Spanish nurse’s aide Teresa Romero…
…now tests virus-free.
Good news. She will remain in the hospital for a while, but she’s also beginning to produce antibodies to the disease.
[ADDENDUM: I was going to add that she is recovering despite never having received a transfusion from a survivor, but it turns out that:
Ms Romero was treated with a drip of human serum containing antibodies from Ebola sufferers who had survived the disease, and other drugs which a government spokesman declined to name.
One was the experimental anti-viral medicine favipiravir, according to the respected national newspaper El Mundo.
I’m not sure what that “human serum” would be. Plasma? Did her blood match that of some survivor in Britain? Or a combination of survivors? It’s very unclear.
Also at the link, there’s an interesting piece (lower left on the page) about William Pooley, the British nurse who was stricken in Sierra Leone and flown back home for treatment in a special facility, much like Dr. Brantly. Pooley has just returned to Sierra Leone to care for more victims:
The 29-year-old said he was ‘delighted’ to return to Sierra Leone’s capital Freetown as he attempts to prevent ‘as many unnecessary deaths as possible’.
There is uncertainty, however, over whether the Suffolk-born nurse is immune to catching Ebola again.
Although it is widely assumed the same person cannot develop the disease twice, the assumption has never been proven by scientists.
The scale of the current outbreak – with already 16 times more deaths than the previous most fatal outbreak in 1976 – could provide the first test to the theory.
Mr Pooley will arrive in Sierra Leone, where 932 people have died of Ebola, tonight and resume work tomorrow in an isolation unit run at Connaught Hospital by British medics.
I assume that Pooley will continue to wear protective gear.]
I wonder if anyone has told her yet that they killed her dog?
Charles:
I was wondering that, too.
I know she loved the dog, but she’s probably very grateful to be alive.
On the immunity question, I wonder if the antibodies from the one strain can lessen the impact of a new strain?
Would a variant have as much of an impact on the immune system?
Neo:
At your CNN link, it says that according to some fellow who’s an “expert on viruses”, not a government spokesperson, she had “an IV drip with the antibodies of an Ebola survivor — a Catholic nun who survived the disease in West Africa.”
It also said: “To fight her lung problems while also battling Ebola, the doctors administered anti-inflammatory drugs to ease her respiratory problems, even while unsure how that treatment might affect the anti-Ebola measures…”
And, of course, she got that experimental drug, favipiravir, as well.
We know not what we face with the current ebola pandemic. This is why extreme caution is required. Instead we have a corrupt lawyer, political hatchet man as the new ebola czar. Excuse me if my confidence of team obama’s ability to respond to this crisis has tanked by -10,000 %. Our 2 cats and 2 dogs are smarter than all of the team obama ‘brain trust’. These idiots are down there where whale poop settles at the bottom of the Mariana Trench. Its beyond sophmoric, we’re talking about toddlers at daycare in charge of the code to activate the nuclear football.
How about the depth of contempt for our citizenry that this obvious, in your face, political appointment of Ron Klain shows?
An appointment that quite clearly demonstrates that Obama & Co. really couldn’t care less about our safety and wellbeing, but really, really do care about protecting their political fortunes; a depth of contempt that could get a lot of us killed if and when the next Ebola victim almost inevitably —absent a travel ban (and perhaps even with one in place)–comes to our shores?
Heard on the news early this morning that the boyfriend of the first nurse to come down with Ebola — the Vietnamese one — has come down with symptoms and has been hospitalized. Haven’t seen it confirmed. Has anyone else.
If he does turn out to have the disease, that would mean it was transmitted from a patient whose viral load was still low, though there was probably plenty of contact.
The number of survivors in Europe and America is probably not be statistically significant yet, but if the trends hold up we can assume that we are doing something effective. So far the common denominator among survivors seems to be the transfusions from Ebola survivors. That doesn’t prove anything but it is an interesting tell.
Pooley has just returned to Sierra Leone to care for more victims:
What a doll. He is on the PBS special that was running this past week (and is on the pbs app as well if anyone wants to watch).
