US - Texas: Mr. Duncan - Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

[Dani]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

The last question I have is why no Zmapp? Since Mr. Duncan was hospitalized, two patients have been given Zmapp (one in Norway and one in Spain), but the Texas hospital said that they couldn't get any, there was none left.

 

[foxp3]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Personally I feel not enough is known about the virus to indicate with confidence a strict correlation reliably exists between earlier diagnosis and best clinical outcome. This is perhaps an over simplistic view.

Undefined variables which could feasibly affect outcome are patients immunostatus at time of viral exposure, presence of coinfections, patients inherent genetic susceptibility, route of transmission/inoculation, ( I.e. how patient was initially exposed mucosal vs systemic route which activates very different different components of immune system), initial viral load, and so on and on .

Both Spanish priests received good care, the first had ZMapp, both died. In contrast William Pooley had mild symptoms and only slight GI disturbances, while others have died within hours of symptoms starting.

Good early cytokine responses are reportedly prognostic, but I can take 4 peoples white blood cells and stimulate them under identical conditions, and amongst these individuals you will always get high TNFa producers and low cytokine producers.


The unpredictable nature of Ebola infections in individuals was discussed by Dr Daniel Bausch last month. He is an infectious disease expert who has worked previously in Uganda with Ebola and has been working for months in Sierra Leone and Liberia Ebola wards.

He was asked

"If you were treating Ebola patients in this country with our facilities and expertise, what do you think the survival rate would be?"


Thus is what he replied.

Quote: http://www.npr.org/blogs/goatsandso...iel-bausch-knows-the-ebola-virus-all-too-well


It's not going to be something where we get it down to a few percentage points; it's still going to be a very serious disease.

I remember this one patient, not in this outbreak but an outbreak in Uganda a few years ago. And we did have control of that ward and we were doing a little bit closer to kind of what we would think of as typical medical rounds back home, examining each patient, and able to gear our care to their needs each day to some degree. And this guy came in, he was a military guy, and his wife had just died of confirmed Ebola, and he came in right away saying, "I have a fever." A young, healthy guy.

I thought, OK, like, here's a guy, I know he's going to have the disease, I got him right at the beginning, and I have time now because the outbreak is somewhat controlled, and I'm really going to just really pay close attention to this guy and his fluid balance, and see if we can get him through.

I don't claim to be the world's best doctor, but I don't think I'm the world's worst either. He got great treatment. But he still died.

http://www.npr.org/blogs/goatsandso...iel-bausch-knows-the-ebola-virus-all-too-well

 

[Pathfinder]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

The last question I have is why no Zmapp? Since Mr. Duncan was hospitalized, two patients have been given Zmapp (one in Norway and one in Spain), but the Texas hospital said that they couldn't get any, there was none left.

Post#167:

Frieden said doses of the experimental medicine ZMapp were "all gone" and that the drug, produced by San Diego-based Mapp Biopharmaceutical, is "not going to be available anytime soon."

Asked about a second experimental drug, made by Canada's Tekmira Pharmaceuticals Corp, he said it "can be quite difficult for patients to take."

Frieden said the doctor and the patient's family would decide whether to use the drug, but if "they wanted to, they would have access to it."

"As far as we understand, experimental medicine is not being used," Frieden said. "It?s really up to his treating physicians, himself, his family what treatment to take."
...
http://www.reuters.com/article/2014/...0HT0MZ20141005

 

[Dani]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Yes, absolutely, we don't know nor will we ever know if getting Mr. Duncan into care earlier would have saved him. That was the whole point of my post from the 8th.

I'm just trying to figure out what the thinking processes were, so that if there is any lesson to be learned, we can learn it.

 

[Dani]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Post#167:

Frieden said doses of the experimental medicine ZMapp were "all gone" and that the drug, produced by San Diego-based Mapp Biopharmaceutical, is "not going to be available anytime soon."

Asked about a second experimental drug, made by Canada's Tekmira Pharmaceuticals Corp, he said it "can be quite difficult for patients to take."

