Monday, August 4, 2014

Ebola and Its Viral Predecessor

Ebola, the deadly viral disease that is now striking people in at least three or more West African countries, may have reached the New York City area via a passenger on a flight from there. Authorities in that city, as well as the hospital where he is currently being evaluated, are assuring citizens that there is little concern the disease will spread, if the  man has it.  At last report, he had at least two of the symptoms that are generally seen in affected persons, high fever and G.I. symptoms. That's as much as we know.

One truly interesting example of how medical research can be pushed to utilize current vaccines being tested in animal models has been seen in the two persons who have been brought back to the United States from Africa and who received an experimental serum.  The serum, which was developed by a California company, had proven to be incredibly effective in monkeys and, since the disease in humans is nearly 100 percent fatal, there seemed to be no choice but to take a chance.

The physicians had to use the serum on moral grounds even if it contradicted the usual medical protocol of animal model, phase 1 (healthy humans without the disease), phase 2 (persons with the disease receive either the serum or a placebo), phase 3 (all persons with the disease receive the serum).  The likelihood that a life or, in fact, two lives here, could be saved left the medical teams no recourse.  It had to be used. We now know that a Liberian physician who was treating Ebola patients has died and another prominent physician in Sierra Leone has been infected.

Reports coming out of Emory University Hospital indicate that the serum appears to be working very fast and both patients are improving.  This is a very encouraging sign and it may mean that there is hope for the persons in West Africa who are currently affected by the disease.

Highly contagious and transmittable diseases are quite frightening, even if you are a medical professional and have to deal with one of these patients on any level.  I know because I  once worked had a psychiatric hospital when we received a call from a local medical facility that wanted us to come and do an evaluation on a patient in the ER.  The patient in question had AIDS. It was a disease that made everyone uneasy and near panic was certainly in the air.

During the late 1980s,  the very mention of AIDS struck fear into the hearts of anyone who thought they might come into contact with an infected person.   Remember what happened to Ryan White? The boy had to leave school because parents thought that their children might catch the disease from just sitting near him.  Of course, that isn't the way the virus is transmitted, but information was scant and fear was rampant. Today, more than 35 million people are living with AIDS all over the globe. It was a death sentence but it's not any longer because of new medical treatments.

I was part of the team that was sent to the ER and, when we walked in, we were confronted by a young man in an orange jumpsuit who was strapped to a gurney.  He was completely coherent and concerned that he might die and he wanted to see his mother.  A call was placed and she did come, but she was so afraid that she might catch AIDS from the tears that were flowing from his eyes, that she wouldn't touch him without wearing rubber gloves.  The evaluation was completed and he was sent to our hospital.

Once he arrived at the hospital, the staff was just as frightened of catching the disease as his mother had been and one bedroom was quickly cleared of everything but a bed with a desk barring the door so that no one could enter.  He was not permitted to come out of his room and, in fact, when he requested a television the electricians went to the outside of the building and ran a special line through a Chamberlain screen for his TV.  They refused to enter the room.  A nursing aide was stationed at the desk in the doorway and made notes on the patient's behavior every half-hour.  This went on for two weeks.

The psychological trauma to that young man must have been compounded by the fear of the staff and the isolation that he was put in.  He had no one to speak to, no phone, all his meals were slid across the desk to him and no one entered his room.  Even physicians and psychiatrists were not entering the room and wanted him to keep a distance from the doorway when they spoke to him.

There was no need for psychiatric treatment at that point and he was transferred back to the local community jail where he had been taken for some type of minor criminal offense initially.  I don't know what happened to him once he went back to jail because we never heard.  I think the staff quietly said a prayer of thanks that he didn't come back to us. I've never seen so much Clorox used to clean a room as I did when he left.

Years have passed and the incredible advances that have been made in treatments for AIDS patients are encouraging, especially in light of this latest challenge with Ebola.  If the serum does work as well as it seems to be working now, perhaps we will have reached a new milestone in medical research but it only happened because someone would surely have died if they didn't receive the serum.  Morality won out here and all of us are the better for it.