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Because Ebola takes over the immune system and uses it to replicate more and more of the virus, how does the body survive?
Is it a case of the virus being self-limiting and eventually just getting 'too big for its britches' so to speak? Or does the body somehow eventually start producing antibodies to fight it off?
While the ebola virus infects a lot of human cells, immune system cells it infects are mainly monocytes and macrophages. The cells in our body mainly responsible for adaptive immunity, T cells, are at least not completely infected:
Our data indicate that 20-30% of CD4 and CD8 T cells died during the course of infection1
That's a lot, but the ones that survive get activated and it's apparantly enough that between 80 and 10% of the infected (depending on the strain) can survive the infection. Little is known about the details of the immune reaction to ebola, but the immune system does get activated. The immune system even remains on "high alert" for quite some time after infection and recovery.
And the antibodies do stick around, at least for 10 years. Whether they confer immunity against all strains of ebola, we don't seem to know - ebola isn't very well-researched yet.
What happens to your body if you get Ebola?
Derek Gatherer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Lancaster University provides funding as a founding partner of The Conversation UK.
The Conversation UK receives funding from these organisations
This morning you woke up feeling a little unwell. You have no appetite, your head is aching, your throat is sore and you think you might be slightly feverish. You don’t know it yet, but Ebola virus has started to attack your immune system, wiping out the T-lymphocyte cells that are crucial to its proper function.
These are the same cells that the AIDS virus (HIV-1) attacks, but Ebola virus kills them far more aggressively. Exactly when and where you caught Ebola virus is unclear, it can take anything between two and 21 days from initial infection to the first symptoms. What is more certain is that you are now infectious yourself. Your family, friends and anyone in close contact with you are all in mortal danger.
The next week or so will determine if you are one of the lucky minority who survive. In the 24 Ebola virus outbreaks prior to the present one, a cumulative total of 1,590 people, two-thirds of all cases, have died.
The current outbreak, which began in the village of Meliandou in eastern Guinea in early December 2013, and which has now spread across Guinea and into the neighbouring countries of Sierra Leone and Liberia, has killed 251 people as of June 5, nearly half of the identified cases.
The west African Ebola epidemic is now the largest outbreak seen since Ebola virus was discovered in 1976. The World Health Organisation issued its first communiqué on the situation on March 23, and since then has been producing regular reports.
Over the next few days your condition deteriorates. Your body aches all over, you have chronic abdominal pain, the fever intensifies and you start to vomit and develop diarrhoea. After anything between a couple of days and a week of misery, you will have reached the crisis point – now the symptoms will either gradually recede or you will progress to the horrors of “cytokine storm”, a convulsion of your ravaged immune system that will plunge you into the terminal phase of Ebola virus disease known as haemorrhagic fever.
Cytokine storm releases a torrent of inflammatory molecules into your circulatory system. Your own immune system, now completely out of control, attacks every organ in your body. Tiny blood vessels burst everywhere and you begin slowly to bleed to death. The whites of your eyes turn red, your vomit and diarrhoea are now charged with blood and large blood blisters develop under your skin. You are now at the peak of infectiousness as Ebola virus particles, ready to find their next victim, pour out of your body along with your blood.
Fortunately, however, it seems you have survived. Rehydration therapy kept you strong in the initial phase and pure luck saved you from haemorrhagic fever. Understanding why some Ebola virus patients avoid the terminal phase is an active area of research, and one possible answer is that those whose T-lymphocytes survive the initial attack of the virus possibly retain sufficiently intact immune systems. Even when you are merely in the first phase of feeling vaguely unwell, it may be possible to determine if you will live or die.
Even though you are feeling much improved, and perhaps even ready to return to work, you will remain infectious for a while. All your bodily fluids will still contain virus. In particular, the virus can be sexually transmitted, especially if you are a man, up to 40 days after recovery.
Epidemiological modelling studies have shown that Ebola virus is about as infectious as influenza or very slightly more so – each infected person will probably infect two to four others. That’s not tremendously infectious compared to some of the super-infectious viruses such as measles or polio, which have corresponding numbers of five to 18, but it is nevertheless enough to sustain a pandemic. The question of why we haven’t seen a worldwide pandemic of Ebola in pre-modern times therefore becomes rather perplexing.
Ebola: Three reasons why most U.S. patients have survived
Grim tales of the thousands of sick, dead, and dying from the Ebola outbreak in West Africa contrast greatly with the high success rate of medical treatment for a small number of Ebola patients in the United States. What are the factors that make the biggest difference in saving the lives of people infected with the lethal virus?
"There's no magic going on. The supportive care in the U.S. is just incredibly different," Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital in Manhasset, N.Y., and Long Island Jewish Medical Center in New Hyde Park, N.Y. told CBS News.
