Ebola: A Medical Drama Unfolds
By Brenda Goodman, MA
Reviewed by Brunilda Nazario, MD
Aug. 22, 2014 -- Ebola has been raging through the West African countries of Guinea, Sierra Leone, Nigeria, and Liberia for nearly 9 months. With 2,615 cases and 1,427 deaths so far, it's the deadliest single outbreak of Ebola yet, according to the most recent update from the World Health Organization. At the current rate of illness, experts project the numbers from this epidemic will soon eclipse total cases and deaths of all other documented Ebola outbreaks combined.
It's also the first time Ebola infection has touched U.S. shores, igniting the public's interest along with its worst fears.
This is the story of how the epidemic started and the dramatic rescue effort that brought two infected Americans home.
Oct. 15, 2013 -- Dr. Kent Brantly, his wife Amber, who is a nurse, and their two children depart for Liberia to serve a 2-year medical mission with the nonprofit relief agency Samaritan's Purse. He is posted at ELWA Hospital in Monrovia.
"Ebola was not on the radar," Brantly says.
Dec. 6, 2013 -- A 2-year-old child dies in Guinea from a rapidly advancing illness that includes fever, black stool, and vomiting. A 3-year-old sister, their mother, grandmother, and great aunt also die after having the same symptoms.
Jan. 25, 2014 -- The village midwife who treated the family in Guinea, as well as many others in the area, is hospitalized. She dies 8 days later.
March 10 -- Hospitals and clinics around Gueckedou and Macenta, an area that touches the borders of Guinea, Liberia, and Sierra Leone, alert the Guinea government's Ministry of Health to an outbreak of infectious disease characterized by fever, severe diarrhea, and vomiting.
March 12 -- Local teams from Medecins sans Frontieres, MSF, also known as Doctors Without Borders, are alerted to the outbreak. They notify their European office.
March 18 -- Disease detectives from MSF arrive to take blood samples for testing. The samples are sent to biosafety labs in France and Germany for analysis. Tests confirm the Zaire strain of the Ebola virus, with an initial 86% death rate.
End of March -- Investigators count 111 suspected cases and 79 deaths.
One of the main ways the virus is spread is through local burial customs that involve kissing a corpse.
"In the hours after death with Ebola, that is when the body is most infectious, because the body is loaded with the virus. Everybody who touches the corpse is another infection," Ken Isaacs, vice president of programs and governmental relations for Samaritan's Purse, said in congressional testimony.
Brantly says the medical team at ELWA hospital first learned the Ebola infection had spread to Liberia in March.
June 2014 -- The medical team at ELWA hospital treats its first Ebola patient. "We began preparing for the worst," Brantly says. "We were ready."
June to July -- The number of Ebola patients treated at ELWA hospital increases steadily. "Our amazing crew at ELWA Hospital took care of each patient with great care and compassion. We also took every precaution to protect ourselves from this dreaded disease," Brantly says.
July 20 -- Brantly takes his wife and children to the airport for a planned visit to the U.S. After they left, "I poured myself into my work even more than before."
July 22 -- Dr. Sheik Umar Khan, the doctor leading the fight against Ebola in Sierra Leone, learns from a test he's caught the virus. He is quarantined in a medical ward run by MSF.
Doctors that work for the WHO offer Khan's medical team an experimental drug that's never been given to people. It's called ZMapp. They have a small box of frozen samples.
"There was only one box of drugs in the whole African continent" that might fight the disease, says Richard Furman, MD, a retired surgeon and co-founder of World Medical Mission, the health care arm of Samaritan's Purse.
Hoping Khan could pull through on his own, his doctors declined the treatment.
"They decided it was too much risk," Furman says.
July 23 -- Brantly says he wakes up feeling "under the weather." He isolates himself at the hospital.
July 26 -- Brantly and Nancy Writebol, a missionary serving as a personnel coordinator for SIM, another medical missions organization, are confirmed as having Ebola, according to Ken Isaacs.
