Ebola almost killed Nancy Writebol in July and she also made her famous, which helped broadcast to the world the need to respond more aggressively to what had grown from a small outbreak in an epidemic out of control.
Writebol, an associate clinical nurse, fell ill with the disease while working for the SIM missionary group in Monrovia. She and her husband David talked with Science September 24 on a subject that has not received much attention: How health workers who are trained to protect nevertheless be infected Ebola? The Writebols also discuss how the epidemic has grown into an epidemic and the treatment she received both Liberia and then to the hospital of Emory University in Atlanta. Questions and answers have been written for clarity and conciseness
Q:.? Any idea how you became infected
NW: I do not know know how I became infected and how I contracted. There are some thoughts on how I could have gotten it. Nobody really knows, least of all me. I felt as dangerous and I felt like I walked into a situation where I was exposed. I was on the weak side risk things. I was never in crisis or Ebola center. I was always outside. I made sure the doctors and nurses were dressed properly before going, and I decontaminated before going out. We kept close control of each other to find out if people felt safe.
We had an employee who did the same job I was doing. He got sick and I did not know he was sick. He has not told anyone. He actually thought he had typhoid. The day I started having symptoms at least a fever, was the last day I saw him. It has Ebola. He did not survive.
I never remember to touch, but it's possible he could have picked up a spray to decontaminate someone, I would have picked up the sprayer. Or we hit the same. I have touched
Q:.? You have been educated about the transmission of Ebola virus
NW :. Oh my God, yes
Q: Do you have sufficient personal protective equipment (PPE)
NW: Yes, we did. It was my responsibility to make sure they were dressed properly before they entered EPI isolation. I did not want one of our doctors or nurses to be infected. I mean, I saw people dying of Ebola virus. We had and have followed every single protocol PPE [Doctors Without Borders (MSF)] had in their manual and had been trained by MSF
Q :. Do you wear PPE in your work, disinfection of doctors and nurses?
N.W :. gloves No, I was wearing and a disposable apron. There were times when I wore a mask. I was behind a line where I was disinfecting. They were on one side of a line and was on the other side. I crossed those lines. We have not even an idea of what happened.
I've often wondered if I was back there now, having lived the experience, what I would do differently. The only thing is that I was taking temperatures of family members coming to see patients. I had to turn anyone away because they had a temperature, but it is possible that I might have been in contact with someone outside who had Ebola and perhaps shaken a hand? Although we are not really shake hands with everyone. Most people are afraid of ourselves. They felt like to be involved with Ebola, you
Q:.? On what date did you start feeling symptoms
NW: Tuesday, July 22. This afternoon I started to run a fever. I felt as if I had malaria. I contacted a SIM doctor. We did a test of malaria and it was positive. I had drugs against malaria at home, and I went home and I stayed at home. I was weak. I had headache. Had a fever. These are my symptoms. I took medicine against malaria, but was simply shaking fever at all. On Saturday, our doctor came and she said, "We'll just do the Ebola test to relieve everyone" I just still thinking malaria They made another test of malaria and it showed negative, because.. . I had taken the drug Then they made the Ebola test Saturday morning and Saturday night the results came back positive I
. Q: Do you think that you confused with malaria, Ebola
NW: I did that I tested positive for it
Q...? Qu 'is what happened next
NW :. They left me at home for the next 10 days
Q: is it David
NW:.. Yes it's just the grace of God that David did not come down with Ebola for all four days they thought that it was just malaria, David did the cooking in our house. I did not feel well. We were still sharing our room. Our doctor was exposed and she dined with us at night, she said that I had Ebola. I had malaria once this year. I knew how he felt and he was so similar
D.W: .. They isolated me after that. For a few days I went to see Nancy in PEP. Our home became a segregation unit. Then they said, "We can not let you do that anymore because you can not return to the United States by commercial aviation." They kept me away
NW :. Luckily there was a window near where my bed was, and David could stand outside and talk to me
Q:.? David, did you check your temperature every few hours
DW: Yep. I am close to 99.2 ° [37.3°C], but I realized after taking my temperature I had to have a cup of coffee
Q:.? What happened with Kent Brantly
NW: I got sick 22 and 23. Kent Kent was actually much sicker to begin with, and then I took a turn for the worse. Kent was released on Saturday, August 2. I went 4.