Frieden said the doctor and the patient's family would decide whether to use the drug, but if "they wanted to, they would have access to it."

"As far as we understand, experimental medicine is not being used," Frieden said. "It’s really up to his treating physicians, himself, his family what treatment to take."
...
http://www.reuters.com/article/2014/...0HT0MZ20141005

My point is, the Zmapp was not all gone. Two people have received it since Mr. Duncan was diagnosed, one of them while he was still alive (Norway, Oct, 6th). Ms. Romero just got just got some in Spain. Also, Mr Duncan did receive an experimental antiviral after the date of that reuters article. So really what I'm asking is how the company distributes the zmapp, because Mr. Friedan's statements don't match up with what has happened with the zmapp.

 

[foxp3]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

To tackle the issues surrounding the experimental drugs.

Firstly ZMapp.
Europe may as you highlight have a few doses left. On another topic on this forum it was reported that the first Spanish priest used only one of the three doses, and Willism Pooley UK needed only 2 doses of his 3 doses as he didnt get sick ( think they even diluted his doses). These residual quantities of ZMapp belong to ECDC i.e. they belong to European Centre for Disease Control, and not America CDC. They were not sent for Dr Sacra either. If America had no more of their quota left, they cant then simply demand that Europe hands over the few doses they have left. These quotas were distributes a few months back. Europe must be allowed to give its residents its remaining doses ? I think Liberia may still have a few of its 9 doses left for HCWs. America doesnt have authority to Liberias quota either. I dont think it is unfair distribution , simply a case of America having used their quota.

The second experimental drug refused wasTKM- Ebola. A complicated drug as they described and I will try to explain why.

(I wrote about this on another forum so forgive me if you read it.) I don't have references to hand but look on manufactures website and it is all there.

So Tekmira Pharmaceuticals drug is called TKM-Ebola it was given to Dr Sacra intravenously for 7 days/ This drug is being developed by Tekmira.

Bit of history on this drug.

In a primate model TKM-EBOLA had been very successful, so next they went to humans.

Company began Phase 1 clinical trials to test safety, tolerability, and pharmacokinetics in healthy volunteers. However in June the trial raised concerns so was suspendedby the FDA.

The concerns were that dangerously high inflammatory cytokine elevation was observed at the highest dose. One subject had life threatning levels.

Without going too deep many drugs and vaccines are now trying to use a tactic where the active part is delivered inside artificial lipid vesicles. These lipids are designed to stimulate the immune response, and increase the uptake of the drug complex into host immune cells.

Problem is at higher doses the lipids can overstimulate cytokine production ( officially called lipid-amplified innate immune stimulation ).

One tactic to overcome this hyperactivation is to give the high dose drug, but to suppress the immune system a little while you are doing it. Other active development candidates by Tekmira using the same lipid system were conducted in trials in the presence of transient immune suppression with steroids. Steroids which dampen down some aspects of immune system, while leaving other parts intact.

Problem though, thus drug was for Ebola, what is the feasibility of steroid pre-treatment during an Ebola infection, I.e. do you really wanting to be suppressing the immune response early in this condition.

While the company were working on solutions to lift this FDA suspension, the Ebola epidemic was raging as was the ethical debate over use of experimental treatment. The company suddenly found thenselves part of this, and last month the FDA partially lifted the clinical hold on TMK, meaning it could be used in Ebola infected patients, but not healthy individuals. It was argued that Ebola patients were not likely to gave such vigorous cytokine responses, and would have lower functional white blood cells, so would not experience the dangerously high cytokine levels they healthy controls had.

Now Dr Sacra got TMK-EBOLA drug without the pre immunosuppression steroids. Their plan would have been to monitor his cytokine levels and interfere if cytokine storm became evident.

Now after his treatment we know 2 things happened. The Nebraska medical team stated the drug was complicated to use ( they didn't go on to use it again either in Mr Duncan, or in the cameraman they are currently treating), and secondly we know Dr Sacra ended up back in hospital.

Now the above are all facts anyone can look up on drugs website or on previous links on this forum..... but this next bit is my guess work and I could be wrong, I am just trying to tie the ,2 facts together.

