody already dealing with immune dysfunction, I expect that could be dangerous.

[LisaL]

21. A doctor in Africa supposedly had good outcomes with an HIV drug.

[magical thyme]

22. yes I read that article. there will always be anecdotes like that.

Presumably when looked into they don't pan out.

I'm sure the manufacturers of that HIV drug would love to find an additional use for it.

[LisaL]

24. It hasn't been tested yet in US.

"Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases says that theoretically, Logan's approach has some merit. Lamivudine is a nucleocide analog, and other drugs in this class are being studied to treat Ebola."

http://www.cnn.com/2014/09/27/health/ebola-hiv-drug/

[magical thyme]

28. but they are looking into it. hopefully this will pan out. nt

[librechik]

7. yeah, that's the therapy. Keep him hydrated and comfortable. It's in the hands of god

or mother nature or Duncan's immune system. They have to let the fever run its course.

There's nothing else they can do, although some doctors elsewhere have been trying experimental therapies, such as using antivirals normally used on AIDS patients. Not yet in Dallas. In Africa there's all kinds of crazy therapies. It's best not to mention them.

[kestrel91316]

30. They can do things to tweak his electrolytes and acid-base and such in response to

aberrations, and they can throw drugs at complications, but really there is not much they can do proactively.

[magical thyme]

19. if they transfused from unmatched blood they could kill him outright.

They can only transfuse specific blood types into him. If the recovered patients who are able to give blood are the wrong type, he's out of luck.

[TexasTowelie]

27. What is there to lose?

I know that this is callous for suggesting it, but from the POV of the hospital they are losing a room that could be occupied by another patient that has the ability to pay since I doubt that this man has any insurance (I hope that I'm wrong). Then there are the other associated costs of personnel and other supplies. While the hospital will respect basic human rights for health care and keep him away from the general public in quarantine, I doubt that they are going to spend extraordinary amounts of money on him--a sad reflection on the ethics in the US healthcare industry.

[Louisiana1976]

29. That's why we need single payer. Our current medical system is permeated with greed.

[TexasTowelie]

32. I agree with you 100%.

The quality of medical care that someone receives should not be based on any discriminatory characteristic or income.

[Sienna86]

31. Healing prayers for him

Hoping things start to improve.

[Lancero]

33. Yeah, bullshit.

But not really surprising, with how ingrained racism is in this country.

We brought back ebola patients to treat with experimental medication. They lived. They were white.

We refused to allow a non-infected person to return to the US who was seeking care for a unrelated illness. He died. He was black.

We are refusing to treat a ebola patient with experimental medication. He'll proably die. He's black.

People who say 'it's not about race!!!' are idiots. We pulled out all the stops to bring back ebola infected whites for experimental treatments, and we've left one black man to die and are refusing to give the same level of treatment that whites received to another.

[TorchTheWitch]

34. It isn't up to doctors to decide whether or not to use

an experimental medication. That's a conversation with the doctors, him (if he's in any condition to voice an opinion) and his family. People are not lab rats, and whatever the illness or injury no doctor should ever be using experimental treatments on patients without the consent of the patient or family members if the patient is unable and not without a thorough understanding of the risks/benefits.

It's unknown if the US health department would even allow it, and they don't make up their minds overnight. In this country we can't use any treatments or procedures without first being cleared by the FDA, and they never have without extensive reports on testing including human testing.

Want to see how difficult and time consuming it is to use a new treatment method on a patient when there is no other alternative and there IS extensive reporting on the method in humans and even AFTER the FDA has given approval? Watch this Dateline episode called "A Leap of Faith" on stemcell surgeries using a patient's own stemcells. Since it was a special report it's about an hour and 20 minutes long but VERY well worth the watch...

http://news.yahoo.com/ebola-patient-dallas-turns-critical-no-u-cases-000058624.html
Frieden said doses of the experimental medicine ZMapp were "all gone" and that the drug, produced by San Diego-based Mapp Biopharmaceutical, is "not going to be available anytime soon."

Asked about a second experimental drug, made by Canada's Tekmira Pharmaceuticals Corp, he said it "can be quite difficult for patients to take."

Frieden* said the doctor and the patient's family would decide whether to use the drug, but if "they wanted to, they would have access to it."

"As far as we understand, experimental medicine is not being used," Frieden said. "It’s really up to his treating physicians, himself, his family what treatment to take."


* Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC)

[TBF]

36. I can't imagine they'd give him experimental meds -

this guy most likely knew he had Ebola (or was at risk) and lied on his questionnaire. I'd be really surprised if they undertook any extraordinary efforts to save him.

Personally I think many would do the same in his shoes, perhaps I would myself if I found myself in that position. It is easy to empathize with the guy. But he will be prosecuted for the behavior if he makes it - and I think that is doubtful at best.

[morningfog]

37. That is not the measure we use.

[TBF]

38. Not in our talking points we don't -

but we know damned well talking points are far different than reality.

[magical thyme]

39. Last July, Tekmira's Tek-Ebola trials were put on hold due to safety concerns at high doses

It was later taken off hold and put back onto fast track. But there were issues of safety at higher doses. That it is not an easy drug to take is not a talking point. It is a fact that was noted prior to Duncan's infection.


http://www.reuters.com/article/2014/08/07/us-health-ebola-tekmira-idUSKBN0G72FQ20140807
Tekmira's drug has only been tested in a few dozen healthy people. The FDA stopped its study in July because of safety concerns among people taking the highest doses of the drug who experienced problematic immune responses.

Now consider that fact with the other fact that Ebola directly attacks the innate immune system, ignites a cytokine storm, and then directly attacks the specific immune system, depleting the body of anti-body response ability with the fact that high doses lead to problematic immune responses.

We have been out of Zmapp since August and none is expected for months.

Transfusion from a survivor requires the correct ABO type or will kill him outright.

Those are all facts.