American Ebola Patients Returning to the U.S.
By Brenda Goodman, MA
Reviewed by Michael W. Smith, MD
Aug. 1, 2014 -- Air rescue efforts were underway Friday to return two American health care workers infected with the Ebola virus to the United States.
Both patients will be treated in a special isolation unit at Emory University Hospital in Atlanta, said Bruce Ribner, MD, an infectious disease specialist at Emory who will be caring for the patients. A patient with Ebola virus has never before been cared for in an institution in the United States.
The two workers, Dr. Kent Brantly and missionary Nancy Writebol, were in serious condition Friday afternoon. The air ambulance that was transporting the patients, which is operated by Phoenix Air, had not yet left the ground in Africa, Ribner said.
"We feel we have the environment and expertise to safely care for these patients and offer them the maximum opportunity for recovery from these infections," Ribner said at a news conference.
"The primary care for somebody with a hemorrhagic fever and specifically Ebola is supportive care. We know we can deliver a substantially higher level of care and a higher level of support to optimize the chances that the patients will survive this episode," he said.
Supportive care may include giving the patients IV fluids or putting them on a respirator. Since many patients develop kidney failure, specialists are on standby to help if needed, Ribner said.
The patient bio containment unit at Emory is one of four such specialized facilities in the U.S., Ribner said.
Ribner said he believed Emory was prepared to handle the cases.
The containment unit is separated from the rest of the hospital, Ribner said. Staff in the unit, including two nurses who would care for each patient, and a team of four infectious disease doctors who would oversee their care, have been specially trained to enter the patients' rooms.
The air the patients breathe goes through a high-efficiency particulate air (HEPA) filter before it is exhausted outside the hospital. There is no recirculation of air, so no one who works inside the facility is at risk.
Their bodily waste, including stool, will be flushed into the public sewer system. Ribner said there was no risk of transmission to the general public because waste management practices will kill any virus that's flushed into waste water.
"The U.S. public health service has established that that is an effective way of dealing with these viruses," he said. "Whatever comes out of the public sewer system should not be contagious."
Ebola viruses are not especially hard to kill, he said.
"Any standard disinfectant will be more than capable of inactivating Ebola," he said. "We don't think there will be any secondary cases as a result of caring for these patients in the U.S."
He said the patients would be able to see visitors through a plate glass window. They will be able to communicate by telephones and through an intercom system.
"They should be back in the U.S. by early next week," says Palmer Holt, a spokesperson for SIM, the organization Writebol works for in Liberia, where she contracted the virus.
Ribner said he and his team were in discussion with the FDA and National Institutes of Health about what kinds of experimental protocols might be offered to the patients. There is no vaccine or treatment that's approved for treating Ebola.
Previously, the isolation unit has housed patients infected with SARS and a suspected case of the Marburg virus, Ribner said.
SOURCES: Palmer Holt, spokesperson, SIM. CDC. News releases, Emory University Hospital. News conference, Emory University Hospital. Bruce Ribner, MD, infectious disease specialist, Emory Healthcare.