Heard on the news early this morning that the boyfriend of the first nurse to come down with Ebola – the Vietnamese one – has come down with symptoms and has been hospitalized. Haven’t seen it confirmed. Has anyone else.
I hope not, but I wouldn’t be surprised. We are far from out of the woods on this thing, and this is only the first case. (If we refuse to shut down travel we know there will be others).
A couple people have been kicking around the idea that some in Africa have partial immunity to Ebola, which may have helped the liberian immigrants but that would not probably apply to americans. Something to watch, at any rate.
illuminati:
The other common denominator (among the more recent survivors, anyway) is very early detection.
The older survivors, such as Brantly, I believe were much sicker when they came to the West, although I’m not sure. But their survival rate was not quite as good—for example, the two Spanish priests died, although they were transported to Spain for treatment. I think they were in the later stages, however, although it’s hard to get information on that.
I believe it’s possible that if Duncan had been diagnosed on his first ER visit, he could have lived. Even Frieden said that (or rather, implied it):
Lea:
There have been on-again off-again rumors about Phan’s boyfriend. I think it’s just a rumor; I think he’s okay. Time will tell. I would actually be surprised if he came down with it. She was diagnosed and isolated quite early in her illness.
She was diagnosed and isolated quite early in her illness.
I haven’t actually heard a good timeline on when any of the nurses treated Duncan, versus when they came down with symptoms. I’m sure they were detected early since they were monitoring.
Lea:
She was hospitalized when her only symptom was a somewhat elevated fever. I believe hers was only around 100 at the time (unlike some of the others, who had somewhat higher fevers before hospitalization).
I have followed it closely, and I’m pretty sure that Phan, Vinson, and Romero all were hospitalized and treated when their only symptom was fever, which is the earliest symptom of all.
Neo:
She was hospitalized when her only symptom was a somewhat elevated fever.
Right, I was just not sure when they actually treated Duncan (early or later)? And then how many days out they showed symptoms and were tested. I’ve read quite a bit about it as well, and I don’t recall these things being spelled out. I note, we’re also not out of the woods for the healthcare workers later on in his illness.
Since there is no cure or even real treatment, why do you think hospitalizing a patient earlier would result in a better survival rate? This isn’t a rhetorical or sarcastic question; I’m genuinely interested in hearing your thoughts, or anyone else’s, on this.
Neo said:
“The other common denominator (among the more recent survivors, anyway) is very early detection.”
That is puzzling. Without definitive treatment, what difference does it make?
It is it possible that some people die due to dehydration and electrolyte imbalance rather than from the virus itself. In that case early diagnosis would be helpful. That would only apply to a small subset of patients since most of them seem to die of multiple organ failure.
The alternative is that the experimental therapies and transfusions do help and they are more effective if they are given early. There is probably not enough data to prove the therapies are effective against the virus but it certainly looks hopeful.
illuminati; reticent:
Yes, it’s odd. Supposedly, treatment doesn’t improve survival all that much (a little, but not much). But early treatment does improve it? How much?
My guess is that, in Africa, early treatment is very very rare.
I’m just quoting Frieden here; he seems to think it matters. He doesn’t say why. Here’s an article that tries to look at the patterns in the people who’ve been treated in the West.
I am convinced that early diagnosis does matter. But early diagnosis can only occur in people who are alert to the early symptoms, and who have some sort of special risk factors (travel from Liberia, etc., or exposure to a known ebola patient). Otherwise early-stage ebola resembles any number of other illnesses. It’s only the history that tips medical authorities off to the possibility of ebola, and allows early detection.
An easy screening test would be good; they’re working on it. But it has to be so easy that it could be administered to everyone with a mere fever! Don’t think that will happen. Plus, in an epidemic, since hospitals would immediately become overburdened, screening probably wouldn’t help much because people couldn’t get that sort of comprehensive care anyway, at home, and would there be enough hazmat suits to go around? (Although it seems that rehydration by IV can be done at home, by laypeople.)
It is it possible that some people die due to dehydration and electrolyte imbalance rather than from the virus itself.
I think this is the main thing that we know, you can treat the symptoms and make sure the patient stays alive and healthy enough to fight off the disease (hopefully!). It probably helps the stats that most of our American patients have been relatively young and healthy when they were struck down.