The Ebola virus is fatal in about 70 percent of patients in the current outbreak in West Africa, according to estimates from the World Health Organization. Since March, more 4,900 people have died, mostly in Guinea, Liberia and Sierra Leone. More than 400 health care workers in West Africa have been infected with Ebola during this outbreak, and 233 had died as of Oct. 8.
But while the number of deaths in West Africa continues to soar, people being treated in the U.S. are, in most cases, surviving.
Of the nine people treated for Ebola in the U.S. so far, only one case has proven fatal. Thomas Eric Duncan, a Liberian man infected before he arrived in the U.S., died at a Dallas hospital on Oct. 8. In New York City, Dr. Craig Spencer is currently reported to be in serious but stable condition after being hospitalized last week. The other patients -- mostly health care workers who contracted Ebola while caring for others -- have all recovered.
Here are three of the key reasons why:
Ebola Virus Outbreak
1. Speed of medical intervention
With the exception of Duncan, who was initially sent home from the hospital without a correct diagnosis, Ebola patients in the U.S. have started receiving treatment very early in the disease -- as soon as a low-grade fever was detected.
"Ebola is a bi-phasic disease. There are several different clinical stages of the illness," Faber explains. The first phase, showing symptoms of fever, headache and sore throat, is soon followed by the G.I. phase when more severe gastrointestinal symptoms such as vomiting and diarrhea begin. If supportive care begins early, patients have the best chance of pulling through.
2. Quality of supportive care
U.S. hospitals are used to providing basic supportive care, including providing intravenous fluids and nutrients and maintaining blood pressure. Farber explains that a person with Ebola loses a lot of fluids. A patient experiencing Ebola symptoms such as extreme diarrhea and vomiting can rapidly become dehydrated and needs about 300ccs, the equivalent of one soda can, of intravenous fluids every hour to sustain their organ systems.
Farber says effective treatment of Ebola is about getting ahead of dehydration. "If you can keep up with simple hydration during that phase, you can prevent a lot of deaths."
This life-saving care can keep people alive long enough to allow the body to develop its own defenses to fight off the virus.
Dr. Bruce Ribner, who runs the infectious disease unit at Emory University Hospital in Atlanta and led the team that treated two American aid workers who contracted the virus in Liberia over the summer, told CBS News, "We just have to keep the patient alive long enough in order for the body to control this infection."
3. An all-out assault on the virus with experimental treatment options
It has not yet been proven whether a number of experimental Ebola treatments work, but doctors have reason to believe they may help.
Most U.S. patients have received blood or plasma transfusions from an Ebola survivor who's developed antibodies to the disease, in the belief that it may help boost the patient's ability to fight the virus. Dr. Kent Brantly, one of the first two American aid workers to survive, has donated his blood several times. While still in Liberia, Brantly himself received a blood transfusion from a young patient of his who'd survived.
Brantly and fellow missionary Nancy Writebol also received doses of ZMapp, an experimental drug shown to cure monkeys of Ebola in lab tests. However, supplies of ZMapp ran out in August and it's expected to be at least another month before more becomes available.
Brincidofovir, another experimental antiviral drug, was given to Duncan, the Dallas patient, but was not enough to save his life. American journalist Ashoka Mukpo received the same drug and recovered.
"The jury is still out on whether antiviral therapies work," says Farber.
However, given Ebola's high fatality rate, doctors and patients see little reason not to give them a try. Clinical trials are planned for several of these treatments to try to establish just how effective they really are.
Surviving Ebola: For those who live through it, what lies ahead?
As the Ebola virus continues to ravage West Africa, one thing has become all too clear: this highly contagious virus has an incredibly poor prognosis. This outbreak is the largest ever recorded. At least 319 have been killed in Guinea, 224 in Sierra Leone and 129 in Liberia.
Anywhere from about 60 to 96 percent of people who contract Ebola will die from it. There are currently no effective drugs to fight the virus. But what exactly happens to those few patients fortunate enough to survive the disease's deadly clutches?
Any chance of surviving Ebola largely hinges upon early access to medical care when symptoms such as fever, headache, and joint and muscle pain first arise. By the time the disease progresses to hemorrhaging, it's almost always too late.
Patients who receive supportive therapies early on to manage symptoms and complications have a better chance of living through it, although survival is still far from certain. Early interventions may include intravenous fluids and electrolytes for dehydration, maintaining blood pressure, transfusions to replace blood lost due to hemorrhaging, as well as treating any subsequent infections that result from the virus. Most Ebola patients actually die from low blood pressure and shock rather than blood loss.
