The Atlanta Journal-Constitution
‘We can be ready within one hour of the call’ about Ebola
is once again at the center of containment efforts. The ongoing epidemic in the central African country has infected 2,659 people over the past year, killing more than 1,780, and is now the second-largest Ebola outbreak in history.
Over the past year, the Centers for Disease Control and Prevention has sent 200 experts, including epidemiologists and infection prevention and control experts, to the DRC, neighboring countries and the World Health Organization headquarters in Geneva.
Meanwhile, the special isolation unit at Emory stands ready to care for CDC employees, as well as other Americans exposed to Ebola while working to stop the spread of the disease.
Inside the unit
After 2014, the Emory unit was expanded from two isolation rooms to 11. And it now contains a larger clinical laboratory.
On a recent afternoon inside the unit, cardiac monitors were in place, and extra long, pale green medical gloves were stocked. The beds were already made, with white sheets and perfectly folded navy blue blankets, and the temperature was set at a cool 68.4 degrees.
The word “Teamwork,” framed and in capital letters, hung on a wall.
“We can be ready within one hour of the call,” said Sharon Vanairsdale, a clinical nurse specialist.
Vanairsdale was working in Emory’s ER department on July 31, 2014, when a top Emory official walked by and asked what she was working on. Ebola education for the nurses, she said. It’s out there, she added. Yes, it’s close, closer than you know, the official responded.
Within hours, she got the call and was asked to join the medical team to care for Brantly.
“I was never afraid,” said Vanairsdale, who is now 38 and lives in Atlanta. “It was like a team huddle with a sports team. It was purposeful conversation discussing our game plan.”
Brantly arrived at Emory very sick, severely weakened by the virus attacking virtually every organ.
Media satellite trucks lined Clifton Road, and television helicopters hovered overhead.
On social media, residents expressed concern that patients stricken with the deadly disease would be coming to Atlanta.
And Dr. Donald Siegel — a DeKalb County surgeon and former chief of aerospace medicine at Dobbins Air Force Base, where a specially equipped plane landed with Brantly — called the decision to bring the patients here “foolish.” He said he didn’t understand why the CDC wouldn’t have flown the equipment and personnel to Africa.
But the CDC and Emory had long planned for the medical emergency.
Collaborating with the CDC, the hospital’s Serious Communicable Diseases Unit was built in 2002 to care for the agency’s scientists and staff who contracted lethal diseases in laboratory settings or while traveling abroad. As the years went by, with only false alarms, the unit was used for training.
Until early August 2014. Then the unit became a medical haven for Americans who had contracted Ebola while taking care of patients with the disease. It turned out none worked for the CDC.
Brantly was the first of four patients treated that year for Ebola at the hospital.
On Friday, he and missionary Nancy Writebol, another patient, reunited with their doctors and nurses at Emory for a news conference marking the anniversary.
“People have asked me if it’s traumatic to remember my experience here, and it’s not for me,” said Brantly. “I really have feelings of nostalgia from my time at that unit because after the first three or four days here, when I kind of turned the corner, this was a place and a time when I knew everything was going to be OK.”
The Emory medical team provided extraordinary care, including a nurse at his bedside around the clock, he said. In West Africa, he added, care can be limited to Tylenol and a health care worker able to spend only a fraction of that time with a sick patient.
In recent years, Brantly has been living in Texas and teaching in the residency program at John Peter Smith Hospital, which serves Fort Worth’s poorest residents. He and his wife wrote the book “Called for Life: How Loving Our Neighbor Led Us Into the Heart of the Ebola Epidemic.”
Other than Brantly and Writebol, others treated for Ebola at Emory were Dr. Ian Crozier, who volunteered with WHO at an Ebola treatment unit in Sierra Leone; and Amber Vinson, a nurse who became infected while caring for a patient in Dallas.
Crozier was the most critically ill, requiring both kidney dialysis and a ventilator. He also stayed at the Emory unit the longest, about five weeks.
Since then, the Serious Communicable Diseases Unit has been used only a few times: once to treat a missionary with Lassa fever, an acute viral hemorrhagic illness endemic in parts of West Africa, and a couple of other times when suspected cases of Ebola turned out to be false alarms.
It is one of four high-level biocontainment units in the U.S. The other three are at the National Institutes for Health in Maryland, Rocky Mountain Laboratories in Montana and University of Nebraska Medical Center. They are set up to contain infectious diseases such as severe acute respiratory syndrome (SARS), smallpox, tularemia, plague, viral hemorrhagic fevers and drug-resistant illnesses.
Constant training
The Ebola virus causes fever, bleeding, vomiting and diarrhea. The death rate is about 50%.