I don’t think we have a big enough n on any of these experimental treatments to make a determination. The way Zmapp works sounds fascinating, though.
Yes, it’s odd. Supposedly, treatment doesn’t improve survival all that much (a little, but not much). But early treatment does improve it?
I don’t think there is any disease where a doctor wouldn’t prefer early dx, although for something like huntington’s it might be a mental turmoil. Ebola, even though very dangerous, does not kill all patients even without treatment. And we have treatments, we just don’t have a cure. Treatment, for a disease that is not always fatal, is sort of bound to help some patients, right? If only because it gives their bodies more of a chance of fighting it off on their own. I think that’s logical.
The question as I understand it is not whether it is better to diagnose Ebola before a person is totally hypovolemic and in shock or earlier in the disease but whether a delay of a day or two as in Mr. Duncan’s case makes a difference. As I understand it, Mr. Duncan was not in extremis at the time he was admitted. He was probably somewhat dehydrated but was probably not shocky. If that is the case, his dehydration should have been easily reversed with IV fluids and he should have recovered if he had overcome the damage caused by the uncontrolled viremia.
illuminati:
I got the impression his illness was quite far gone by the time he was admitted. And that it went way downhill in a day or two and he was sedated (essentially an induced coma). Of course, that might have come to pass if it had been caught earlier. But my hunch is that once the virus gets a grip and weakens a person so greatly (without the help of hydration, etc. from the start), it becomes harder to fight it off and pull back from the brink.
“I got the impression his illness was quite far gone by the time he was admitted.”
Neo, if you are interested in his medical course you can go to this link:
http://www.oregonlive.com/today/index.ssf/2014/10/thomas_eric_duncans_final_days.html
My impression is that the delayed diagnosis by the hospital had no effect on his outcome whatsoever. It appears he was probably normotensive and ambulatory when he came in and remained so for some time after admission. What killed him was the direct damage by the virus not a delayed diagnosis. Even after he was admitted they were still not certain of his diagnosis since there were other considerations like Malaria.
If one of the experimental treatments had been available sooner, or better yet if a transfusion from an Ebola survivor had been available, that might have made a difference. Probably those things are more effective if given very early in the course of the disease. As it was Duncan received optimal supportive treatment early on and then heroic measure of renal dialysis.
illuminati:
I’ve already read that article and many others, including this one:
Not normotensive even before he got to the hospital. That may have been going on already for a day or two. He’d had diarrhea all night, as well.
It is actually impossible to say how much early intervention would have mattered. However, my guess is that the weaker you are when you come in, the less likely any intervention will help. He was already quite weak, particularly as compared to the two nurses, whose only symptom on admission was a mild fever.
Nice link.
It is interesting that the second link provides his exact temperature 104 degrees which is highly abnormal but does not give his blood pressure. The vague statement that his blood pressure was “low” does not tell us much since “low” pressure can still be within the normal range. Did she measure his pressure sitting up?
One outlier is that Mr. Duncan is African. Generally Africans have a radically different lifestyle from Americans so his pressure might be lower normally. However we don’t know that since Duncan is from an urban center where the diet probably included more refined foods and less exercise than the average African.
I assume that Mr. Duncan’s hospital records would have a notation if he were significantly hypotension but I recognize that you could easily argue the other side. Since we are relying on someone else to summarize the records it is possible that they didn’t recognize the significance of his low blood pressure and omitted the information.
I’m not certain why I concentrated on the blood pressure rather than on the uncontrolled fever. DAH. Even in the hospital they were unable to get his fever under control.
In reviewing the link I provided it appears that at admission Duncan’s temp was 103.1 degrees which was less than the 104 degrees the daughter reported. Would he have lived if he had been admitted earlier and if his temperature had been treated earlier? No.
The reason his temperature was so high was because Duncan had an overwhelming infection. He died because of extensive cellular damage by the infection which no amount of supportive care could overcome.
illuminati:
You make a lot of statements that are not necessarily correct. There is nothing in the information we have about ebola that supports what you’re assertring.