Medical experts say most people who manage to recover from an acute Ebola infection will likely be able to return to their life and resume normal activities. But unfortunately, Ebola survivors do often develop certain chronic inflammatory conditions that affect the joints and eyes, problems that can follow a survivor through the remainder of their life. Dr. Amar Safdar, associate professor of infectious diseases and immunology at NYU Langone Medical Center, told CBS News these chronic conditions are a result of the body's immune response.
He said Ebola survivors are at risk for arthralgia, a type of joint and bone pain that can feel similar to arthritis. Ebola survivors also frequently report complications with eyes and vision, an inflammatory condition known as uveitis which can cause excess tearing, eye sensitivity, eye inflammation and even blindness.
Ebola Virus Outbreak
"No one knows exactly why," Safdar told CBS News. "Certain infections or certain viruses have been known to cause uveitis. It is treated with giving steroids and primarily something that will dilate the pupil."
It's not completely known how long a person can continue to shed the virus once the acute infection has subsided. It's likely that the recovery from Ebola varies as much as the incubation period of the virus, which can last anywhere between 2 to 21 days. According to the World Health Organization, a lab worker who contracted Ebola on the job was found to have traces of the virus in his semen 61 days after the initial infection. Though it has not been documented, this could theoretically mean a man could infect his partner during sexual intercourse weeks after he seemed to get over the disease.
Researchers are still trying to understand what factors help some patients survive Ebola when so many others do not. Sadfar and others speculate that genetics may be linked to Ebola survival. "There's something about the host population, not the virus itself," said Sadfar. "Which is why in certain demographic regions it's devastating."
One possibility is that Ebola may hide in specific spots in the body that are somewhat protected from the immune system, such as the eye and the testes, the researchers wrote. These "privileged" areas of the body are less prone to inflammatory attack by the immune system when foreign substances are found. The fact that men who reported vision issues after their recovery were likelier to harbor Ebola RNA seems to bolster this notion, the researchers wrote.
As people age, perhaps their immune system becomes less robust, the researchers suggested. Their weakened immune systems may enable the Ebola virus to hide out in these certain immune-privileged sites, such as the testes.
However, figuring out how to provide new information on how to prevent the sexual transmission of Ebola, without making things worse for Ebola survivors, could prove tricky, the researchers noted.
"For many survivors, the physical manifestations of the disease have been compounded by the stigma encountered with their return to their communities," the researchers wrote in their paper. "Survivor messaging regarding viral persistence, if demonstrated, must provide information that can be used to protect loved ones but at the same time not risk further ostracizing by society."
Feature Article: New Tech Makes Detecting Airborne Ebola Virus Possible
Natural outbreaks of the Ebola virus, while severe, are typically isolated and usually affect no more than a few hundred people at a time. However, from 2014-2016, infections from this deadly virus caused more than 11,000 deaths in West Africa. During this time, several cases of Ebola virus disease were also diagnosed in other countries, including the United States, due to infected travelers from West Africa that had unknowingly harbored and incubated the virus while en-route to their respective destinations.
By the time a person infected with Ebola virus becomes symptomatic, they are typically starting to shed the virus. During an outbreak, health care workers and family members of patients are often the first to respond and provide care. In this role, they are at a high risk of becoming infected with the virus as well. Therefore, it is important to understand how we can best prevent transmission in both clinical and home settings.
Human to human transmission of the Ebola virus occurs primarily through direct contact and exposure to the blood or other bodily fluids of infected patients. However, there have been new infections that occurred without documented contact between a patient and health care provider or family member. While these cases are uncommon, it is possible that a small fraction of the cases of Ebola virus infection may be the result of exposure to small droplets or aerosols containing the virus.
Laboratory studies have shown that the Ebola virus can remain infectious outside of the body for long periods of time. The virus can survive in blood samples on various surfaces for several days, even in hot and humid conditions that would typically kill most other viruses and bacteria. In an aerosolized form, the Ebola virus can survive for over an hour. Additionally, laboratory experiments have demonstrated that inhaling small amounts of Ebola virus can be fatal , and there are examples of Ebola virus disease being transmitted between individuals in close proximity, even though they had never been in direct contact with each other .
However, assessing the risk of transmission via droplets or aerosols is a complicated process. While the minimum amount of virus required to cause infection is thought to be very low, so far it has not been possible to determine a definitive value. This is because commonly used testing methods are often not sensitive enough to detect or measure the amount of infectious virus in the air. To address these challenges, researchers at the Department of Homeland Security (DHS) Science and Technology Directorate’s (S&T) National Biodefense Analysis and Countermeasures Center (NBACC) designed and conducted a study to optimize methods for collecting and measuring very small amounts of Ebola virus in the air.