Q: You and Kent Brantly both received zmapp. Do you think it helped
N.W:. is given at three different times. I have had two doses of Liberia, and the third at Emory. I do not know what I can say when I was given the zmapp it made a huge difference in how I felt. I think I'm very, very, very sick, very sick. I'm not saying it did not help, I think he had some advantage to it, but it was not this big, dramatic "I had this zmapp and now I can sit down and take a shower."
they give zmapp via IV and give slowly, then rotate it a bit. When they turned up on me, my hands started itching terribly and then they turned back down, so I would not have a reaction. It's the only thing I remember the zmapp
Q:.? Were you very sick when you left Liberia
NW: I don 'know if I would survive the flight
DW :. I do not know either. She had to be carried in the aircraft. She did not walk or walk off
N.W: .. I was in the PPE entire trip back. And I am dehydrated. They had a terrible time in Liberia to find a vein in which to run fluid. At one point, they decided to try to get an IV into the bone. This was very painful. They do not really know what happened, if the slope of the needle when he entered in the bone, but once they have tried to push the fluid, it was awful and they decided to stop. When I arrived at Emory they just put a central line in
Q:.? Did you go back and work in an Ebola treatment unit
NW: I did some reading on this issue and spoke Emory doctors about it. My doctors at Emory are not sure how long the immunity would last. It has not been studied. I read that even if a survivor was willing and able to assist in the management of patients Ebola, because there are so many strains of Ebola, it would still be wise and necessary to operate and not PPE only guess you are. immune
Q: What do you think of your own role in this epidemic and the fact that it was not until you get sick and Kent Brantly that the world began to take notice that something was seriously amiss
NW: never in my life would I have dreamed that it would happen. We had been in Liberia for a year and had a doctor come into the country in March or April, which established a graph of other calendars Ebola and how the disease had gone along the Congo and Uganda, and how it was just that little balance disease its way along and spikes and peaks again and grows into a fungus. He covered when Liberia was on this graph. He made the observation that we had not yet seen the worst
D.W: .. People have calmed down and found. In early June, Monrovia began receiving multiple cases of Foya [a town in the north that borders both Sierra Leone and Guinea, the two other hard-hit countries]
N.W: .. We had not started to hit the fungus at all. And then the Samaritan's Purse had an epidemiologist who came into the country who sat with us and said: "I went to Foya. You have not seen the end of this. It will hurt "
DW: .. All along, we were concerned that there was not a broader response is the publicity that was generated. . from Nancy's story and Dr. Brantly who woke things it was amazing
. Q:? You knew he was madly out of control
NW. I never have predicted the WHO figures [the World Health Organization] and CDC [the Centers for Disease Control and Prevention] now predict I looked at it and thought, "Oh my God"; we had no idea he was going to that extent talk about one half million in Liberia
Q...? What do you think of the media coverage of zmapp
DW: Initially, it seemed a bit sensational: this is the magic formula is what they do, they gravitate towards that, but they also declined this and had a more balanced approach.. It is promising, but do not put too much hope in it until further studies are done
NW: .. I think they understand, too, nobody really knows how much it helped. Because there were so many other things that play into it. There was blood transfusions. The other care given to us
Q:.? Have you had a blood transfusion
N.W :. I did. I have had blood transfusions in Liberia and Emory. Neither was the convalescent serum, however. There was not a match
Q:.? How is your health now
N.W :. I recovered. I regain my strength. When I left Emory, I could barely walk up steps at all. I have some neuropathy in my feet. While at Emory was atrocious. They could not even put bed sheets or blankets on my toes. It's much better.
I wear easily. And of course, there's just the emotional side of it. I was working on it from the case on June 11, the first patient we had, to July 22, and I saw about 40 people and we saw a survivor during that time period. To watch the rest of these people die was difficult. I dealt with some of their families and try to encourage them and pray with them. To watch families watching their loved ones die, which is difficult, too.
For a story on the risk of infection with Ebola virus for health workers here.
* Ebola files: Given the current Ebola outbreak unprecedented in terms of the number of people killed and the rapid geographic spread, science and science Translational Medicine made a collection of research articles and news on the viral disease available for researchers and the general public.
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