We simply don’t know why some ebola patients live and some die. Most authorities say that earlier medical intervention improves survival, but they don’t give cutoffs or specifics for when it matters and when it doesn’t, or how much it matters.
There is no cutoff for a certain temperature, for example. In fact, by the way, Duncan’s temperature had reached 103 in his first visit to the ER (unless you provide a link for that later temperature figure on his admission, I’ll assume you’re confusing his temp during his first visit with his temp at his admission), and we can assume it remained very high for the 2 days he was home before his actual admission. We can assume those extra two days took a large toll.
Also, he had reported dehydration on that first visit (decreased urination was one of the symptoms he reported). So he suffered from dehydration for several extra days because he was sent home. He died in part from kidney failure, and I think it’s highly possible those extra days of increasing dehydration probably mattered.
I am from Spain. Yes, Teresa has tested negative in a 4th test and is now officially ebola-free (although she is still very weak). Everyone is happy about that and there are no more people infected. A scientific committee is dealing with the ebola crisis and things seem to be working out well. They and the doctors are sharing information with international experts.
Neo,
No, I’m not confusing his temperature at the time of admission. It was 103.1 when he was admitted. That temperature is high but not dangerous. When I read that the daughter had reported a fever of 104 degrees I thought I had missed something. I’m not saying she was necessarily wrong, he might have spiked up that high, but hospital record indicates that Mr. Duncan was not maintaining that temperature.
The reason people develop a fever when they are sick is because it is a survival strategy for the body. The infection does not cause the fever, the body causes the fever as part of the immune response. At some point a fever is no longer protective and that is why we bring the temperature down to safe levels. 103.1 is not good but it is not dangerous.
People suffer from dehydration frequently without kidney damage. The question is whether he maintained enough blood pressure to profuse his kidneys adequately. So far there is no indication that Mr. Duncan suffered serious hypotension during his stay at home. The fact that he was ambulatory and he did not faint when he stood up indicates that he was not severely hypotensive. The hospital records, as reported, do not indicate any problems with his blood pressure at admission. Incidentally, we know that Mr. Duncan did not die of renal failure. When his kidneys failed, Mr. Duncan was placed on dialysis.
Mr. Duncan did have significant liver damage which was probably a much more significant factor in his death. Another potential cause of death was damage to the central nervous system. Many Ebola patients suffer from headaches early on and later they develop seizures. I’m not certain how effective the virus is in breaching the blood brain barrier but that is not necessary. Damage to the blood vessels in the brain is enough to cause cerebral edema and death.
It is comforting to convince ourselves that if we diagnose Ebola early and maintain vigorous treatment the patient will probably live. That is often not the case. Many health workers in Liberia, who know exactly how to diagnose Ebola and who make very early diagnoses on themselves die. The virus destroys so many cells in the body that supportive care is just not enough. On the other hand, any effective antiviral treatment, like transfusions, are much more effective if given early while the viral load is still manageable and before there has been too much tissue damage. In Duncan’s case the antiviral medication was given late in the illness too late to do much good. If you want to blame the hospital for Mr. Duncan’s demise, that is a much more fertile approach although we don’t know whether the medicine works even in ideal circumstances.
illuminati:
I have never blamed the hospital for his demise, nor have I said earlier treatment would have saved him.
I have always been careful to say it MIGHT have, and that we just don’t know. I completely stand by that.
What I think the hospital was guilty of is a series of egregious errors, first in initial diagnosis, then in protection for its staff, and all along the way in communicating things honestly and clearly to the public (first saying the info about coming from Africa wasn’t communicated to staff at intake, then taking it back, first blaming the electronic records, then taking it back, etc. etc.). What the consequences were to Mr. Duncan I simply don’t know. I am merely saying earlier diagnosis might have mattered (it certainly would have kept his relatives from being exposed in later stages of the illness, which turns out to not have mattered because they did not catch it, but which could have mattered greatly).
Also, I’m very curious where you got the info about his temp, etc., on admission. I’ve never seen that information, at least I don’t recall seeing it. Have you a link? I would really like to see a link so I could study it myself.
By the way, speaking of headaches, Duncan had what was described as a “sharp headache” on his very first visit to the ER, when he was turned away.