Nancy Writebol wanted barbecued chicken and fried okra instead of hospital food for dinner Friday, so her sons went out and got it, and had it passed to her isolation room in the special containment unit at Emory University Hospital.
Writebol, 59, is one of two American missionaries who contracted the Ebola virus while working at a hospital in Liberia. She was flown back to the United States on Aug. 5 strapped to a stretcher, receiving oxygen and encased head-to-toe in a white space suit meant to protect others from the deadly infection.
She has come a long way since then.
The other missionary, Dr. Kent Brantly, is also on the mend. On Friday, he sent out a statement saying that he was “recovering in every way.” But he added, “There are still a few hurdles to clear before I can be discharged.”
The care that Writebol and Brantly are receiving at Emory is expected to greatly improve their odds of recovery. And they are providing a rare opportunity to study the disease with extensive testing not available in Africa. Their doctors are hoping the scrutiny will yield information that could be used to help patients in Africa and reduce the high death rates there.
“We hope to learn a great deal from them,” said Dr. Bruce S. Ribner, who is leading the team of infectious disease specialists treating the two at Emory. “They may be asked, when they recover, to participate in additional testing. But the focus now is to help them survive.”
The medical team said they could not talk specifically about Writebol or Brantly because neither had given permission for medical details to be released. But the doctors were willing to speak generally about Ebola and its treatment. And Writebol’s sons, Jeremy, 35, and Brian, 33, talked about her.
They described their mother as a boisterous, spunky woman with an uncommon knack for engaging with other people and making them feel comfortable. The family is deeply religious, and Writebol and her husband, David, fulfilled a longstanding wish 15 years ago to become Christian missionaries in poor countries.
Writebol has no medical training, but when Ebola broke out in Liberia she volunteered to work with Brantly at ELWA Hospital in Monrovia, run by the missionary group SIM. She did not work in the Ebola ward, but when the doctor came out of the ward in full protective gear, she would spray him with disinfectant so that he could remove the gear without contaminating himself. She wore gloves and a mask to do this job, Jeremy said.
They have no idea how they became infected, Jeremy Writebol said. It could have been a mistake in their procedures, but he said they also thought they may have caught the disease from a co-worker who died shortly before they tested positive.
Writebol received the diagnosis July 26. Her husband was instructed to move out immediately and she was isolated in their house, with periodic visits from doctors. David Writebol often sat outside her window to talk and pray with her. Her early symptoms were fever, nausea, diarrhea and tremendous fatigue and weakness, Jeremy said. She was given intravenous fluids. As she became weaker, the family feared that she would die.
Jeremy said she told him Friday that the last daylight she remembered was the day before she got her test results.
“In her words, everything went dark from then until she was brought here and began to recover,” he said.
Her sons cannot enter her room, but can see her through a window and talk by telephone. Her husband has not seen her yet. He returned to the United States and voluntarily quarantined himself for the 21-day incubation period of the disease even though it was not medically necessary.
Emory’s containment unit is one of only four in the country designed to house patients with dangerous infectious diseases. Ribner said it was built 12 years ago at the request of the Centers for Disease Control and Prevention, which is less than a mile away. Officials from the CDC wanted a facility ready in case their scientists contracted dangerous infections in the lab or when deployed to outbreaks like the one in West Africa, Ribner said.
Before leaving Liberia, both Writebol and Brantly began receiving the experimental treatment ZMapp, a mixture of antibodies, but it is not clear whether that has played a role in their recovery.
Ribner said the key to treating Ebola patients was supportive care - things like stabilizing blood pressure and pulse, maintaining the body’s balance of fluids and salts and giving transfusions if needed. He said the idea was to keep patients alive long enough to allow their own immune systems to kick in and fight off the virus, which begins to happen two or three weeks into the illness.
Before the body can defend itself, the virus attacks blood vessels and internal organs, Ribner said. The damage to vessels can lead to the bleeding for which the disease is notorious, though it occurs in only about half of patients and is not as profuse as is sometimes reported. The infection also touches off inflammation that can harm the patient. But much of this damage seems to be reversible, Ribner said.
One of the most dangerous symptoms is severe diarrhea, comparable to what occurs in cholera, Ribner said. The result is an enormous loss of fluids and electrolytes like potassium and magnesium, which can shut down the kidneys and play havoc with heart rhythm. How the virus causes such diarrhea is not understood, he said.
“Patients lose a lot of potassium,” he said. “I don’t think our colleagues realize how much.”
Doctors in Africa may not be aware of the severity of the electrolyte loss, he said, because hospitals there do not have the equipment to measure it. But he said that if doctors could be informed, they might be able to modify treatments to cope with the problem, even without the ability to monitor it.
It is not clear when Writebol and Brantly will be well enough to leave the hospital. Lab tests will be used to make sure they are no longer contagious. Some research has suggested that the virus may persist in semen and vaginal fluid for weeks or maybe even a month or two after a person has recovered. But the data is not clear.
People who recover from Ebola become immune to it, but only to the type they had, said Pierre Rollin, an epidemiologist at the Centers for Disease Control and Prevention. There are five types of Ebola virus.
The plight of the two missionaries helped draw attention to a deadly outbreak that had been spreading for months in West Africa without much awareness in the rest of the world. Jeremy and Brian Writebol said they and their mother wondered whether her illness might have been part of a divine plan.
“Maybe God brought suffering to our family,” Jeremy said, “to use it, we hope, to help thousands of others.”