“Ebola can be both a national security and public health concern,” explained Lloyd Hough, who leads S&T’s Hazard Awareness and Characterization Technology Center. “We’re looking forward to applying these methods to better characterize the risks associated with Ebola virus, and are hopeful that others can benefit from these techniques as well.”
NBACC researchers assessed and compared multiple devices designed for collecting microorganisms from the air. They concluded that filters made of gelatin were the best for collecting infectious Ebola virus from the air and were also the easiest and safest type of sampling device to use. The researchers utilized a cell line, developed by the Centers for Disease Control and Prevention, in an assay designed to measure the amount of infectious Ebola virus present in a sample. The cell line glows when infected by the virus, which enabled the researchers to differentiate Ebola virus infection from other causes of cell death.
After testing various sampling and assay methodologies, the NBACC researchers found that the combination of the gelatin filter samplers and improved assay was easier to use, more reliable, and nearly ten times more sensitive than the previous methods utilized to measure the amount of infectious Ebola virus in air samples. The results of these experiments have been published in two peer-reviewed journal articles [3,4], which will enable researchers at other institutions to understand and utilize these newly developed sampling and assay methodologies.
“Our ability to detect Ebola virus in air samples at levels that are ten-fold lower than what was possible with previous methods, will enable us to provide a better understanding of the aerosol hazard posed by this virus,” said Mike Schuit, an investigator in the Aerobiology group at NBACC.
The new sampling and assay methodologies developed by NBACC researchers, as well as the data from associated studies, will be useful in a number of ways. For example, these methods are currently being employed in a study in partnership with the National Institute of Allergy and Infectious Diseases (NIAID) to determine the minimum amount of Ebola virus that needs to be inhaled in order to cause infection or death in an animal model of Ebola virus disease. This study will also determine whether infected animals produce aerosols containing Ebola virus when they breathe, which will help scientists to better understand the potential for natural aerosol transmission of the virus. Various DHS components and partners, along with the Department of Defense and the Department of Health and Human Services, will use these data to conduct hazard modeling and gain a better understanding of the potential risk for airborne transmission of Ebola virus and how it may impact health workers.
Taking lessons learned from the response to Ebola virus, the NBACC researchers are conducting similar studies with SARS-CoV-2, the virus that causes COVID-19. This includes studying the performance of aerosol samplers with SARS-CoV-2, and optimization of methodologies to detect small quantities of SARS-CoV-2 in the air. Furthermore, the NIAID partnership has been extended to examine how much virus it actually takes to start a new infection when aerosol particles containing SARS-CoV-2 are inhaled. As with the Ebola study, this study will also measure whether infectious virus is present in the exhaled breath of infected animals to better understand how COVID-19 spreads in human populations and inform strategies to prevent its continued spread.
Ebola survivors feel long-term effects of virus
WASHINGTON, Feb. 26 (UPI) -- The Ebola virus remains in the bodies of survivors at low levels after recovery, causing symptoms and leaving open the possibility of spreading it, according to three recent studies of survivors in West Africa.
Post-Ebola syndrome continues to affect some of the approximately 17,000 people who survived the virus as many have eye, musculoskeletal or neurological symptoms, researchers have found in recent months.
Ebola has been found in the eyes, semen, spines and brains of survivors for six months or more after recovery. The World Health Organization suggests patients wait at least 90 days after recovery before having sex, or to practice safe sex, because doctors suspect the virus has been spread by sexual contact.
"There has been mounting evidence of both mental and physical health problems in Ebola survivors after the virus is cleared from the bloodstream," Dr. Janet Scott, a researcher at the University of Liverpool, said in a press release. "In some cases these health problems, such as damage to joints, brain and eyes, may be caused by Ebola virus persisting and causing damage in some of the compartments of the body that are less accessible to the immune system."
Scott was involved in a study, published in the journal Emerging Infectious Diseases, treating 84 people in Sierra Leone with Ebola, 44 of whom survived. Interviewed three weeks after they'd been cleared of the virus, 70 percent of survivors reported musculoskeletal pain, 48 percent had headaches, and 14 percent had problems with their eyesight.
A study with 82 Liberian survivors, conducted by the National Institute of Neurological Disorders and Stroke, found most had some type of neurological abnormality at least six months after they contracted Ebola. The most common problems among patients were weakness, headache, memory loss and depression, in addition to one who reported hallucinations and two who were suicidal.
"While an end to the outbreak has been declared, these survivors are still struggling with long-term problems," Dr. Lauren Bowen, a researcher at the NINDS, said in a press release.
Similar reports came from survivors in another study conducted by the Liberian Ministry of Health.