One possibility is as they upped and upped dosage with Dr Sacra and his viral load decreasing , then probably a threshold was reached and his cytokines became too elevated. Perhaps he like the healthy clinical trial began to reach a possible cytokine storm. At this point they wouldn't have wanted to give steroids as it is too encompassing, i.e. a blanket immunosuppressent. Logically they probably decided instead to pick off on certain cytokines. One would have been TNFa which is central to cytokine storms. Anti TNF therapy ,( antibodies which bind and block TNF molecules) is used in patients with RA, ulcerative colitis etc. However anti TNF leaves the airways very open to infection as it is a cytokine essential for defence in that area.....pneumonia is a real concern, hence why Dr Sacra may have ended up back in hospital with a pretty bad chest infection.

This of course is only my opinion, and may not be the case, but TM- EBOLA they do claim is tricky to balance, so I wonder what experience they really had with it for them not to use it on their other patients.

Just my thoughts and sorry should be sticking to facts.

 

[Dani]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

To tackle the issues surrounding the experimental drugs.

Firstly ZMapp.
Europe may as you highlight have a few doses left. On another topic on this forum it was reported that the first Spanish priest used only one of the three doses, and Willism Pooley UK needed only 2 doses of his 3 doses as he didnt get sick. These residual quantities of ZMapp belong to ECDC i.e. belong to Europe Centre for Disease Control, and not America CDC. They were not sent for Dr Sacra either. I believe America had no more, and they cant then simply demand the few doses given to Europe. This quota was given out months ago, America cant simply have authority to take it from Europe. It is not unfair distribution as you implied, simply a case of America having used their quota.

I didn't imply that. What I said was that I wanted to know what the distribution of Zmapp was, as it was far from clear, and facts on the ground conflicted with what Dr. Friedan had said. I had never read about a quota, so thank you for that information.

 

[Emily]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

To tackle the issues surrounding the experimental drugs.

Firstly ZMapp.
Europe may as you highlight have a few doses left. On another topic on this forum it was reported that the first Spanish priest used only one of the three doses, and Willism Pooley UK needed only 2 doses of his 3 doses as he didnt get sick ( think they even diluted his doses). These residual quantities of ZMapp belong to ECDC i.e. they belong to European Centre for Disease Control, and not America CDC. They were not sent for Dr Sacra either. If America had no more of their quota left, they cant then simply demand that Europe hands over the few doses they have left. These quotas were distributes a few months back. Why in your post do you say this is unfair distribution. Why should Europe not be allowed to give its residents its remaining doses ? I think Liberia may still have a few of its 9 doses left for HCWs. Americas doesnt have authority to Liberias quota either. It is not unfair distribution as you implied, simply a case of America having used their quota.

The second experimental drug refused wasTKM- Ebola. A complicated drug as they described and I will try to explain why.

(I wrote about this on another forum so forgive me if you read it.) I don't have references to hand but look on manufactures website and it is all there.

So Tekmira Pharmaceuticals drug is called TKM-Ebola it was given to Dr Sacra intravenously for 7 days/ This drug is being developed by Tekmira.

Bit of history on this drug.

In a primate model TKM-EBOLA had been very successful, so next they went to humans.

Company began Phase 1 clinical trials to test safety, tolerability, and pharmacokinetics in healthy volunteers. However in June the trial raised concerns so was suspendedby the FDA.

The concerns were that dangerously high inflammatory cytokine elevation was observed at the highest dose. One subject had life threatning levels.

Without going too deep many drugs and vaccines are now trying to use a tactic where the active part is delivered inside artificial lipid vesicles. These lipids are designed to stimulate the immune response, and increase the uptake of the drug complex into host immune cells.

Problem is at higher doses the lipids can overstimulate cytokine production ( officially called lipid-amplified innate immune stimulation ).

One tactic to overcome this hyperactivation is to give the high dose drug, but to suppress the immune system a little while you are doing it. Other active development candidates by Tekmira using the same lipid system were conducted in trials in the presence of transient immune suppression with steroids. Steroids which dampen down some aspects of immune system, while leaving other parts intact.

