Suddenly Lance knew what he would do. As he would explain it later, “God gave me an overwhelming peace, and I decided to split the dose.” He would break all the rules. He had already broken triage by deciding to give the drug to Nancy, and now he would divide the drug between the two patients. He would do everything the inventors of the drug had told him not to do. He had made his choice, and this time it was final. “Kent, I’m going to give you the antibodies,” he said.
“Okay,” Kent answered.
There was a problem. All three doses of the drug were half a mile away, and Kent was now actively dying. Two of the doses were frozen rock hard, sitting inside the foam cooler on Nancy Writebol’s porch. And one bottle was in Nancy’s room and might already be in her bloodstream.
Plyler got into his truck and drove it wildly half a mile down the road, and skidded to a stop by Nancy Writebol’s house. He jumped out, opened the cooler, and took out a bottle of ZMapp. It was frozen solid. He stuffed it in his armpit, held it there for a short while, and took it out. It showed no sign of defrosting. It was a useless lump of ice. Kent was dying.
Lance went to Nancy’s window and asked Dr. Deborah Eisenhut to bring Nancy’s dose to him. The doctor took the bottle out of Nancy’s bedding, sterilized the outside of the bottle with bleach water, put it into triple bags, sterilized the bags, and then handed it to Lance through the front door of the house. He traded the bottle for a solidly frozen bottle from the cooler. The frozen bottle was placed in Nancy’s bedding, where it began to slowly thaw.
Plyler jumped into his truck, tucked the bagged, half-frozen bottle into his armpit, and drove at high speed back to Kent’s house, praying that the drug would melt in time.
He arrived at Kent’s house, ran to the window—Kent was still alive. He took the drug out of his armpit and saw that it had melted. He handed it through the door to Dr. Linda Mobula. The time was 7:20 p.m. The sun had set, and the sky was growing dark.
Simultaneously
Night had almost arrived, and fast-moving clouds darkened the grounds of the Kenema hospital. The gravediggers had finished their work. Humarr Khan’s pallbearers, dressed in moon suits, passed straps underneath Khan’s casket and lowered it into the grave, leaning backward against the straps to brace themselves against the weight of the casket. A handful of people stood watching. One of them was Nadia Wauquier, the French scientist who had been testing blood, and who had enjoyed smoking cigarettes with Khan as they chatted in her office. She watched the pallbearers take off their biohazard suits and toss them into Khan’s grave, the standard gesture of farewell to an Ebola victim. The gravediggers began shoveling dirt back into the hole over the suits. Afterward, Nadia suited up and entered the Hot Lab, and resumed testing blood.
ELWA HOSPITAL
Thirty minutes later, shortly before 8 p.m., July 31
While Lance Plyler watched through the window, Dr. Mobula filled an infusion bag with 750 milliliters of Ringer’s solution, broke the bottle’s wax seal, unscrewed the top, drew up the drug in a syringe, and injected it into the saline bag. They prayed, and Lance sent a text to Lisa Hensley, telling her that he was splitting the drug between the two patients, and he was about to give one of the doses to Kent Brantly. Nancy would get a dose as soon as it was defrosted. “About to start,” he texted.
Dr. Mobula set the infusion to a slow drip, and started it running. The time was 8:00 p.m. Kent Brantly had become Experiment Number One, the first human to receive ZMapp. The drip would run for most of the night while the dose of the drug built up slowly in Brantly’s bloodstream. But just a minute or two after the drug began hitting his bloodstream, he began shaking. As an Ebola patient dies, the person’s body can convulse. Brantly began to shake violently.
Plyler diagnosed it as a form of shivering called rigors. “That’s just the antibodies kicking butt on the virus,” he said to Brantly, speaking through the crack in the window.
It may have been shivering, or it may have been the agonal stage of death from Ebola infection, the moment when the person dies with shaking or tremors. Brantly’s shivering continued, while Dr. Mobula reported that his temperature had started to drop. In fifteen minutes it fell from 105 down to 100—from fatal range down to a mild fever. The shaking went on for half an hour, gradually decreasing, and finally it stopped. It was now thirty minutes after the drug had started entering his bloodstream. Brantly sat up in bed. Just then, Plyler put his phone up against the screen in the window and took a picture of Brantly—his mouth is open, his eyes are sunken and half closed, but he looks very much alive.
