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First Ebola-Infected Patient Arrives in United States and Western Hemisphere; Risk vs Compassion

Sun August 03 2014 11:26 am  http://www.arlingtoncardinal.com/?p=70656
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A U.S. doctor infected with Ebola was able to visit with his family at an Atlanta hospital after being flown from Africa.

A U.S. medical doctor, Dr. Kent Brantly, who was infected with the Ebola virus while working in West Africa was flown to Atlanta to be treated in a high-security ward at Emory University Hospital in Atlanta, hospital officials said on Thursday, 31 July 2014. The aircraft made a quick re-fueling stop in Bangor, Maine before arriving in Atlanta.

Dr. Kent Brantly, working for Samaritan’s Purse, and an aid worker, Charlotte missionary worker Nancy Writebol were helping Ebola victims and working to prevent exposure in Liberia when they became infected. Dr. Kent Brantly, 33, medical director for the aid group Samaritan’s Purse from North Carolina, and his colleague Nancy Writebol, were both being treated at the center in Monrovia where they were working.

The arrival of the American doctor marks the first time an Ebola patient is known to have been located in the United States and in the Western Hemisphere. The actual Ebola virus has already been located in the United States while scientists study the virus in Maximum Containment Laboratories. On February 11, 2014, a researcher grazed her hand with a needle while testing Ebola treatments on Ebola-infected mice. Officials at the U.S. Army Medical Research Institute of Infectious Diseases sent her home overnight to pack her belongings and any personal items before she was admitted to a Patient Isolation Suite to last about one month. Ebola is not believed to be transmissible in the first day after exposure. The Patient Isolation Suite contains air filters that prevent viruses from passing to outside air via air ventilation. A special disinfecting shower prevent live viruses from draining into the outside sewer system.

The risk of exposure to Americans has been downplayed compared to the promotion of the importance of caring for Dr. Kent Brantly and Nancy Writebol to save their lives.

“There’s absolutely no risk, none, for the people in Atlanta. If there is a risk, it would be in the context of medical care, and the folks at the Emory Hospital have a special isolation unit, they’re all very well trained. So I think the risk, even to healthcare workers, is going to be exceedingly low.”

— William Shaffner, MD Infectious disease specialist at Vanderbilt University in Nashville, Tennessee

Symptoms of Ebola, similar to the common cold or abrupt influenza, typically start two days to three weeks after contracting the virus, with a fever, sore throat, muscle pains, and headaches. The disease typically progresses to nausea, vomiting, diarrhea and decreased functioning of the liver and kidneys. At this point, some people begin to have problems with bleeding. Bleeding into the skin may create bruise-like petechiae, purpura, ecchymoses, and hematomas (especially around needle injection sites). Internal and subcutaneous bleeding may present itself through reddening of the eyes, gastrointestinal tract bleeding with bloody vomit and bloody feces, bleeding from the respiratory tract with bleeding from the nose and coughing up blood, and bleeding from the vagina and gums.

Blood loss is not believed to be the cause of death. Death occurs from multiple organ failure (MOF), low blood pressure, disseminated intravascular coagulation (DIC) — a clotting cascade that disrupts local blood supply and causes damage to organs and local tissue death.

There is no cure for the disease, except for providing life support and hoping the victim’s own body can overcome the virus. The current epidemic from West Africa is believed to have about a 64 percent mortality rate. Historically, Ebola outbreaks overall have a mortality rate of about 50 percent to 90 percent.


Upon arrival in the U.S., Nancy Writebol and Dr. Kent Brantly will be tended by specially-trained infectious disease experts.

Maximum Containment Laboraties
Ebola is classified as a biosafety level 4 agent, as well as a Category A bioterrorism agent by the Centers for Disease Control and Prevention. Ebola has the potential to be weaponized for use in biological warfare.

In the United States, the Centers for Disease Control and Prevention (CDC) specifies levels for isolation of dangerous biological agents in an enclosed facility. Biosafety Level 4 (BSL-4) is required for work with dangerous and exotic biological agents that pose a high individual risk of aerosol-transmitted laboratory infections, and agents which cause severe to fatal disease in humans, which have no vaccines or other treatments available. These agents include Ebola virus and Bolivian and Argentine hemorrhagic fevers, Crimean-Congo hemorrhagic fever, Lassa virus, Marburg virus, and various other hemorrhagic diseases.

BSL-4 employees wear positive-pressure suits commonly called “space suits” and breathe filtered air as they work.

Safety Incidents at Maximum Containment Laboratories
In 2013, USAMRIID had 18,724 entries into BSL-3 laboratories. During that time, there were 14 safety incidents within those laboratories; 9 were characterized as Potential Biological Exposures (PBE). A PBE means that some risk of exposure to infectious agents and/or toxins may have occurred, resulting in medical staff placing the personnel involved on precautionary medical surveillance. No illness or disease occurred. The 2013 incident rate for BSL-3 laboratories was 0.075 percent.

With regard to BSL-4 laboratories, USAMRIID had 9,312 entries during 2013, with a total of 38 incidents and no Potential Biological Exposures (PBE). The 2013 incident rate for BSL-4 laboratories was 0.41 percent.

U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID)

Internet searches on Bing, Google and Yahoo do not retrieve any documents in top pages that mention Emory University as having a BSL-4 facility, although there are many documents that include content on BSL-4 training at Emory University.

Bing bsl-4 emory university

Google bsl-4 emory university

Yahoo! bsl-4 emory university (Bing powers Yahoo! search)

One of the components of a BSL-4 facility is tight security. Only authorized personnel can pass though perimeter security.

Category A Bioterrorism Agents/Diseases Definition
The U.S. public health system and primary healthcare providers must be prepared to address various biological agents, including pathogens that are rarely seen in the United States. High-priority agents include organisms that pose a risk to national security because they …

can be easily disseminated or transmitted from person to person;

result in high mortality rates and have the potential for major public health impact;

might cause public panic and social disruption; and

require special action for public health preparedness.

CDC Category A Bioterrorism Agents List

The Centers for Disease Control and Prevention (CDC) in Atlanta has a BSL-4 Maximum Containment Laboratory (Building 18), and Fort Detrick, Maryland, home of the U.S. Army Medical Research Institute of Infectious Diseases biocontainment laboratories (Source: U.S. Army) is known to have a BSL-4 Maximum Containment Laboratory.

Security at Detrick, Maryland includes perimeter fencing, armed security guards, closed-circuit TV surveillance, intrusion alarms and nighttime security lighting.


CNN’s Dr. Sanjay Gupta offers the first look inside Emory Hospital’s isolation ward where Ebola patients will be treated.


A plane carrying one American patient infected with the Ebola virus arrives in Georgia at Dobbins Air Reserve Base.


An American doctor infected with the Ebola virus in Africa arrived in Atlanta for treatment Saturday. U.S. officials are confident the patients can be treated without putting the public in danger.

See also …
CDC Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition

NIH.gov Biosafety Level 4 Laboratory Tour

Defense Technical Information CenterTransporting Patients with Lethal Contagious infections [PDF]

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