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.

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.

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.

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.

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’ve already read that article and many others, including this one:

Ms Jallah said, her mother called her and asked her to come to their home in the now infamous Ivy Apartments complex.

Speaking to the Washington Post Ms Jallah recalled her mother’s words: ‘She said, “Your step daddy is not feeling OK. He’s been going to the bathroom all night. You should come over and fetch him some breakfast.’

Ms Jallah did not bring her children with her when she went over, though Mr Yah also saw Mr Duncan that morning.

He told MailOnline: ‘He was lying on the bed. I asked him how he was and he said, “I’m not okay”.’

By the time Ms Jallah arrived Mr Duncan had no appetite for breakfast.

She recalled: ‘I brought him hot tea but he could drink only half of it.’

A trained nursing assistant, Ms Jallah took his temperature which was 104F and his blood pressure which was low.

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.

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.

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.