Problem though, thus drug was for Ebola, what is the feasibility of steroid pre-treatment during an Ebola infection, I.e. do you really wanting to be suppressing the immune response early in this condition.

While the company were working on solutions to lift this FDA suspension, the Ebola epidemic was raging as was the ethical debate over use of experimental treatment. The company suddenly found thenselves part of this, and last month the FDA partially lifted the clinical hold on TMK, meaning it could be used in Ebola infected patients, but not healthy individuals. It was argued that Ebola patients were not likely to gave such vigorous cytokine responses, and would have lower functional white blood cells, so would not experience the dangerously high cytokine levels they healthy controls had.

Now Dr Sacra got TMK-EBOLA drug without the pre immunosuppression steroids. Their plan would have been to monitor his cytokine levels and interfere if cytokine storm became evident.

Now after his treatment we know 2 things happened. The Nebraska medical team stated the drug was complicated to use ( they didn't go on to use it again either in Mr Duncan, or in the cameraman they are currently treating), and secondly we know Dr Sacra ended up back in hospital.

Now the above are all facts anyone can look up on drugs website or on previous links on this forum..... but this next bit is my guess work and I could be wrong, I am just trying to tie the ,2 facts together.

One possibility is as they upped and upped dosage with Dr Sacra and his viral load decreasing , then probably a threshold was reached and his cytokines became too elevated. Perhaps he like the healthy clinical trial began to reach a possible cytokine storm. At this point they wouldn't have wanted to give steroids as it is too encompassing, i.e. a blanket immunosuppressent. Logically they probably decided instead to pick off on certain cytokines. One would have been TNFa which is central to cytokine storms. Anti TNF therapy ,( antibodies which bind and block TNF molecules) is used in patients with RA, ulcerative colitis etc. However anti TNF leaves the airways very open to infection as it is a cytokine essential for defence in that area.....pneumonia is a real concern, hence why Dr Sacra may have ended up back in hospital with a pretty bad chest infection.

This of course is only my opinion, and may not be the case, but TM- EBOLA they do claim is tricky to balance, so I wonder what experience they really had with it for them not to use it on their other patients.

Just my thoughts and sorry should be sticking to facts.

Thank you from me, too, fox3p. I got the impression a ZMapp supply had been distributed on a per country or region basis and that was the only way I could reconcile Dr. Friedan's statements with what has been happening.

Thanks, also, for the lipid-amplification discussion.

 

[foxp3]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Just like to say sorry to Dani for using the word " imply". Typed so quick didn't read over fully, can see how that word may have come out in the wrong context. Didn' t mean to say you were " implying it was unfair"......have changed the wording in my original post, hope no offence was taken.

Fp

 

[Dani]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Just like to say sorry to Dani for using the word " imply". Typed so quick didn't read over fully, can see how that word may have come out in the wrong context. Didn' t mean to say you were " implying it was unfair"......have changed the wording in my original post, hope no offence was taken.

Fp

No worries. Your post was very informative, thank you. I think a little speculation about treatment is also good, heaven knows I am doing it all the time!
I also hope more detailed information about the care of patients such as Dr. Sacra is published. I know that there are privacy concerns, but there is a lot to learn about this, and not much time in which to do it.

 

[Ray]

NYT on Dallas Case

NYT on Dallas Case

The handling of the first person found to have Ebola in the United States has raised questions over whether the country is prepared for an outbreak. Nearly a dozen federal, state and local government agencies, as well as several private entities, were involved in responding to the case in Dallas.

http://www.nytimes.com/interactive/...ed-for-an-ebola-outbreak.html?smid=tw-nytimes

 

[Dani]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

I did not know this- Nancy Writebol also was not diagnosed with Ebola and was sent home the first time she was seen for Ebola symptoms. And she worked in the Ebola treatment center! Ebola Survivor Originally Sent Home With Malaria Diagnosis.I'm feeling quite a bit more charitable toward the ER doctors at Texas Presbyterian, and their misdiagnosis of Thomas Duncan. The early signs must be very nonspecific, and they were blindsided by the first case, ever, diagnosed outside of Africa. Must remember that everything looks different through the retrospectoscope.