Of 1,022 survivors enrolled, 60 percent had eye problems, 53 percent had musculoskeletal problems and 68 percent had neurological difficulties, researchers reported during a presentation at the Conference on Retroviruses and Opportunistic Infections.
"Currently, there is a lot of anecdotal evidence of Post-Ebola Syndrome," Scott said. "The continued study of survivors is necessary if we are to learn more about how the Ebola virus works and how it affects them. The Ebola epidemic is waning, but the effects of the disease will remain."
What Happens After Someone Survives Ebola?
Learning more about patients who've recovered from Ebola -- as well as people who are naturally immune -- could save lives.
While most of the recent coverage of the ongoing Ebola outbreak has focused on rising death tolls and a few infected U.S. citizens, other segments of the population have passed mostly unnoticed from the harsh glare of the media spotlight: Survivors, and those who are seemingly immune to Ebola.
People who survive Ebola can lead normal lives post-recovery, though occasionally they can suffer inflammatory conditions of the joints afterwards, according to CBS. Recovery times can vary, and so can the amount of time it takes for the virus to clear out of the system. The World Health Organization found that the virus can reside in semen for up to seven weeks after recovery. Survivors are generally assumed to be immune to the particular strain they are infected by, and are able to help tend to others infected with the same strain. What isn’t clear is whether or not a person is immune to other strains of Ebola, or if their immunity will last.
As with most viral infections, patients who recover from Ebola end up with Ebola-fighting antibodies in their blood, making their blood a valuable (if controversial) treatment option for others who catch the infection. Kent Brantly, one of the most recognizable Ebola survivors, has donated more than a gallon of his blood to other patients. The plasma of his blood, which contains the antibodies, is separated out from the red blood cells, creating what’s known as a convalescent serum, which can then be given to a patient as a transfusion. The hope is that the antibodies in the serum will boost the patient’s immune response, attacking the virus, and allowing the body to recover.
But this treatment method, like all Ebola treatment methods, is far from ideal. To start with, scientists aren’t even sure if it works. In addition, the serum can only be donated to people with a compatible blood type to the donor, and it’s unclear how long the immunity would last. Adding to the confusion, there are several different strains of Ebola, and there’s no guarantee that once someone has recovered from one strain of Ebola they are immune to others.
When Nancy Writebol, one of the survivors of Ebola who was whisked back to Atlanta soon after contracting the virus, was asked by Science Magazine if she would consider going back, she said:
People who survived the disease are of particular interest to researchers, such as those working on the ZMapp drug, who hope that they can synthesize antibodies in the hopes of creating a cure.
But even less understood than the survivors are the people who were infected with Ebola but never developed any symptoms. After outbreaks in Uganda in the late 1990’s, scientists tested the blood of several people who were in close contact with Ebola patients, and found a number of them had markers in their blood indicating they carried the disease, but they were totally asymptomatic—they managed to completely avoid the horrifying symptoms of the disease.
In a letter in the Lancet this week, researchers look into the existence of these asymptomatic patients, and hope that identifying people who are naturally immune could help contain the outbreak as scientists work on developing a treatment. A 2010 study published by the French research organization IRD found that as much as 15.3 percent of Gabon’s population could be immune to Ebola.
“Ultimately, knowing whether a large segment of the population in the afflicted regions are immune to Ebola could save lives,” Steve Bellan, an author of the Lancet letter, said in a press release. “If we can reliably identify who they are, they could become people who help with disease-control tasks, and that would prevent exposing others who aren’t immune. We might not have to wait until we have a vaccine to use immune individuals to reduce the spread of disease.”
Being able to reliably identify naturally immune patients is still a ways off, but Bellan and his fellow researchers hope that by studying the current outbreak and looking for asymptomatic individuals, they might be able to save lives in the future.
Ebola Survivor: 'You Feel Like . Maybe . A Ghost'
Dr. Senga Omeonga pictured outside St. Joseph's Catholic Hospital in Monrovia. Omeonga moved to Liberia from DRC in 2011. He contracted Ebola but survived it.
Dr. Senga Omeonga met us under a huge mango tree outside St. Joseph's Catholic Hospital in Monrovia, Liberia. Behind the main building, several dozens of disinfected rubber boots worn by health care workers were propped upside down on stakes planted on a patch of lawn.
This is the hospital where Omeonga works as general surgeon and the head of Infection Prevention Control. It's also where he came down with Ebola on Aug. 2.
He says his days in treatment were "a living hell." And the experience has changed his view of the world — and the way he treats patients.
Omeonga is from the Democratic Republic of the Congo but came to Liberia four years ago. He's 53, married and has four children — two sons and two daughters. His family lives in Canada.
