Ebola Death: "It's Real Now"

Doctors who treated Ebola patient Thomas Eric Duncan, the 42-year-old Liberian man who died in Dallas Oct. 8, likely missed their window of opportunity.

“It’s hard to say exactly what happened, but they sent him home and he came back later—and with Ebola, the earlier the treatment, the better,” said Sanjey Gupta, MD, head of the emergency department at Franklin Hospital in Valley Stream, NY. His hospital, part of the North Shore-LIJ health system is making extensive preparations to avoid that happening. Catching cases before the infection rages out of control is key, he said.

Since all the drugs that show signs of efficacy are still experimental, and because Duncan did not respond to the one he got (brincidofovir/CMX-001/Chantix), according to Texas Health Presbyterian Hospital, his best hope for survival was likely in extensive but early supportive care, Gupta said.

Duncan got brincidofovir starting Oct. 4, the hospital said. The drug is a nucleotide analog meant to keep the virus’ RNA from replicating. Though still in clinical trials, the US Centers for Disease Control and Prevention has cleared it for emergency use in treating Ebola.

“It sounds like it was just too late,” Gupta said, adding that he had no personal knowledge of what happened in the case.

Duncan, who had traveled to the Dallas area to reunite with the mother of his son, contracted the virus in Liberia, apparently by helping transport a 19-year-old neighbor to a hospital there. The young woman died of Ebola.

Duncan became ill shortly after his Sept. 20 arrival in Texas, but when he sought treatment at Texas Health Presbyterian Hospital he got only outpatient care. On Sept 28 he was sick enough to be admitted to the hospital.

Reports of his death spread quickly, alarming both the general public and the physicians at hospitals already on high alert for possible outbreaks. That included Gupta, whose hospital is “a 10-minute ride from JFK International Airport.” It is the hospital where sick airline patients are sent, he said.

Additionally, the facility is near Queens County, which has a large population of people from West Africa and gets many visitors from that region, Gupta said.

On the afternoon of the day the world learned of Duncan’s death, Franklin Hospital was conducting an Ebola drill. An actor pretending to be a patient came into the emergency department (ED) so Gupta and others could evaluate whether admitting staff properly screened him.

“We told them early on it was just a drill, though,” Gupta said, “we didn’t want to cause a panic.”

Hospitals in New York have longed used that approach, said a spokesman for the Greater New York Hospital Association, in a variety of scenarios.

Gupta said the staff at Franklin did a good job, a proper travel history was taken—a key to finding visitors who may have been exposed to the deadly virus. Franklin has also stocked up on haz-mat suits and respirators, and other equipment needed to protect workers from the virus.

“Our concern level is up, and we have geared up,” Gupta said, and the death brought home the danger posed by Ebola. “It’s real now,” he said.