"He [Brantly] is such a meticulous physician. He does everything almost to perfection. I just couldn't believe that he had gotten it," Furman recalls.
For Furman, the news was especially hard to bear. He had helped to make the decision to send the Brantlys to Liberia.
"It's a tough time to realize that someone we chose to go could be dying from Ebola. It was just a tough time," he recalls.
Samaritan's Purse is offered the same box of frozen ZMapp serum samples that was extended to Khan's care team. They take it.
July 29 -- Dr. Sheik Umar Khan dies in Sierra Leone.
July 31 -- With his condition deteriorating rapidly, Brantly is given a dose of the experimental treatment, ZMapp.
Furman gets updates via telephone every 6 to 8 hours from Lance Plyler, MD, the doctor treating Brantly in Africa.
Plyler tells Furman that Brantly's temperature is "sky high" and his breathing is rapid at 40 respirations per minute. Normally adults take 12 to 16 breaths per minute.
"Our doctor there said he didn't think he was going to make it. That was the first time they ever said that," Furman recalls.
"That's when he got the medicine," Furman says. "And it was remarkable. His temperature starts down and his breathing started slowing down, and for the first time, he said, 'I think I'm going to make it.'"
Writebol is also given a dose of ZMapp, though her response was not as dramatic.
5pm, July 31 -- A jet equipped with a special isolation pod is dispatched from an airfield in Cartersville, GA, to evacuate the American Ebola patients from Liberia, according to CNN reporters who witnessed the plane's takeoff.
The plane can carry only one passenger at a time.
"There is only one airplane in the world with one chamber to carry a level-4 pathogenic disease victim," Isaacs said during his congressional testimony. "That plane is in the United States. There is no other aircraft in the world that I can find. That means the U.S. does not have the capacity to evacuate its citizens in any significant mass."
Samaritan's Purse realizes that if any more of its workers get sick, they will effectively be stranded.
"The idea was, 'What if all of a sudden eight or ten start getting it?' You know, that runs through your mind, what can happen," Furman says.
A decision is made by the organization to get out, regroup, and go back. Samaritan's Purse decides to bring all non-essential personnel home.
Aug. 2 -- Brantly arrives at Emory University Hospital in Atlanta for treatment and becomes the first patient ever treated for Ebola infection on U.S. soil.
Furman says Brantly's return to the U.S. was a great personal relief.
"As a doctor, what I didn't realize is that Ebola can shut down the liver and the kidneys. If you shut down the kidneys over there, he's dead," Furman says. "There is no dialysis or anything like that."
At Emory, at least, he could get dialysis if he needed it. But it turns out Brantly isn't sick enough to need that kind of help. In a now-famous photograph, he stuns the world by walking off the ambulance and into the hospital.
"For him to walk instead of them carrying him, just that was a big deal [for Brantly]," Furman says. "He's an eager-type person. He's very upbeat."
Aug. 3 -- Writebol is given a second dose of ZMapp.
Aug. 4 -- The plane and isolation pod return to Liberia to pick Writebol up. The flight takes off in the early morning hours.
Aug. 5 -- Writebol arrives for treatment at Emory. Bruce Johnson, the president of SIM USA, describes her condition in a press conference as "very weak." She is wheeled into the hospital on a stretcher.
Like Brantly, she is treated in the hospital's special bio-containment unit, one of only four such wards in the country capable of isolating highly infectious patients. The other units are at the Nebraska Medical Center in Omaha; St. Patrick Hospital in Missoula, MT; and the National Institutes of Health in Bethesda, MD.
In a statement from Liberia, where he is still under quarantine, Writebol's husband, David, says: "A week ago we were thinking about making funeral arrangements for Nancy. Now we have a real reason to be hopeful."
Aug. 19 -- After 2 weeks of treatment, Writebol is quietly discharged from Emory.
Aug. 21 -- The dozens of doctors and nurses who treated the two Americans at Emory line the halls of the hospital as Brantly is released from the isolation unit. He high-fives and hugs the medical team as he leaves.
"Today is a miraculous day," he says later at a news conference.