"We [health care workers] are the warriors, so we need to fight this disease."
Dr. Senga Omeonga, head of Infection Prevention Control at St. Joseph's Catholic Hospital
He remembers how unprepared everyone was for the outbreak. Medical workers were touching patients with their bare hands in the early days. He himself treated a patient with a wound from a motorcycle accident. When the patient was later diagnosed with Ebola, Omeonga was quarantined. But he didn't catch the virus.
Then he treated a sibling of Patrick Sawyer, the Liberian-American who flew to Nigeria after contracting the Ebola virus and later died of the disease. And that, Omeonga says, is how he thinks he became one of Liberia's nearly 8,000 cases.
Omeonga was one of the fortunate ones. He was taken to the Ebola treatment unit, or ETU, at the Eternal Love Winning Africa hospital. After several weeks, he recovered and is now back at work.
He spoke with us about how Ebola nearly took his life — and how the experience changed his life and the way he practices medicine.
You must have been very scared.
Yeah, I was very, very scared. Knowing what Ebola is and the death rate . the chance of survival was very, very low. Because I was vomiting, my only hope was to take as much as I can, the fluids, the orals. I was forcing myself.
You mean the oral rehydration liquids to replenish lost fluids?
Yeah. So I was taking that every day, at least four liters every day. I think they helped to keep me very well-hydrated, even though I was vomiting, and I was very weak. And then, I was transferred to ETU. That was a very bad experience. A very, very bad experience. People were lying on the floor — no bed, very few [health care workers]. They come in the morning, maybe once a day.
Describe the scene in the ETU.
For one week I had my bed in the hallway. And you see everybody laying on the floor. They just gave us [a] mattress to put on the floor. At that time there was one toilet. But because a lot of people were using it — Ebola comes with the diarrhea — it overflowed and clogged. "Poo poo" all over the floor. So when I wanted to use the bathroom, there was no way. We just stand at the door. [There was] no way to go in.
What did you do?
They were giving the people buckets. So everybody has a small bucket for vomit, for everything. You're living like a nonhuman. You get in a depression.
And sometimes you can have your bucket with you for all day [with] nobody to empty it. So you live in this area the smell is all over. Sometimes you don't even have food because nobody [can] come in, [there are] not enough PPEs [personal protective equipment] to give to the staff. And you can scream all day of hunger. That's how people were living in their ETU day in/day out. You can have food maybe once a day because nobody can come three times to give you the food.
It sounds subhuman.
Yes. A lot of people died because of lack of care inside the ETU.
And they're dying around you.
Goats and Soda
The Insights Of An Ebola Doctor Who Became A Patient
Every day. When you wake up in the morning, you see the person who was next to you is no longer there. There were a few discharges [of patients who were cured] at that time. The one who get discharged really was a big event. But it was just death, death, death, death. And you see people, they're very weak. And you have someone that is very dehydrated the water is there but nobody to give to [them], and they die of dehydration.
When people die, are their bodies removed right away?
Yeah, sometimes even less than 30 minutes or 10 minutes the body is gone, because they have maybe 10 patients waiting outside for someone to die inside to get a bed. So those waiting for a bed, they're happy. And for those inside it's just waiting: Who's next, who's next, who's next?
When you were at your most depressed, what did you do to keep your spirits?
One of the patients brought me a Bible. I was reading the Bible and I was talking very often with my family in Canada. I had a lot of people calling me: my colleagues, my nurses or my patients. And they were praying with me over the phone because there was no visitation at that time. That gave me a lot of hope.
Over time, did caregivers help to ease the situation?
Yeah, the health care [workers], they were very good, and they were very dedicated to the patients. I really congratulate them. The courage they were giving, the attention they were giving to the patients. I was even thinking they were pastors because they were just coming, and sometimes instead of giving you medication, they start preaching and talking about the Bible and maybe read a verse of the Bible. And then they give you the medication, and say, "OK, God will help you."
When you have Ebola you can't be touched by anybody people come to you wearing these big PPEs. Did you miss the human touch?
Goats and Soda
When A Loved One Has Ebola, How Can You Reach Out Without Touching?
When you become a patient, you want the doctor to touch you and to maybe check your hemoglobin. I remember I was just all the time asking, "Dr. [Jerry] Brown, I think you need to check my hemoglobin." He said, no, I think everything is fine. I said, "No, you need to check my hemoglobin." So you want someone to touch you. You miss the human touch. But at the same time, you understand they need to protect themselves. Because, yeah, they have a PPE, but you can make a mistake. When they touch the patients they [can come ] in contact with the virus, and they can contaminate themselves when they're removing the PPE or even when the gloves are damaged.
