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Emory hospital isolation ward staff more than ready for Ebola patients

NationHospitals and ClinicsHealthcare ProvidersDiseases and IllnessesLiberiaU.S. Centers for Disease Control and PreventionEbola
Ebola lands in U.S. as first patient arrives at Emory isolation ward; second American is expected this week
High-stakes mission to bring Ebola patients home was medical duty and humanitarian obligation, doctor says
Opposition to importing Ebola minimal, mainly from right-wing pundits and people griping on social media

There is no cure for the Ebola virus ravaging West Africa, and it kills most of those it infects. But when Bruce Ribner got the call that two Americans stricken with Ebola were headed to his hospital, he did not hesitate.

"I said, 'Hey, we've been practicing for this for 12 years,'" he said.

Ribner is an infectious disease specialist who oversees the isolation ward at Emory University Hospital, which is designed to house people suffering from highly lethal illnesses that could decimate a population if not contained.

Two nurses who form part of the team trained to work in the ward canceled vacations to treat the patients.

And on Saturday, team members in hazmat suits stood by as a convoy accompanying the ambulance carrying patient Kent Brantly arrived at Emory after an overnight air ambulance flight from Liberia.

The driver of one vehicle flashed a victory sign as the convoy turned onto the hospital grounds. A medical worker, whose hazmat suit included a protective hood and mask, clambered out of the rear of the ambulance. Then Brantly, also wearing a special suit, carefully lowered himself to the ground. He leaned on the medical worker as they walked slowly through a door into the isolation ward.

Nancy Writebol was expected to arrive from Liberia this week on the same air ambulance that carried Brantly. Brantly, a doctor, and Writebol, a missionary, became sick last week while working in Liberia and treating others infected with Ebola.

"It was a relief to welcome Kent home today," his wife, Amber Brantly, said in a statement released through Samaritan's Purse, the aid agency Brantly was working with in Africa. "I spoke with him, and he is glad to be back in the U.S. I am thankful to God for his safe transport and for giving him the strength to walk into the hospital."

Although Brantly was able to walk, albeit with assistance, he remains seriously ill; the virus has no cure and a mortality rate as high as 90%, depending on the strain.

Ribner said the high-stakes mission to bring Brantly and Writebol home was born as much out of medical duty as humanitarian obligations. Their chances of survival were lower in Africa than in this country, where they will receive the kind of care that could enable their bodies to recover enough to fight off the virus.

"The critical component … is supportive care," Ribner said. "We're talking about maintaining blood pressure. We're talking about supporting respiration up to and including a respirator if the condition becomes that severe. People with Ebola virus infection may have kidney failure, so we are potentially talking about dialysis."

There is no other treatment for Ebola, which is named after the river running through the region in Africa where it was discovered in 1976. Until Saturday, the virus had never entered the United States.

But opposition to its importation via the ailing patients has been minimal, limited mainly to right-wing pundits and individuals griping on social media or eyeing the media horde bivouacked outside Emory.

"They're getting more than they bargained for," one man, Jeremy Eagins, said of the medical experts as he walked near the hospital, which is less than a mile from the Centers for Disease Control and Prevention headquarters. "We don't even know what's coming over our southern borders. We shouldn't be bringing something like this in."

"KEEP THEM OUT OF HERE," Donald Trump tweeted.

But there was no sign of fear, anxiety or opposition around Emory on Saturday, and Ribner said there never was, from the moment staff learned of the patients' imminent arrival.

"Everybody at Emory is extremely supportive of this mission," Ribner said. "We realize it's an important part of being an advanced healthcare facility."

U.S. Rep. Adam B. Schiff (D-Burbank), speaking on CNN, said the fact that Brantly and Writebol had a potentially deadly illness should not bar them from entering the country. "I don't think we should be so spooked because of the novelty of this terrible virus that we turn our back on Americans who are troubled," he said.

Ribner agreed.

"We have two individuals who are critically ill, and we feel we owe them the right to receive the best medical care which is available to them," he said.

The ward where the pair will receive care is one of a few such facilities in the United States and was built with assistance from the CDC. Because it is designed for only the rarest of serious communicable diseases, it has been used — or activated — only a handful of times.

It was used to treat a patient with severe acute respiratory syndrome, or SARS, which sickened thousands and killed hundreds of people in 2002 and 2003, mostly in Asia. Someone showing symptoms of Marburg virus, which causes hemorrhagic fever, was isolated in the ward until tests showed the person did not have Marburg.

Otherwise, the unit is not used. But Ribner and Alexander Isakov, executive director of Emory's Office of Critical Event Preparedness and Response, said the doctors and nurses who volunteer to work in it are put through drills every few months to prepare for possible patients.

The drills include donning the hazmat suits, drawing blood, monitoring blood pressure, and providing other care without exposing themselves to a patient's bodily fluids.

Patients infected with Ebola experience sudden fever, intense weakness, muscle pain, headaches, vomiting and diarrhea. As the disease progresses, it can cause organ failure and internal bleeding.

Staff must follow proper protocols when entering and leaving the room while also showing compassion for their patients, who cannot have any direct human contact. Visitors are confined behind glass and speak to them via phone or intercom.

Each patient will be cared for by two nurses as well as infectious disease doctors and other specialists. All medical staffers who treat them will wear masks, hoods, gloves and an outer shell over their clothing to protect them from vomit, saliva, mucus and other fluids that can spread the virus.

The isolation required for treatment can add stress to patients, especially when their prognoses are unclear. Ribner said he could not say how long either patient might be kept in the special room, but Emory officials were confident they could save them.

As Jay B. Varkey, an infectious disease specialist at Emory who will help treat the pair, said after Brantly's arrival: "We are ready."

tina.susman@latimes.com

Copyright © 2014, Los Angeles Times
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NationHospitals and ClinicsHealthcare ProvidersDiseases and IllnessesLiberiaU.S. Centers for Disease Control and PreventionEbola
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