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Ebola

First Ebola patient diagnosed in US dies from virus

NEW YORK — Thomas Eric Duncan, the first person diagnosed with Ebola in the United States, died from the virus Wednesday while in isolation at a Dallas hospital, ending a case that helped bring into sharp focus the nation’s risk from the disease.

The incident showed that Ebola could quietly make its way into the country, and that hospital protocols designed to control it may not always work. At the same time, it rang an alarm for medical professionals and federal officials to tighten the safety net.

Duncan was diagnosed with the disease on Sept. 30 after contracting it in West Africa, where Ebola has infected more than 8,000 people, killing about half. He came to the U.S. to marry his girlfriend, Louise Troh, who hasn’t shown symptoms but remains in quarantine. Duncan was listed in serious condition until Oct. 4, when his kidneys failed and he went on dialysis.

“This morning we received word that Eric passed away. His suffering is over,” Troh said in a statement released through her church. “My family is in deep sadness and grief, but we leave him in the hands of God.”

Duncan, who traveled to the U.S. from Liberia, developed a fever and stomach pains on Sept. 24, four days after arriving in the U.S. He was initially sent home from Texas Health Presbyterian Hospital Dallas’s emergency room on Sept. 26, after doctors failed to diagnose him with Ebola.

The hospital has sent mixed messages over why Duncan was released, saying on Oct. 3 that doctors didn’t see a nurse’s note saying that Duncan had recently been in Africa because of a gap in the electronic medical record system. Later, the hospital said there was no problem with the records system and the travel history should have been seen by a physician.

Two days after he was released by the ER, Duncan arrived back at the hospital in an ambulance and was confirmed as having the disease. The hospital has declined to comment further on this issue.

On Oct. 4, Duncan was given the experimental drug brincidofovir, made by Durham, North Carolina-based Chimerix Inc., and has been treated during his stay with oxygen, fluids and medication to stave off other infections, according to statements from the hospital.

Jana Shaw, an infectious disease physician at Upstate Golisano Children’s Hospital in Syracuse, New York, said the earlier treatments are given, the more likely they are to be effective. Brincidofovir may work by halting Ebola’s ability to make copies of itself, so it’s possible there was already too much virus in Duncan’s body for it to be effective when it was administered, she said.

“If you start treatment when the virus is integrated they may not help at all,” Shaw said by telephone. “It’s very likely his body was already overwhelmed by this virus and this drug had very little chances of working.”

Other patients who were treated in the U.S. and survived “were all diagnosed very, very quickly,” said William Schaffner, an infectious disease specialist at the Vanderbilt University Medical Center in Nashville.

“If you start all those things earlier, you are much more likely to have the body respond appropriately,” Schaffner said by telephone. “The longer the illness goes the more difficult it is to restore the patient to good function.”

Duncan’s general health before he got the infection — which is unknown — could also have affected his odds of surviving, according to Schaffner. If Duncan got a higher dose of Ebola when he was infected, compared with other patients, this may also have made the course of the illness more severe, he said.

While it could be that Duncan got the Chimerix drug too late and that no drug would have worked at that late point, it also may be the Chimerix drug is not as effective as ZMapp or TKM-Ebola, two other drugs that have been tried on Ebola patients, said Thomas Geisbert, a virologist at the University of Texas Medical Branch at Galveston.

None of the experimental Ebola treatments that have been tried on patients have been proven to be effective in people.

Of dozens of drugs that have been shown some promise in the laboratory over the years against Ebola, only ZMapp from Mapp Biopharmaceutical Inc. and TKM-Ebola from Tekmira Pharmaceuticals Corp. have been shown to completely protect monkeys infected with the virus, Geisbert said. The monkey tests are considered the animal tests most likely to be predictive of efficacy in people, he said.

“We have no idea whether any of them work. That is a great question mark,” Vanderbilt’s Shaffner said.

A nephew, Josephus Weeks, said Wednesday that Duncan didn’t receive any serum from Ebola survivors, a treatment given to others who have survived. Kent Brantly, a U.S. doctor who recovered after being infected, has donated serum to at least two other patients.

Asked in a text-message interview if the family thinks blood serum derived from disease survivors should have been used, Weeks said, “We begged and pleaded several times. They said it’s too late in his treatment. They didn’t try any other options but saline, oxygen and water.”

Duncan’s case has drawn widespread interest, spurring calls by some to limit or better control air flights from West Africa, and opening concerns within the Liberian community in Dallas about the stigma they face. At the same time, the Rev. Jesse Jackson arrived in Dallas Tuesday with Duncan’s mother, Nowah Gartay, to preach tolerance and compassion during a vigil he led.

A hospital spokeswoman, Candace White, didn’t immediately respond to multiple requests for comment on Duncan’s specific treatments, or how much his care cost. The bill may eventually total $500,000 including indirect costs such as the disruption to other areas of hospital care, said Dan Mendelson, chief executive officer of Avalere Health, a Washington consulting firm.

What will happen to Duncan’s body remains unclear, as local health officials have not detailed what plans they have in place. Bodies of the deceased are extremely infectious and the spread of the virus in West Africa in past and current outbreaks has been attributed in part to family members touching bodies during funerals.

The hospital will handle the remains, said Barbara Reynolds, a spokeswoman for the U.S. Centers for Disease Control and Prevention. She said she didn’t know whether CDC personnel would assist in handling the body.

“We need all the help we can get,” said Weeks, Duncan’s nephew, in a text message after the death was announced. “We need help with everything.”

The National Funeral Directors Association has received guidelines from the CDC, which says that only trained personnel dressed in full protective gear should touch the body. Remains should be placed in a body bag, which then must be disinfected then cremated or placed in a casket that is airtight and secured against the escape of microorganisms, the CDC guidelines say.

The case has also opened debate on whether airline passengers from West Africa need to be better screened. Travelers from Guinea, Liberia and Sierra Leone — the countries at the center of the outbreak — will have their temperatures taken and be asked about possible exposure to Ebola as part of new entry measures into the U.S. beginning next week at five major airports, the CDC said today in a statement.

If passengers from the region have a fever or other symptoms of the disease, U.S. Customs and Border Protection will determine with the CDC whether they should be evaluated at a hospital or allowed to travel further, the CDC said. The airports are New York’s John F. Kennedy, Washington-Dulles, Newark, New Jersey, Chicago-O’Hare and Atlanta, which receive 94 percent of the travelers from the three most-affected countries, the agency said.

At least six patients have been or are currently being treated in the U.S. for Ebola.

American aid workers Kent Brantly, Nancy Writebol, and Rick Sacra were treated and discharged. Brantly and Writebol received ZMapp, an antibody cocktail by Mapp Biopharmaceutical Inc., which has since run out.

Sacra received a drug made by Tekmira Pharmaceuticals Corp. NBC cameraman Ashoka Mukpo is currently being treated at the University of Nebraska Medical Center and has received Chimerix’s drug. There is also an unidentified patient at Emory University Hospital.

Shares of Chimerix dropped as much as 15 percent after the news of Duncan’s death. Joseph Schepers, a spokesman for Chimerix, declined to comment when reached by telephone.

With assistance from Robert Langreth and Cynthia Koons in New York and Ed Dufner in Dallas.

© 2014, Bloomberg News

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