It was normal to see someone wearing PPE. But it was difficult because you cannot recognize the person treating you, you don't see the face. Everything is difficult to recognize.
So they must become kind of nonhuman too.
[Laughs] At some point, yes. The funny thing is when I was discharged I could not even recognize them.
Did you think you were going to die?
At some point, when I passed my second week, when my diarrhea stopped, my vomiting stopped, I was having hope I would survive. Because at that time, I started eating well, I started having my appetite back, and I started having my strength little by little. And the fear of dying started vanishing.
You were given ZMapp, the experimental anti-Ebola drug.
I was among the first recipient in Liberia. I was very lucky.
Were you the only one to get ZMapp?
No, there were three who received it, three health care workers.
Do you think you would have survived without it?
Goats and Soda
As Ebola Spreads in Nigeria, Debate About Experimental Drugs Grows
Maybe. Because at that time, I started to feel much better my vomiting stopped. The diarrhea was not that much anymore maybe I was start going to the bathroom maybe two or three times a day, and before it was more than that. That's the time I received my ZMapp. After receiving the second dose I started feeling much better, much stronger. So I think it helped speed up the recovery.
Your two colleagues who also were given ZMapp, did they survive?
One died because of underlying conditions. But one was in a coma, and once she received the ZMapp, after the second dose, she got off from her coma, and she started working, and she survived.
What was it like being disconnected from the outside world?
It's very difficult. You don't feel like [you're] living in a normal world anymore. The ETU is like a living war or hell. It's like you're living in hell. The only person you see is the nurse, and they even stay a distance from you when you talk, so no touch. So you feel like . I don't know how to describe it . maybe a ghost.
Is there anything that you learned from being a patient that you keep in mind as you treat Ebola patients?
"What I experienced with Ebola, I don't think there is any sickness that can equal Ebola symptoms — the way people feel in the body."
I learned the suffering of Ebola. As a doctor, I'd never seen a disease like Ebola. What I experienced with Ebola, I don't think there is any sickness that can equal Ebola symptoms — the way people feel in the body. I don't want these [Ebola patients] to go through what I went through. It's a very, very unbearable disease. Even after surviving, when you think about what you went through, it's not easy. I think that experience gave me the courage to do what I'm doing now [at the hospital].
Does it make you feel invincible having survived Ebola?
No, it doesn't [make me] feel invincible, but it gave me just another dimension of thinking: Ebola, we can overcome it. If I did it, other people also can do it.
Do you feel like it changed you?
It changed my way of work. I need to be very cautious. Infection prevention is a key element, so taking care of the patient, you have to protect yourself. Even though you are immune, you can also transmit to others. So I can bring the virus from one patient to another. So it changed my way of dealing with my work. Also, it changed my way to see this: We, as health care workers, we are victims, we are in the front line, but we also are the solution to this problem. If we having the fear of facing the virus, this virus will never be eradicated in Liberia. We are the warriors, so we need to fight this disease.
Has it changed the way you look at your own life?
It helped me to see the world very different now. Nothing is [taken for] granted.
Do people treat you differently knowing you're an Ebola survivor?
The stigma is almost over. But when we just came from the ETU, the stigma was there.
When people were coming to see me they'll stay at the door outside and just greet you there. So they don't even want to come inside the door, inside of your house, because they're still thinking you can give the virus to others. So even to go outside, it was very difficult. For people who know you and saw you, maybe at a gathering, maybe a church, people start taking a distance from you. So you have to live with it and deal with it.
I've dealt with that in my way. It's normal to have fear of being close to me, but I think I'm the one who feels sorry for you because I survived Ebola, but you haven't contracted Ebola yet. And I feel sorry for you just in case — God forbid — you have the disease [and] you may not have the chance of survival. It's normal to have a fear, I understand you. But we don't contract Ebola this way [from survivors]. So we need to agree to accept those people who survived Ebola. They are free of the virus.
Did it make you feel doubly victimized having been victimized already by Ebola?
Yes. Because you are victimized being sick and now victimized by the community or the society.
You must have felt lonely.
Yeah, you feel lonely. You feel like you're rejected.
How has your family dealt with this?
Thank God my family was not here when I was sick. All of my family lives in Canada. My daughter was here in May and left in June. I was sick just a month after she left Liberia.
Did you wish they were there?
If I was sick they would be the ones to take care of me, and they could be exposed [to Ebola]. Maybe I could have a chance to survive, maybe one of them not. So I praise God for none of them being with me.
Do you remember the day you were declared Ebola free?
It was Aug. 27 when my test result came, and they called me and said I was free of Ebola.
What was that like?
I could not believe it. I was very, very happy. I was praising the Lord.
Did you celebrate?