There is no cure. The key, doctors and nurses have discovered, is keeping patients alive long enough for their bodies to successfully fight off the infection. Medical staff provide supportive care measures, such as replenishing fluids and electrolytes, oxygen therapy and medication to reduce vomiting and diarrhea and manage fever.
The disease can spread easily through contact with bodily fluids.
Vanairsdale remembers being trained five years ago on wearing a Personal Protective Equipment (PPE) suit, not something one expects to see at a local hospital. The gear is made of ultrastrong, waterproof synthetic material that won’t easily rip or tear. A powered air-purifying respirator is used to prevent inhaling viral particles.
Vanairsdale made sure everyone who wore the special PPE gear followed a 23-step process to remove each piece, cleaning hands several times between the steps.
There are other precautions in place as well. In patient care rooms, the air pressure is negative. The air flows from the hallway to the anteroom to the patient room, meaning doors don’t need to be sealed, since airflow goes into the room, not out. The unit uses filters that can trap very small particles.
Now the director for Emory’s Serious Communicable Diseases Program, Vanairsdale has focused on educating health care workers across the country on Ebola treatment and preparedness protocols. So far, she’s helped train more than 3,500 people.
Training at Emory is near-constant. Emory uses a virtual reality immersive experience to help prepare its staff for what it’s like to care for patients with Ebola and other infectious diseases while wearing cumbersome protective suits. Staff members also train for a scenario in which several people with Ebola symptoms show up at different regional hospitals. Using isolation techniques, health care workers collect and ship samples for diagnostic tests and transport patients to a regional Ebola treatment center, including the one at Emory.
Still, in a recent interview, Siegel said he’s not convinced it make sense to care for Ebola patients in the United States. The risk of the disease spreading may be extremely low, he said, but “it’s not zero. Why risk it at all?”
He pointed to Vinson, the nurse in Texas who was unknowingly infected with Ebola while treating a patient. She traveled on a flight before realizing she, too, had the disease. It was “lucky” that didn’t lead to a catastrophe back in 2014, he said.
But Emory and CDC experts say there is no way to eliminate the risk of a person, perhaps unknowingly, arriving in the country with a highly infectious disease. The best way to contain an illness, they said, is to be prepared when the unexpected happens.
Dr. Ryan Fagan, a medical officer with the CDC who is leading the agency’s domestic infection-control efforts related to Ebola, said infectious diseases such as Ebola and SARS have and will show up in the United States. Back in 2014, Vinson was infected because, when Thomas Eric Duncan traveled to Dallas from Liberia, he seemed perfectly healthy. He ended up at a hospital where the nurse worked and would be diagnosed with Ebola.
Over the past five years, U.S. hospitals are becoming more prepared, Fagan said. He pointed to a report by the Department of Health and Human Services that found the percentage of hospitals reporting they were unprepared to care for emerging infectious disease threats such as Ebola dropped from 71% in 2014 to 14% in 2017.
This current outbreak in the DRC is extremely challenging. Ebola has been declared an international health emergency by the World Health Organization after taking hold in the African nation, which is three times the size of Texas and home to 80 million people.
The outbreak zone, too, is located in an area with violence and armed conflict. Briefly last year, CDC experts were working in Beni, the city that’s ground zero for the outbreak, but the Trump administration forced them to withdraw from the area because of security concerns. Even top CDC officials have acknowledged that working at a distance has hampered efforts to control the outbreak.
Emory reunion
On Friday, Brantly and Writebol hugged doctors and nurses in an emotional and tearful reunion. Crozier had also planned to participate, but he has been urgently deployed by WHO to the city of Goma in the DRC.
Both Brantly and Writebol made an impassioned plea for more support and more attention to fight the Ebola outbreak in the DRC.
Writebol, who returned to Liberia after recovering from the disease, said Friday she has been working as a trauma healing counselor to help Ebola survivors. She is planning to head to the DRC this fall.
Brantly, who was accompanied Friday by his wife and their two young children, also discussed his plans: returning to Africa, specifically Mukinge Mission Hospital, a 200-bed facility with three doctors. Located in Zambia, it’s about 1,000 miles from the current Ebola outbreak.
The 39-year-old doctor said he’s been called to serve.
“We are making this move to Zambia for the same reasons we moved to Liberia in 2013: because we feel like God has given us a call in our lives to care for the poor, to have compassion (for) people in need, to join in the work of the fixing the broken things in this world.”
‘I was never afraid. It was like a team huddle with a sports team. It was purposeful conversation discussing our game plan.’ Sharon Vanairsdale
Director, Emory’s Serious Communicable Diseases Program