At nine o’clock, Kent said that he wanted to visit the bathroom. He hadn’t been able to get out of bed for a day and a half, and had been completely incontinent. He got out of bed and walked to the bathroom, while Dr. Mobula supported him and managed his IV pole. He said he was feeling a little better. Slightly more than an hour had passed since the drip had been started. By then, only about 12 percent of the first dose had gone into his bloodstream.
At 9:09 p.m., while Brantly was in the bathroom, Lance Plyler sent a text to Lisa Hensley: “Honestly, he looks distinctly better already. Is that possible?”
She replied hastily. “Gary [Kobinger] said they see changes [in the treated monkeys] within hours. They may look better but then seem to slip a bit. Yes it is possible.”
Lance Plyler stayed by Kent Brantly’s window all night, praying with him at intervals, and he watched Brantly get steadily better as the hours went by.
In fact, what had happened to Kent Brantly was a medical miracle. The drug clearly had saved Brantly’s life. There are no two ways about it, either. ZMapp had hammered Ebola in Brantly’s body. It had started killing the swarm of particles in his body only minutes after the first drops of the drug hit his bloodstream. The idea that any drug could wipe out an Ebola infection in about ninety minutes, or that a drug could rip a person out of an Ebola crash at the very moment the person’s body is shaking in death throes, seems like a fictional scene in a screenplay, something that reality would never invent. But there it is. At least in Kent Brantly, who was Experiment Number One, the drug was a true angel’s sword, and it tore the heart out of the virus. As this is being written, exactly what ZMapp did to Ebola inside Kent Brantly is still a mystery, but whatever happened, it wasn’t pretty for Ebola. In a larger sense, though, the drug opened a window into the future. Drugs like ZMapp could put down a biological weapon or stop any emerging natural virus. ZMapp was a crude version of sharper swords that are already being developed and tested. The drug also—maybe—lived up to Larry Zeitlin’s original idea (which he got while he was collecting unemployment) that if you could design a drug that would defeat Ebola, you could pretty much kick the shit out of all kinds of viruses.
At ten o’clock that night, Dr. Deborah Eisenhut placed a needle in Nancy Writebol’s hip bone and started an infusion of ZMapp straight into the bone. The veins in her arms had gotten soft and fragile, and an infusion needle would have broken the vein and started a hemorrhage. Soon after the drug started hitting her bloodstream, she got terrible itching in her hands. It was probably an allergic reaction. She did not improve noticeably as the drug built up overnight in her bloodstream, though she remained alive. That in itself may have been something of a miracle.
Lisa Hensley stayed awake in her hotel room, monitoring the developments. When she was sure that both patients had started receiving ZMapp, she sent a text to Lance Plyler telling him she’d been recalled to the United States. She didn’t tell him why.
* * *
—
Kent Brantly was carried to Monrovia’s international airport in the back of a pickup truck and was placed inside the biocontainment capsule in the Phoenix Air jet, and it took off. When it landed in Atlanta, Brantly walked off the jet, wearing a moon suit, and he was rushed by ambulance to Emory University Hospital and placed in a high-level biocontainment ICU. Three bottles of ZMapp had be
en delivered to the hospital, having been rushed there from Kentucky BioProcessing. As soon as Brantly was inside the biocontainment ICU, a staff of four infectious disease doctors and twenty-one nurses started working on him. ZMapp may have saved his life in a few minutes, but he wasn’t well yet, and his life wasn’t going to stay saved without an excellent medical team and the world’s best medical technology. He arrived at Emory Hospital on August 2.
TERROR
KENEMA GOVERNMENT HOSPITAL
Saturday, August 2, 2014
Humarr Khan had been dead for four days. By now, eight of the Ebola nurses were dead, and the surviving nurses were traumatized. Most couldn’t go into the Ebola wards anymore, but there were sixty to seventy Ebola patients distributed among the wards, and the number of patients was growing. Some Kenema staff did continue to work, including Nurse Nancy Yoko, who had prepared Auntie’s body for burial.