No. I prayed. There was no way to celebrate while you see a lot of people around you dying and sick. I was just praising the Lord and saying OK, "Thank you, to make it through this." In the meantime, even though you're happy, you see all the people lying, dying, so it's no celebration.
Are you treating Ebola patients now? How many Ebola patients do you have at the hospital?
This [hospital] is not an ETU we don't treat them here. But we can receive some suspected cases that we transfer to ETUs [elsewhere in Monrovia]. I think, so far, we've received like six suspected cases since we opened the hospital two weeks now which we transferred to the ETU.
You said when you went to the ETU you had 15 colleagues who were also infected. What happened to them?
Six survived, and we lost nine.
Yeah, we were co-workers. They really work here as a family, everybody, we all love each other here. To lose even one person is very, very sad. And those nine people died I think in three days.
Were you with them at the ETU? Were you able to give them any comfort?
We were hopeless because we were all very weak. I remember one day when I was able to walk a little bit inside the ETU, and I went there and the two sisters were there with us. I couldn't even recognize one of the brothers who was here, Brother George. And the sister said, "Doctor, that's Brother George." And he was very weak. He had his bottle of mineral water he could not even take it. I just look at him and said, "Brother." He looked at me, and he just opened his eye, and it was finished. So very sad.
The president of Liberia had said she wants zero new cases by Christmas.
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I don't think it is realistic. Maybe we hope by January or February or in three months maybe we can, because we are containing the outbreak in Liberia. But it's not over yet. Only one case can make things again coming back. So we have to be very prudent. It's not time for celebration yet.
What would you say to people who are in isolation wards and cut off from the rest of the world, if you could say something to them, being a survivor?
What I can tell them is even though they are isolated it's not because the people don't love them. The people will still be loved by their family, by their loved ones. They need to keep hope. Ebola is a deadly virus, but there's a lot of people who survived. They just have to keep hope, take their medication, drink a lot of water to fight the dehydration, because one of the causes of death is dehydration. And they need to remember people outside are praying for them, loving them, and want them back.
How Long Is An Ebola Victim's Body Contagious? You Don't Want To Know
The protective gear worn by Ebola burial teams is critical: A corpse can be contagious for up to 7 days. These workers are carrying the body of a woman who died of the virus in her home in a suburb of Monrovia, Liberia. John Moore/Getty Images hide caption
The protective gear worn by Ebola burial teams is critical: A corpse can be contagious for up to 7 days. These workers are carrying the body of a woman who died of the virus in her home in a suburb of Monrovia, Liberia.
People in West Africa often touch and wash the dead in their community. That's a problem when it comes to handling Ebola victims. Their bodies are known to be contagious. And so Red Cross body collectors receive careful training and protective gear before they embark, but it's tough to alter this tradition.
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Now researchers have confirmed how long those bodies can be contagious. The Ebola virus can survive for up to a week in a dead primate.
"As long as the virus is viable then there shouldn't be any difference between a live body and a dead body," head researcher Vincent Munster, a virus ecologist at the National Institute of Health, tells Goats and Soda. His findings will be published in May in the journal Emerging Infectious Diseases.
Ebola isn't the only virus that can linger after death.
"Just because a body dies, it doesn't mean that all cells die simultaneously," says Alan Schmaljohn, a microbiology and immunology professor at the University of Maryland, who is unaffiliated with the study. Viruses continue to reproduce, although the total number of viral cells decreases exponentially as the body decays.
Of all the viruses that stick around, the most persistent is smallpox. "It can last for an exceedingly long time," Schmaljohn says, describing how the virus remains viable in scabs. "That's part of what makes the smallpox vaccine such a good vaccine," he says. Because the virus is so tough to kill, doctors could easily move the vaccine from place to place without refrigeration.
But it'd be tough for a smallpox scab to harm another person. Schmaljohn says that a person would have to grind up the scab and apply it to broken skin before the virus would pose a risk. So exhuming a corpse from a 1910 victim "would not be hazardous," says Schmaljohn.
A respiratory illness like influenza also isn't such a concern, because the dead aren't likely to sneeze on you. Still, a living person who touches influenza-infected mucus, even from a dead person, might get sick.
As for Ebola, it can spread through many different channels. So it's really easy to catch from people living and dead. "When somebody succumbs to the Ebola virus, the virus is everywhere [on that person's body]," says Munster. "Anywhere you would take a swab you will find the virus." The decaying body emits fluids — blood, saliva, pus, feces — and all of them could carry the Ebola virus. So if any of those fluids come into contact with an orifice or an open cut on a living person, there's a decent chance that person will get infected. And that's the case for at least one other disease that seems far less exotic: norovirus or stomach flu.