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Ebola patients leave Georgia hospital

by New York Times News Service on August 22, 2014 10:34 AM

ATLANTA — To evaluate the condition of Dr. Kent Brantly, the American aid worker who became the first person to be treated for Ebola in the United States, all anyone needed to do Thursday was notice what he was not wearing.

Gone was the bulky white suit he had been put in upon his arrival on Aug. 2, amid heavy security, at Emory University Hospital here.

Instead, appearing trim and vibrant and wearing a button-down shirt and slacks, Brantly stood before reporters as he prepared to leave Emory after his doctors declared him recovered from the virus he contracted while working in Liberia.

“Today is a miraculous day,” Brantly, his wife at his side, said in a steady voice that wavered when he thanked his health care team. “I am thrilled to be alive, to be well and to be reunited with my family.”

Emory said Thursday that Brantly, who lived in Fort Worth, Texas, before going to Liberia, and Nancy Writebol, a missionary from Charlotte, N.C., who also contracted Ebola while in Africa this summer, had been released from its specialized isolation unit this week. The hospital, in a statement, said it was “confident that the discharge of these patients poses no public health threat” and said the decision to release them was linked to the results of urine and blood tests.

Writebol, who did not appear before reporters, was released Tuesday, but the hospital did not announce her discharge until Thursday morning. Her husband, David Writebol, said in a statement that “the lingering effects of her battle have left her in a significantly weakened condition” that required additional rest without an onslaught of public scrutiny.

But he added, “Her departure from the hospital, free of the disease, is powerful testimony to God’s sustaining grace in time of need.”

Emory officials, whose decision to admit Brantly and Writebol prompted questions about whether their arrivals could spread the virus in the United States, on Thursday defended their actions.

“We understand that there are a lot of questions and concerns regarding Ebola virus and the infection that it causes,” said Dr. Bruce S. Ribner, the Emory infectious diseases specialist who coordinated the treatment of Brantly and Writebol. “However, we cannot let our fears dictate our actions. We must all care.”

Ribner said it was “the right decision” to evacuate the patients to Emory from Liberia, both because they could receive superior care in the United States and because the lessons learned in treating them could eventually assist doctors treating patients on the front lines.

Emory doctors were able, Ribner said, to carefully monitor levels of electrolytes in the patients, as well as any abnormalities in their blood clotting.

It will be difficult, though, to apply such guidance in West Africa. Joanne Liu, president of Doctors Without Borders, said in an interview Tuesday that patients in their treatment centers received only a single blood test — a screening for the Ebola virus — between admission and death or recovery. There were no tests for electrolytes or clotting factors, she said, because it is simply too risky to handle the blood of Ebola patients, especially in conditions where doctors and nurses are stressed and overworked from an outbreak that has killed more than 1,200 people.

Even if electrolytes cannot be easily measured in the emergency field hospitals that dot Africa, Ribner said, the Emory experience showed the importance of replacing lost electrolytes in patients suffering from Ebola.

At Emory, Brantly and Writebol were held in an isolation ward built 12 years ago after consultation with the federal Centers for Disease Control and Prevention, which has its headquarters near the hospital. Visitor contact was limited — glass separated Brantly and Writebol from family members — and hospital staff members donned specialized gear before interacting with the patients.

Faced with questions of whether Emory was gambling public health to assist the two patients, the hospital and its supporters, including the director of the disease centers, said there was no risk for the infection to spread.

Ribner said there was no virus in their blood and that they no longer had any symptoms.

“We are confident they pose no public health threat,” he said. Virus has been found in the semen of men who recovered from Ebola as long as three months after recovery.

But the disease has never been proven to have been transmitted through sex. The CDC suggests that men who have recovered use condoms temporarily, and Brantly was informed of the CDC’s recommendation, Ribner said.

Although Ribner conceded Thursday that doctors “didn’t know what to expect” about how Brantly and Writebol would fare in the United States, he said Emory officials had “always suspected that we had a good chance of helping these patients survive.”

It remained unclear Thursday whether an experimental drug the two received while still in Africa had aided in their recoveries.

“Frankly, we do not know whether it helped them, whether it made no difference or even, theoretically, if it delayed their recovery,” Ribner said.

But Thursday, Brantly focused on thanking the five doctors specializing in infectious diseases, the 21 nurses and many other sub-specialists Emory said were involved in caring for him and Writebol.

And then, before he hugged teary-eyed members of his medical team who stood behind him during his statement, he said, “Above all, I am forever thankful to God for sparing my life and I’m glad for any attention my sickness has attracted to the plight of West Africa in the midst of this epidemic.”

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