The World Health Organization continued to send doctors to Kenema to try to stabilize the hospital. One of them was John Schieffelin, a pediatrician at Tulane University School of Medicine. He signed up for a three-week tour of duty at Kenema Government Hospital. His pay was one dollar, with twenty-five cents deducted from it to cover administrative costs. Schieffelin had never seen an Ebola patient, had never worn PPE. A Land Cruiser dropped him at the hospital, and he stood in front of the Annexe ward believing that there was a good chance he would never see his family again.
A British doctor named Catherine Houlihan briefed Schieffelin, showed him how to put on PPE, and together they walked into an Omaha Beach of medicine.
The ward was in horrifying chaos. It officially had seventeen beds, but there were about thirty Ebola patients in the ward. There were whole families with Ebola in the ward. Disoriented, infected patients were wandering about. Patients were moving themselves from bed to bed, choosing to lie in beds that seemed cleaner. Sick parents came into the ward, bringing their uninfected children with them, because villages were refusing to take in the children of Ebola-infected parents. Schieffelin and the other WHO doctors didn’t know what to do with these healthy children, and they put them in wards where people were less sick and hadn’t yet tested positive for Ebola. It wasn’t the best thing for the children, but Schieffelin’s only other choice was to put them in wards where patients were in late-stage Ebola and were even more infective. “Did we make mistakes? Absolutely, we did. We were just trying to survive, trying to do the best we could, and we were treading water,” he said.
Nurse Nancy Yoko worked in the ward for as many hours as she could, but at night there was often no medical staff in the ward. In the mornings Nancy Yoko and the WHO doctors would remove a few corpses, often from the toilets, and leave them by the Ebola ward. Not long after Schieffelin arrived, the Kenema wards had a hundred Ebola patients in them, and Schieffelin and his colleagues thought about closing down the Kenema Ebola wards, to quell the chaos. They realized, though, that if the wards were shut down, infected people would end up at home being cared for by family members, and the virus would continue to spread and more people would die. They had to keep the Kenema wards open in order to draw Ebola-infected people out of the community and keep them in one place.
John Schieffelin had previously worked in the Lassa research program as a pediatrician, and he knew many of the Ebola nurses. When he arrived, he found his friends Mohamed Yillah and Nurse Alice Kovoma in the Ebola ward—they had been carried by ambulance from the Doctors’ camp to the Kenema hospital. On the day he arrived, he examined Yillah and saw that his case was fatal: He had hiccups and he was urinating and defecating blood. Schieffelin broke the rules of triage and did everything he could to help Yillah, even though there was no hope. In the same way, he worked on Alice Kovoma, though there was little hope for her. She would die in his care. Mainly, though, Schieffelin focused his efforts on children and young adults. He was a pediatrician, after all. “We all had one or two patients that we took care of when they first arrived,” Schieffelin said. “For whatever reason, we put our heart and soul into those patients. Most of them didn’t make it.”
Rob Fowler, a Canadian WHO doctor, was working in the Kenema wards, covering thirty to forty Ebola patients by himself. “As soon as I walked into my treatment area in the morning, I met people in bed calling out for things,” Fowler recalled. “I was asking myself, ‘Whose bed do I go to first?’ To the three-year-old who’s comatose? To the thirty-year-old woman who’s speaking the loudest? If I go to someone’s bed first, five other people are saying, ‘Doctor, Doctor! Please!’ If I hang a liter of fluid, six other people are asking for the same thing. I have a hard time talking about it.”
Schieffelin began to notice that the Ebola patients in the Kenema wards were forming themselves into a kind of community. With very few doctors and nurses around to help them, they began to help themselves. The community of Ebola patients developed leaders, younger people who had survived and were recovering. They began helping out with nursing tasks on the ward.
John Schieffelin had been caring for Mohamed Yillah, and to his complete surprise he perceived that Yillah was getting better. His hemorrhaging stopped, his hiccups stopped, and his fever tapered off. Somehow his immune system had fought off the virus. Yillah’s survival is a mystery—he hadn’t worn PPE while he cared for Auntie, and he’d had massive exposures to the virus. On August 9 the Hot Lab reported that Yillah’s blood was negative for Ebola, and he went home to the family compound on the slopes of the Kambui Hills. Yillah had always been a thin man, and now he was a human skeleton. He walked into his house with a smile, and said to his mother, Kadie, “It’s all over, I’ve tested negative.”
