By Brenda Goodman, MA
WebMD Health News
Reviewed by Arefa Cassoobhoy, MD, MPH
Aug. 5, 2014 -- As the second American infected with Ebola in Liberia returned to the United States, health officials were trying to determine how both became infected with the virus.
Both Nancy Writebol, who arrived in Atlanta on Tuesday, and Dr. Kent Brantly were working under strict patient care rules that had been approved by experts at the CDC, says Bruce Johnson. He's the president of SIM USA, the aid organization Writebol was working with.
"We have protective protocols in place for all our staff. We don't know how Nancy contracted this. We don't know where that point of contact was," Johnson says.
Writebol was a personnel coordinator with SIM. Part of her duties involved washing down and disinfecting doctors and nurses as they entered and left the Ebola treatment area at the hospital where she worked.
"She did not have direct contact with patients," Johnson says. "She wasn't working in the Ebola unit. She was spraying down people as they came out of the unit."
Johnson says that soon after Brantly and Writebol were infected, SIM and Samaritan's Purse, another aid organization staffing the hospital, asked the CDC to do a detailed review of how they might have been infected.
He says the results of that review are pending. CDC staff are also on site in Liberia, testing people with symptoms to see whether or not they have the virus.
Johnson couldn't provide a precise timeline for when the two workers fell ill or when they were treated with an experimental medication that was rushed to them from the U.S. He says he was told that Writebol was sick on July 26.
Signs of Improvement
Writebol, 58, arrived in a government jet outfitted with a sealed medical pod, and was wheeled into a special isolation unit at Emory University Hospital on a stretcher Tuesday afternoon. Brantly is already receiving treatment in the unit, one of four such specialized facilities in the U.S.
"Nancy is still very weak. She shows signs of continued improvement. She is showing signs of progress and is moving in the right direction. Nancy had yogurt before she got on the airplane," Johnson told reporters at a news conference, reading a statement from Nancy's husband, David Writebol.
"A week ago we were thinking about making funeral arrangements for Nancy. Now we have a real reason to be hopeful," the statement continued.
David Writebol, who was working alongside his wife in Liberia, remains in that country, although efforts are underway to bring him home. Her two sons are also on the way to her bedside, Johnson says.
Isolation Unit Details
The unit where the two are being treated is separate from the rest of the hospital. Staff in the unit, including two nurses who care for each patient and a team of four infectious disease doctors who oversee their care, have been specially trained to enter their rooms.
The air the patients breathe goes through a high-efficiency particulate air (HEPA) filter before it's exhausted outside the hospital. There is no recirculation of air, so no one who works inside the facility is at risk.
Patients' bodily waste, including stool, will be flushed into the public sewer system. Hospital officials have 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.
Johnson says the tab for the care and transport of Brantly and Writebol had reached at least $2 million. He says he expects some of those costs will be reimbursed by medical evacuation insurance that's carried by all missionaries serving with SIM.
Liberia has 50 doctors to care for 4 million people.
That's why, despite the risk, Writebol and Brantly felt a deep commitment to their work there, Johnson says.
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