On Thursday, Dr. Kent Brantly thought he was going to die. It was the ninth day since the American missionary worker came down sick with Ebola in Liberia.
His condition worsening by the minute, Brantly called his wife to say goodbye.
Thankfully, the call was premature.
Brantly is back on his
feet -- literally -- after receiving a last-ditch, highly experimental
drug. Another American missionary with Ebola got the same.
Brantly's and Nancy
Writebol's conditions significantly improved after receiving the
medication, sources say. Brantly was able to walk into Emory University
Hospital in Atlanta after being evacuated to the United States last
week, and Writebol is expected to arrive in Atlanta on Tuesday.
On July 22, Brantly woke up feeling feverish. Fearing the worst, Brantly immediately isolated himself. Writebol's
symptoms started three days later.
A rapid field blood test confirmed
the infection in both of them after they had become ill with fever,
vomiting and diarrhea.
It's believed Brantly and
Writebol, who worked with the aid organization Samaritan's Purse,
contracted Ebola from another health care worker at their hospital in
Liberia, although the official Centers for Disease Control and
Prevention case investigation has yet to be released.
The experimental drug,
known as ZMapp, was developed by the biotech firm Mapp Biopharmaceutical
Inc., which is based in San Diego.
The patients were told that the
treatment had never been tried before in a human being but had shown
promise in small experiments with monkeys.
According to company documents, four monkeys infected with Ebola survived
after being given the therapy within 24 hours after infection.
Two of
four other monkeys that started therapy within 48 hours after infection
also survived. One monkey that was not treated died within five days of
exposure to the virus.
Brantly and Writebol
were aware of the risk of taking a new, little-understood treatment and
gave informed consent, according to two sources familiar with the care
of the missionary workers. In the monkeys, the experimental serum had
been given within 48 hours of infection. Brantly didn't receive it until
he'd been sick for nine days.
The medicine is a
three-mouse monoclonal antibody, meaning that mice were exposed to
fragments of the Ebola virus and then the antibodies generated within
the mice's blood were harvested to create the medicine. It works by
preventing the virus from entering and infecting new cells.
The Ebola virus causes
viral hemorrhagic fever, which refers to a group of viruses that affect
multiple organ systems in the body and are often accompanied by
bleeding.
Early symptoms include
sudden onset of fever, weakness, muscle pain, headaches and a sore
throat. They later progress to vomiting, diarrhea, impaired kidney and
liver function -- and sometimes internal and external bleeding.
The ZMapp vials, stored
at subzero temperatures, reached the hospital in Liberia where Brantly
and Writebol were being treated Thursday morning.
Doctors were
instructed to allow the serum to thaw naturally without any additional
heat. It was expected that it would be eight to 10 hours before the
medicine could be given, according to a source familiar with the
process.
Brantly asked that
Writebol be given the first dose because he was younger and he thought
he had a better chance of fighting it, and she agreed. However, as the
first vial was still thawing, Brantly's condition took a sudden turn for
the worse.
Brantly began to
deteriorate and developed labored breathing. He told his doctors he
thought he was dying, according to a source with firsthand knowledge of
the situation.
Knowing his dose was
still frozen, Brantly asked if he could have Writebol's now-thawed
medication. It was brought to his room and administered through an IV.
Within an hour of receiving the medication, Brantly's condition
dramatically improved.
He began breathing easier; the rash over his
trunk faded away. One of his doctors described the events as
"miraculous."
By the next morning,
Brantly was able to take a shower on his own before getting on a
specially designed Gulfstream air ambulance jet to be evacuated to the
United States.
Writebol also received a
vial of the medication. Her response was not as remarkable, according
to sources familiar with the treatment. However, doctors on Sunday
administered Writebol a second dose of the medication, which resulted in
significant improvement.
She was stable enough to be evacuated back to the United States.
The process by which the medication was made available to Brantly and Writebol is highly unusual.
World Health
Organization spokesman Gregory Hartl cautioned that health authorities
"cannot start using untested drugs in the middle of an outbreak, for
various reasons."
Doctors Without Borders similarly weighed in on the side of caution.
"It is important to keep
in mind that a large-scale provision of treatments and vaccines that
are in very early stages of development has a series of scientific and
ethical implications," the organization said in a statement.
"As doctors, trying an
untested drug on patients is a very difficult choice since our first
priority is to do no harm, and we would not be sure that the
experimental treatment would do more harm than good."
ZMapp has not been
approved for human use and has not even gone through the clinical trial
process, which is standard to prove the safety and efficacy of a
medication. It may have been given under the U.S. Food and Drug
Administration's "compassionate use" regulation, which allows access to investigational drugs outside clinical trials.
Getting approval for
compassionate use is often long and laborious, but in the case of
Brantly and Writebol, they received the medication within seven to 10
days of their exposure to the Ebola virus.
On July 30, the Defense Threat Reduction Agency, an arm of the military responsible for any chemical, biological, radiological, nuclear and high-yield explosive threats, allotted additional funding to MAPP Biopharmaceutical due to "promising results."
CNN