 

[BestlaStormcrow]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

I did not know this- Nancy Writebol also was not diagnosed with Ebola and was sent home the first time she was seen for Ebola symptoms. And she worked in the Ebola treatment center!

Which is what makes me cranky about the low-information media stream repeating the talking points about how our modern medical system will protect us from an African-scale outbreak. I know chances are that won't happen here, but not because of some magical power of first worldism.

Our health care system isn't really a system at all. It's a mosaic of people, infrstructure, funding, education, staffing, all dependent on local variables for effectiveness. Too many places for error to creep in.

 

[Dani]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Our health care system isn't really a system at all. It's a mosaic of people, infrstructure, funding, education, staffing, all dependent on local variables for effectiveness. Too many places for error to creep in.

Some people would say that's not a bug, it's a feature. This is a really huge country with a great deal of geographical, socioeconomic and cultural variation. I had a professor friend who teaches rural public health, and she had a Mary Engelbreit poster on the wall that said, We Don't Care How They Do It In New York." There's a lot of truth in that, when half of the state is not just considered rural but frontier. Which is also true of Texas, BTW- and yet they also have three of the country's ten largest cities and Texas alone is bigger than most foreign nations.

What works in a smaller, more homogenous nation may not work here. Which is not to say that we shouldn't try to streamline things, we sure should, but it is what it is for reasons that go way past just health care. It's always like herding cats when it comes to getting the US to do anything as a unified entity. And it will always be that way.

 

[JohnnyD]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

foxp3, Thank you for your very informative post. If I may ask, what is the other forum you post on? And may I use your post on another forum?

FWIW, the government is scrambling to find a "cocktail" that will control the cytokine storm. One company that may become a player is hemispherix, a company I follow (and invest in). Their drugs are now being tested in 6 bsl4 labs. Here is an abstract that was presented last week at 4th Congress on Virology. the last sentence being the most relevant.
---
William Mitchell
Vanderbilt University School of Medicine
USA.

Title: The Unique Role of TLR3 Agonists and Its Induced Products of Innate Immunity as Pharmaceutical Agents Efficacious Against Highly Lethal Emerging Viruses

Abstract:
The Toll-Like Receptors (TLRs) represent a family of class I transmembrane receptors that are elements of an ancient system of immune response to pathogen associated molecular patterns (PAMPs). TLR3 uses a unique non-MyD88 intracellular signaling pathway to induce innate immune responses including Type 1 interferons (IFN) with reduced inflammatory responses compared to the MyD88 pathway used by the other nine TLRs. The PAMP for TLR3 is dsRNA. Mis-matched base pairing configuration of the two RNA strands (rintatolimod) restricted binding to TLR3. Homologous dsRNA strand base pairing activates TLR3 and cytosolic helicases using the pro-inflammatory MyD88 pathway. Emerging human viral pathogens represent major potential hazards to human populations in which innate immune defenses of the host are compromised. Recent emerging viruses with high lethality in humans include the avian influenza viruses and the human coronoviruses. As example there are six known human coronoviruses (Hu-CoV), four of which are responsible for mild ?cold-like? symptoms. Two (MERS-CoV and SARS-CoV), however, have evolved an infectious advantage over the four mildly pathogenic human coronoviral species by inhibition of innate immune responses. Multiple components of MERS-CoV (M, ORF 4a/b, and ORF 5) inhibit the de novo production of a key component of innate immunity, interferon (IFN),that is an induction product of TLR3 activation. Data demonstrate that natural IFN (Alferon) as well as restricted activation of TLR3 by rintatolimod protect cells and/or animals from infection by emerging viral pathogens or cytokine storm associated pathology.

