Debbie Sacra, wife of Dr. Rick Sacra, an American doctor who contracted the Ebola virus in Africa, smiles as she speaks about her husband's health while addressing members of the media at the University of Massachusetts Medical School on Sept. 4, 2014, in Worcester, Mass. / Stephan Savoia, AP
With all supplies of an experimental drug exhausted, doctors and nurses caring for the third Ebola patient to return to the USA will rely on conventional methods of treating symptoms and preventing complications.
Physician Richard Sacra, 51, arrived Friday at the Nebraska Medical Center in Omaha's special Biocontainment Unit, one of only four such specialized units in the USA, which is designed for patients with dangerous and highly infectious diseases. Although Sacra works as a family physician in Worcester, Mass., he is also an experienced medical missionary, and he returned to Liberia to replace staff who had fallen ill with Ebola.
Smith and several other doctors with the unit repeatedly said Sacra's transfer to Omaha posed no threat to the public, noting Ebola is transmitted through close contact with an infected person.
A team of 35 doctors and nurses will care for Sacra during his hospital stay.
"This unit was specifically designed to care for patients of this nature and is staffed with infectious disease experts who have prepared for years for situations like this one," said Phil Smith, medical director of the 10-bed Biocontainment Unit, in a statement. "The unit is sealed, guarded and secure. It's separate from other patient care areas, and just like the facility at Emory University, which successfully treated two Americans with Ebola last month, we are uniquely prepared to handle infectious diseases here."
But even at a specialized center, there are limits to what hospital staff can do for Sacra.
Supplies of ZMapp, the experimental drug given to seven other Ebola patients, have been exhausted. Five of the patients survived, although it's not known whether ZMapp cured them.
Because ZMapp is in the early stages of development, its maker had only a small quantity at the beginning of the Ebola outbreak. Making more takes several months.
ZMapp includes a cocktail of man-made antibodies designed to help a patient's immune system fight off Ebola. Two Americans who received the drug -- physician Kent Brantly and missionary Nancy Writebol -- both recovered after receiving ZMapp and being transferred to Emory University Hospital.
Experimental vaccines are being tested at the National Institutes of Health in Bethesda, Md. But even in the best case, vaccines won't be available on an emergency basis for months, according to the World Health Organization, which convened a special meeting Friday to address which experimental therapies should be tested first.
Sacra's medical team is discussing experimental treatments, including using blood serum from a patient who has recovered from Ebola, Smith said.
Experts at the WHO meeting concluded that the first priority should be "whole blood" therapies, or transfusions from patients who have survived Ebola, because survivors may have natural antibodies capable of recognizing and fighting the virus. Before Brantly received ZMapp, he received a blood donation from a teenager who had survived the disease.
Patients don't necessarily need advanced medications to survive, however, says Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. He notes that about half of Ebola patients in West Africa have survived. According to WHO, 1,841 of the 3,685 people with Ebola have died.
Simply providing good "supportive care" -- addressing symptoms of Ebola and preventing complications -- can save many lives, Fauci says. "Excellent, carefully monitored care -- that is what improves the prognosis," Fauci says. "That is what is going to help patients survive right now."
In some cases, hospitals can help patients by keeping them stable long enough for their immune systems to "get the upper hand," says Daniel Lucey, an adjunct professor of microbiology and immunology at Georgetown University Medical Center, who treated Ebola patients in Sierra Leone for three weeks of August.
"Ebola doesn't last long," Lucey says. "It either kills you or you recover."
Supportive care can include:
* Treating nausea and vomiting. The hospital can provide drugs to control nausea and vomiting, called antiemetics, says Estrella Lasry, tropical medicine advisor at Doctors Without Borders, which operates several Ebola treatment centers in the affected countries.
* Relieving pain and treating infections. Doctors also can provide antibiotics to treat infections and medications for pain, Lasry says.
* Keeping patients hydrated. Providing intravenous saline can treat the common symptoms of heavy diarrhea and vomiting, Lucey says.
* Maintaining stable blood pressure. Ebola often causes a dangerous drop in blood pressure, which can cause the heart to compensate by beating rapidly. Low blood pressure can prevent oxygen from getting to critical parts of the body and cause patients to go into shock, Lucey says. Doctors can raise blood pressure with drugs, as well as IV fluids containing key salts, such as sodium and potassium.
* Helping the heart continue to beat strongly. Doctors can give drugs such as epinephrine or norepinephrine to help the heart continue beating strongly enough to get oxygen around the body, says Brett Giroir, an infectious disease and critical care medicine specialist who is the CEO of the Texas A&M Health Science Center.
* Control bleeding. Ebola often causes heavy bleeding, with small leaks developing in blood vessels. Doctors can give clotting factors to help the blood clot, Giroir says. Doctors also can give platelets, a type of blood cell that helps blood clot, as well as red blood cells, which carry oxygen. Blood transfusion can also replace blood lost to heavy bleeding, Lucey says.
* Purifying the blood. Doctors can provide medications to prevent liver failure, and put patients on dialysis if their kidneys begin to fail. Temporary dialysis can keep patients alive until their kidneys recover and begin working again, Fauci says.
* Helping patients breathe. Doctors can put patients on respirators if they can't breathe on their own, Fauci says.
Providing this sort of care is impossible at many West African hospitals, some of which lack even the basics, such as rubber gloves. According to a Friday report from the WHO, the West African countries hardest hit by Ebola -- Sierra Leone, Guinea and Liberia -- need nearly 1,000 more beds.
Today, Guinea has only 130 beds for Ebola patients, while Liberia has 314 and Sierra Leone has 130, according to the WHO.
Contributing: Associated Press
CEO and infectious disease physician
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