Ebola Survivor Helped by Fast Care and Small Virus Dose

By Kelly Gilblom and Robert Langreth  

Healhcare workers listen to Barbara Smith, RN, Mount Sinai Health Sysytems, as she... Read More

Related

• Nurse Amber Vinson on Ebola Virus Recovery

Dallas nurse Amber Vinson probably survived Ebola because she’s young and was wearing protective equipment that prevented her from getting a large dose of the deadly virus, doctors familiar with her care said.
Vinson, 29, yesterday become the second Dallas nurse discharged after a relatively short and uneventful hospital stay for the virus. She and 26-year-old Nina Pham were infected by Thomas Eric Duncan, a Liberian national they treated for the disease in a Dallas hospital. He died Oct. 8.
Vinson’s doctors said her young age, rapid diagnosis after onset of symptoms and the fact her gear partially protected her from Duncan’s bodily fluids all played a
role in her recovery from Ebola, a virus that has infected more than 10,000 people in West Africa.
“It’s likely the amount of virus she was exposed to was less than what we see in patients that get infected in less developed countries,” said Bruce Ribner, medical director of the serious communicable disease unit at Emory University Hospital in Atlanta, where Vinson was treated.

The Ebola Scourge

The amount of virus contracted by a person is thought to correlate to the severity of the illness, said Mark Rupp, chief of the infectious disease division at University of Nebraska Medical Center in Omaha.

Source: Akron Public Schools via Bloomberg

Amber Vinson graduated in 2003 from Firestone High School in Akron.

Immune System

“Because they were taking at least some degree of precautions they may have been inoculated with very small numbers of the virus,” Rupp said. Vinson’s immune system “may have been better able to defend itself.”
Eight people have completed treatment for Ebola in the U.S., and only Duncan has died. One additional patient, 33-year-old physician Craig Spencer, is in serious condition at Bellevue Hospital Center in New York City.
While the number of cases is small, the results suggest that treatment in a U.S. hospital offers a far higher survival rate than has been seen in Liberia, Guinea and Sierra Leone.
In West Africa, where about half of people infected die, patients face a dilapidated health-care infrastructure overwhelmed by the sheer number of infected. In the U.S., patients are closely monitored by large teams of doctors and nurses with the most up-to-date medical equipment.
The current standard of care involves replacing fluids and using antibiotics to fight off any secondary infections. While doctors on both continents follow this protocol, tight control of things like electrolytes -- minerals that help regulate blood pressure, muscle function and other functions -- can lead to better outcomes.

‘Huge Difference’

“We truly believe that there’s a huge difference in the supportive care that’s offered here in the United States and other developed countries, versus what they’re able to give in West Africa,” said Rupp, whose hospital has treated two Ebola patients.
“When patients get here from West Africa, they are very electrolyte-deficient,” Rupp said by telephone.
Doctors said that it’s impossible to tell with such a small sample size what is making a difference in treatment. It could be access to experimental medications or blood serum from survivors, which most of the U.S. patients have received.
It could also be early detection. Kathryn Jacobsen, an infectious disease epidemiologist at George Mason University, said that most Ebola patients in West Africa don’t get to a hospital until they have been ill for three or four days -- if they get to a hospital at all.

Already Weakened

“By the time they present to the hospital they are usually very dehydrated and very weak,” she said. “They really are in dire condition a lot of the time before they present to the hospital and they often have to travel some distance to get to an Ebola center.”
Once they get to the hospital they may still not get the kind of carefully monitored intravenous fluids that are standard in the U.S., she said.
Vinson and Pham were treated for Ebola shortly after their symptoms appeared. Duncan, the man they cared for, was initially sent away from Texas Health Presbyterian Hospital on Sept. 26, only to be brought back in an ambulance Sept. 28.
“There is a big difference between being able to be diagnosed right away and treated right away as far as we can tell,” Jacobsen said.
Genetics can also play a role in survival, according to Thomas Geisbert, a virologist at the University of Texas Medical Branch in Galveston.
Some studies of past outbreaks have suggested there were differences at the DNA level between people who survived and those who died, Geisbert said.