Second Ebola Patient Arrives in the U.S., Shows Signs of Improvement

Nancy Writebol, an American aid worker from North Carolina who was infected with the Ebola virus while working in Liberia, arrives at Emory University Hospital in Atlanta, Tuesday, Aug. 5, 2014. The Journal & Constitution, John Spink via AP

ATLANTA, GA—A grey Gulfstream III carrying Nancy Writebol, an American aid worker diagnosed with Ebola, landed at Dobbins Air Force Base north of Atlanta Tuesday morning. An ambulance took her 14 miles to a special isolation facility at Emory University Hospital that was designed not just to treat the worst diseases, but to make sure those diseases don’t get any farther than its walls.

Writebol transited from ambulance to hospital on a gurney. She now joins Kent Brantly, a doctor who’d been volunteering in Liberia with with the Christian aid organizations Samaritan’s Purse and SIM USA when he, too, became infected with the deadly virus. Brantly and Writebol are the first people to be treated for Ebola on US soil—and despite some signs that an experimental drug has improved their condition, the virus still has no known cure. The only accepted treatments are rehydration and time.

Bruce Johnson, president of SIM USA, during a press conference following Writebol’s arrival at Emory. Carolyn Crist/WIRED

“Nancy is still very, very weak but shows signs of improvement, progress, and is moving in the right direction,” said Bruce Johnson, president of SIM USA, at a press conference following Writebol’s arrival. Samaritan’s Purse and SIM USA coordinated with the State Department, Atlanta-based private jet company Phoenix Air and the Centers for Disease Control and Prevention to set up the transport—at a price tag that has already topped $1 million for Samaritan’s Purse and SIM. Writebol, of North Carolina, and Brantly, of Texas, are just two of the 1,600 people who have contracted the virus in four West African nations, according to the World Health Organization. The virus brings on vomiting, hemorrhagic bleeding and organ failure, and more than 800 people have died over the course of this latest outbreak.

For all that researchers know about Ebola, they still have questions—like how Brantly and Writebol got it. Typically Ebola is transmitted via bodily fluids such as blood and urine, but Writebol didn’t have direct contact with patients. The aid groups that employed the patients have invited CDC officials to do a full review of protocols and determine what happened, and for now, the groups’ hospital in Liberia isn’t receiving new patients, just treating current ones. Last week, Samaritan’s Purse sent another doctor to the site, and a few days ago, a SIM USA doctor volunteered to go back to Liberia. “There’s always a possibility that another worker could be infected, but we’re trusting that won’t happen,” Johnson said. “I’m impressed the two doctors said ‘Put me back in,’ and their families supported it.”

Emory, CDC and SIM officials have offered few specifics about the patients’ conditions or treatment. In Monrovia, Writebol asked for potato soup and then yogurt before boarding the plane—doctors regard her increased appetite as a positive sign. Her sons Jeremy and Brian will visit the hospital Tuesday; her husband David is still in Liberia, working on transportation arrangements to the US. Brantly’s wife, Amber, has visited him at Emory—they spoke through a window on the isolation chamber.

It’s possible that Writebol and Brantly have improved because of an experimental drug. According to CNN, CDC officials shipped three vials of an experimental drug called ZMapp to Liberia before the two came to the US. Manufactured by San Diego biotech firm Mapp Biopharmaceutical, ZMapp hasn’t been approved by the FDA, but the two agreed to take it—it’s a monoclonal antibody created by exposing mice to the virus. Brantly initially offered Writebol the first thawed vial, but as his condition deteriorated, he asked to take it and improved within hours. Writebol took two doses in Liberia but was still in “serious” condition before she left Liberia. The difference between the two is likely due to age, Johnson said—Brantly is 33 and Writebol is 58.

When doctors first diagnosed the two workers, SIM officials didn’t consider evacuation. But then the charter flight came through, and Emory University doctors said they were willing to receive Ebola patients. With the CDC headquarters less than a mile from the hospital, Emory University, State Department and CDC officials saw it as an opportunity to closely monitor American citizens and possibly find a cure through research. “You’ve seen the reaction here. We needed to make sure the aircraft, hospital and facilities would have the infrastructure to handle what we’re dealing with here,” Johnson said. “Then we left the decision up to the patients, their doctors and families about who would come first.”

Emory’s purpose-built isolation unit was another reason to bring the two home. The hospital built it 12 years ago with CDC help—with an eye toward treating CDC officials, should the need arise. It’s one of only four facilities of its kind in the country. Negative-pressure airflow systems make sure that HEPA-filtered air flows only inward, from the hallway to the preparation room and then to the patient room, and not the other way. The unit has its own lab facilities to test samples, and the hospital cleans and incinerates the bedding after use.

With both patients now contained, a small team of doctors and nurses will provide care around the clock. Staff not directly involved with the cases aren’t allowed near the unit, said Emory University medical intern Deep Shah. After Brantly arrived Saturday, staff seemed tense but confident about how to treat the patients, he said. That’s because Ebola isn’t “some mystical pathogen with a bizarre mode of transportation,” said Bruce Ribner, the doctor who oversees the isolation unit. It is deadly but not highly contagious. It isn’t an airborne disease, can’t be transmitted by a sneeze and doesn’t survive long outside a host. “The stakes are higher, but it’s easily inactivated with typical hospital disinfectants,” said Tom Frieden, CDC director.

Nancy and David Writebol were making funeral arrangements for her last week in Liberia but now they’re holding off. Johnson talked to David Writebol by phone after Nancy’s departure from Liberia and said he’s not “anxious, fretful or fearful — just relieved.” Getting to the Emory facility has been a good move, too, Johnson said. “We still have a long way to go,” he said. “But we have reason for hope.”