 

[Lizw]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Some people would say that's not a bug, it's a feature. This is a really huge country with a great deal of geographical, socioeconomic and cultural variation. I had a professor friend who teaches rural public health, and she had a Mary Engelbreit poster on the wall that said, We Don't Care How They Do It In New York." There's a lot of truth in that, when half of the state is not just considered rural but frontier. Which is also true of Texas, BTW- and yet they also have three of the country's ten largest cities and Texas alone is bigger than most foreign nations.

What works in a smaller, more homogenous nation may not work here. Which is not to say that we shouldn't try to streamline things, we sure should, but it is what it is for reasons that go way past just health care. It's always like herding cats when it comes to getting the US to do anything as a unified entity. And it will always be that way.

I agree. One problem with a strongly centralized system is that if there is a vulnerability that no one has noticed yet, all members of the system are equally at risk. Plus, the US has such geographical diversity that things which work in one place simply aren't feasible in another. I have friends in Texas who have to drive 20 miles to pick up their mail because the postal service refuses to deliver that far out. And friends in Idaho who can't get grid power or landline telephone service no matter how much they might be willing to pay, because the the utilities simply won't go to their pproperty. Thank God for solar power, and satellite phones and internet, in other words. They drive 100 miles once a month to do their grocedy shopping. These severe differences from one place to another dictate substantial differences in health care structure and delivery.

 

[AlaskaDenise]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

..... These severe differences from one place to another dictate substantial differences in health care structure and delivery.

WE have those same issues here, except add that our most remote communities use telemedicine where there is NO doctor.

.

 

[BestlaStormcrow]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

The variability isn't necessarily a bad thing, but it makes the Cracked.com/Buzzfeed type 'top 5 reasons not to worry about ebola' headlines misleading because there isn't some universal protocol being flawlessly carried out across the country.

If EVD were to start popping up in my area, some people would have access to facilities in the nearest big city, some would count on our smallish regional hospital, but many would wait until later stages of distress because they have no insurance and/or are undocumented immigrants, of which there are plenty since we are an agricultural area. And that's assuming the messaging even got to most people.

But from a population management standpoint, and at this level of EVD spread, it is better to have people remaining calm. I suppose uneven medical services is a bridge to cross if we get to that point.

 

[Lizw]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Undocumented immigrants are my biggest concern as well, given their fear of being identified as such. The situation is uncomfortably similar to that of tribal folk in West Africa who fear western medicine and governmental authority. I worry that it could result in families hiding sick relatives for fear of their own undocumented status being discovered.

 

[Emily]

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

Re: US - Texas: Patient tests positive for Ebola in Dallas - traveled from Liberia -deceased

http://www.nytimes.com/2014/10/12/us/ebola-victims-family-blames-hospital-and-state.html?_r=0

Ebola Victim?s Family Blames Hospital and State
By MANNY FERNANDEZ and JULIE BOSMANOCT. 11, 2014

Dr. Amesh A. Adalja, an infectious-diseases specialist and emergency-medicine expert at the University of Pittsburgh Medical Center who reviewed some of Mr. Duncan?s medical records at the request of The A.P., said that Mr. Duncan had not had a fever when he first arrived at the emergency room, but that he had complained of abdominal pain and a headache. About three and a half hours into his stay, his temperature reached 103 degrees, the highest reading during his four-hour visit.
...
?You have a person who arrived from Liberia in the last 21 days, who has abdominal pain and a headache and eventually exhibits a fever in the emergency department,? Dr. Adalja said. ?That?s clearly a constellation of findings that meets the criteria for Ebola. From the very start, Ebola should have been in the minds of all the health care providers.?

Based on his review of the medical records, Dr. Adalja said the diagnosis given to Mr. Duncan before his discharge included sinusitis, a sinus infection. But Dr. Adalja said that sinusitis rarely caused a fever as high as Mr. Duncan?s and did not cause abdominal pain, and that a CT scan of Mr. Duncan?s head showed no evidence of sinusitis...

They may have given him a CT scan since severe headache and vomiting can be a sign of a brain tumor. Then when that was not found and he developed the temperature, the sinusitis diagnosis was made.

Was malaria ruled out?

http://www.mayoclinic.org/diseases-conditions/malaria/basics/symptoms/con-20013734