She didn’t believe it. This was exactly what he’d said to her the last time, those exact same words, that it was all over, he’d tested negative, just before he’d gone off to the Doctors’ camp to die.
He wrapped his arms around his mother to prove he was negative. She knew he wouldn’t do that if he were positive.
A few months later, Mohamed Yillah and I were sitting in a quiet spot on the grounds of Kenema Government Hospital. He was an extremely thin man, well over six feet tall, with a restrained, thoughtful manner. He seemed wrapped in a dreamlike haze of trauma. He looked to be in his seventies. He was forty-seven. He said that he couldn’t remember some of the horror he’d experienced. He spoke of his regrets when he’d left Dr. Khan alone to die. “It is very terrible when I can’t even remember what it was like. With God’s grace my life was saved,” he said.
CONAKRY, FREETOWN, MONROVIA, LAGOS
August 2014
As it turned out, the destruction of Kenema Government Hospital was only a beginning flare of the emerging virus, an early burst of what became a viral crown fire in the human species. As the wards in Kenema burned with the virus, the real epidemic began, and the cities of West Africa caught fire with the A82V Makona Variant of Zaire Ebola—the Makona strain. On August 8, the WHO reported there’d been a total of 1,779 cases of Ebola, with 961 deaths.
The virus had reached Nigeria on July 20, traveling in an American lawyer named Patrick Sawyer. He caught Ebola in Liberia from his sister, then flew to Lagos, the capital of Nigeria, on his way to a conference in Calabar, Nigeria. He got off the plane at the international airport in Lagos feeling extremely sick, and ended up at a hospital in Lagos called First Consultants Medical Centre. The hospital’s chief physician, Dr. Stella Adadevoh, suspected he had Ebola, and she kept him in the hospital for tests, although Sawyer wanted to leave. The tests confirmed he did have Ebola, and he died soon afterward. Twenty other people contracted Ebola from his case, including Dr. Adadevoh. The virus threatened to go out of control in Lagos, which has a population of twenty million, and many of the city’s inhabitants are poor and live in crowded slums and don’t have access to medical care. If the virus were to amplify itself in the urban population of Lagos, the city could erupt in a viral equivalent of a nuclear detonation. Sawyer had clos
e contacts with seventy people while he was dying in Nigeria, any of whom could have caught the virus from him and spread it to others. Fast, decisive action by Nigerian health authorities and foreign doctors managed to break the chains of infection that had started traveling out of Patrick Sawyer.
Dr. Stella Adadevoh, who had prevented Sawyer from leaving the hospital, died of Ebola afterward; she is now regarded as a national hero for stopping the virus from spreading more widely in Nigeria.
If Ebola had blown up in Lagos, and one person harboring the virus had then traveled from Lagos to, say, a supercity like Dhaka, Bangladesh, or Mumbai, India, the virus could have done real damage in those cities, and would have had many opportunities to mutate again, further adapting itself to humans. The wild Ebola that had jumped into the little boy in Meliandou had changed into the Makona strain after passing through a few human bodies. If the virus swarm passed through many more people, in long chains of infection, the chances were that more mutations would happen in the swarm, and the school of fish would change again, and the virus could become even more humanized. Ebola was able to change, it was reacting to its new host, and it was starting to travel in human bodies to more distant points on the planet.
* * *
—
Two weeks after Humarr Khan died, and when it was clear that ZMapp had helped to save the lives of Kent Brantly and Nancy Writebol, The New York Times published a story about the decision to withhold ZMapp from Khan: “The treatment team, from Doctors Without Borders and the World Health Organization, agonized through the night and ultimately decided not to try the drug.” The article also reported that Khan hadn’t been offered a choice of whether to take the drug or not. When the article appeared, Robert Garry, Erica Saphire, Lina Moses, and Pardis Sabeti were very surprised to learn that Khan hadn’t been given ZMapp. They had assumed that Khan had been given the drug and that it had failed to save him.
Crisis in the Red Zone Page 33
