How was Liberian Ebola patient’s treatment different from American patients who survived?

Article by: EMILY SCHMALL , Associated Press

DALLAS — When Thomas Eric Duncan became the first diagnosed case of Ebola in the United States, his relatives with roots in virus-ravaged Liberia knew what questions to ask.

Would his treatment include experimental drugs? Was a blood transfusion from a survivor an option? What about a transfer from the hospital in Dallas, where he was being treated, to one of four medical centers nationwide that specialize in highly infectious diseases like Ebola?

Duncan, poor and uninsured, did not get all the help his family members wanted, and they now question why his care was different in some ways than that of Americans infected with the deadly virus who survived. Of the nine people who have been treated for Ebola in the U.S., only Duncan has died.

"We asked. We begged. We pleaded. I even offered my own blood, even though it wouldn't do anything for him," said nephew Josephus Weeks, who was so close in age to Duncan that they were raised like brothers. "We requested everything we could think of to save Eric. They said no."

Texas Health Presbyterian Hospital Dallas spokesman Wendell Watson said "many treatment options" were considered, including experimental drugs and a transfusion. What could be done to save Duncan was "discussed daily" with experts at the U.S. Centers for Disease Control and Prevention and Emory University in Atlanta, which has a special isolation unit that successfully treated other Ebola patients. He said all parties decided to leave Duncan in Dallas, where he died Oct. 8.

Duncan's medical records, which the family shared with The Associated Press, note the smallest details of his treatment: what he ate, how he looked, the fluids and drugs pumped into his Ebola-ridden body.

The records probably reflect a fraction of the discussions over Duncan's care. Still, they say relatively little about experimental treatment. Five days passed from the time a doctor first suspected Ebola, when Duncan returned a second time to the ER on Sept. 28, until hospital officials noted they were trying to secure an experimental drug, brincidofovir, for Duncan on Oct. 3.

Worried about the delay, Weeks texted his hospital contact on Oct. 4.

"Is there an experimental treatment we need to speak about?" Weeks said in a text message exchange with a Presbyterian Hospital liaison, Jennifer Rainer.

"He has gotten a first dose," Rainer replied minutes later, adding that she could not say whether the drug was working.

Duncan received another dose of brincidofovir on Oct. 7 — the day before he died, records show.

Experts disagree on whether getting Duncan an experimental drug sooner, giving him a different drug or a blood transfusion would have made a difference.

"No real way to know, since there are absolutely no data on it," said Dr. Greg Moran, an emergency and infectious disease specialist at UCLA.

But Dr. Thomas Geisbert, an Ebola expert at the University of Texas Medical Branch in Galveston, said he had trouble understanding why four days elapsed between Duncan's confirmed test results on Sept. 30 and his first treatment. And he was surprised by the choice of experimental drug given to Duncan.

"The guys who do what I do, working in this field, find it puzzling," said Geisbert, a professor of microbiology and immunology who has been studying Ebola since the early 1990s and was consulted on two of the U.S. cases. "It kind of came out of left field. I think the jury is still out on why this would have any activity against Ebola."

Although treatments have varied, ZMapp and TKM-Ebola are the only drugs proven to protect nonhuman primates from Ebola, Geisbert said.

While the manufacturer of ZMapp ran out of the drug before Duncan's diagnosis, limited doses of TKM-Ebola were available, according to Julie Rezler, a spokeswoman for the drugmaker, Tekmira. READ MORE OF THIS STORY


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