A reminder about ebola treatment

There are a couple of articles about the guy who arrived from Liberia who turned up at a Dallas hospital with ebola.  One is from the DailyMail (UK), which sounds like breathless hysteria inducing gossip mongering, and the other is from Reuters.  I’m going with Reuters for veracity.  In either case, it sounds like this could be serious.  Wait, here’s one more from NBC.

The patient, Thomas Duncan (I’m not using the middle name because he’s not a criminal), reportedly carried an infected pregnant woman to a hospital in Liberia.  That woman later died from the illness.  Then, he takes a flight to Texas.  He’s allowed on the flight because he is symptom free.  Ok, that’s mistake number one.  He probably should have been held in quarantine for the length of time of the incubation period, which can be up to 21 days.  Actually, it probably doesn’t matter if the quarantine happened in Liberia or Texas, though presumably it mattered a great deal to his fellow passengers.  Nah, I’m going with my gut here.  If you’re trying to leave Liberia or one of the other most heavily infected countries, you should be subjected to a quarantine to prove you’re not a carrier.  If Liberia couldn’t do it, Texas, or some other connecting way station in the US, should have.  But then, this is Rick Perryland.  My condolences to relatives that live there.  I know they didn’t vote for him.

Come to think of it, there’s probably going to be a backlash against the African community in Texas that Perry will likewise fail to prevent.  And Texas has all those gun totin’, constitution wavin’, do gooders.  If there is a spread of ebola, plugging one of the patients and allowing infected blood to spill all over Dallas is probably only going to exacerbate the problem.

Which leads to the next issue.  According to the DailyMail (remember, gossip mongering), Mr. Duncan went to a hospital in Texas complaining of symptoms and told the health care workers that he had just arrived from Liberia.  That’s L-I-B-E-R-I-A.  You know, the place with all the sick and dying ebola victims?  That have the same symptoms that he was displaying?  They sent him home with antibiotics.

Now, either somebody wasn’t listening to him or they have the stupidest treatment team in the world in Dallas.  Antibiotics are completely useless against viruses.  I’m going with option one- someone wasn’t listening.  Well, you know, there was probably a language barrier.  I’ll leave it at that.

The NBC article says that Mr. Duncan’s nephew had to call the CDC after the initial treatment in Dallas.  Even he figured out that the health care professionals in Dallas weren’t taking this seriously:

Health officials have acknowledged that Thomas Eric Duncan, 42, was initially sent home from Texas Health Presbyterian Hospital in Dallas when he showed up on Sept. 26 complaining of fever and abdominal pain. He had to return two days later in an ambulance.

That was the day “I called CDC to get some actions taken, because I was concerned for his life and he wasn’t getting the appropriate care,” Duncan’s nephew, Josephus Weeks, told NBC News on Wednesday night. “I feared other people might also get infected if he wasn’t taken care of, and so I called them to ask them why is it a patient that might be suspected of this disease was not getting appropriate care?”

Weeks added that he hoped “nobody else got infected because of a mistake that was made.”

Maybe the insurance time clock alarm went off and the hospital thought he looked remarkably well that morning.  It was probably just a coincidence.

So then Mr. Duncan’s condition worsens.  His family calls an ambulance to take him to the hospital. Before he gets into the ambulance, he vomits all over the sidewalk.  His family is screaming their heads off in panic.  We have no direct evidence that the ambulance team recognized the danger to themselves or others or whether they called a HazMat team or whether they sprayed the area with chlorine and took all of the family members immediately into quarantine.

Hey, this is a convenient time to remind all those right wingers out there that even if you don’t have insurance, the ER is not allowed to turn people away!  Yes, a man in Duncan’s condition can make repeat visits to the ER and vomit all over the chairs while he patiently waits there for hours to see a doctor while the other health care workers obliviously prepare another dose of antibiotics.

Do we know whether Mr. Duncan has insurance?  He’d better because no one in Texas without insurance is allowed to get ebola.  Perry didn’t expand Medicaid. Update: Duncan is not an American citizen.  He’s just here for a visit.  So, we can guess that one of the reasons why the hospital didn’t keep a sick Liberian who was showing signs of possible ebola infection when he first showed up is because they were concerned with the costs.  Oh, yes, my best beloveds, hospitals are more than willing to toss sick people out when it starts to get too expensive for the insurance company.  We have been there.

We really need an investigation of the behavior of the hospital that discharged Mr. Duncan to discover whether this was the result of a bad cost-benefit calculation.  Did the hospital just take a wild bet that Mr. Duncan did not have ebola so they wouldn’t have to keep him in an expensive isolation unit?  Enquiring minds want to know.

Now we come to the treatment phase for Mr. Duncan.  It turns out that ZMapp, the monoclonal antibody (not antibiotic, pay attention, there is a difference), is no longer available.  The DailyMail calls it a “miracle” treatment.  That’s not surprising for the DailyMail but it is misleading, stupid and demonstrates a complete lack of understanding on the part of the “journalist”.  ZMapp is an experimental treatment that had an n of 7 primates before it was thrown into humans.  If the barrier for proving efficacy was that low when I was still in drug design, my project teams would have made the companies I worked for billions several times over by now and would have cured obesity, depression, alzheimer’s disease, multiple sclerosis and several different kinds of cancer.  In other words, there’s not much evidence that ZMapp has cured anything yet.  Sure, a couple of patients took the drug but they had excellent care here in the US and that alone might have been enough to cure them.  The body *will* recover on its own if it can stay well enough to mount a vigorous immune response.

Anyway, ZMapp monoclonal antibodies are grown in tobacco plants.  My lab partner had more experience in growing proteins in plants so she could probably talk about this in more detail.  But from my own experience growing proteins in insect cells and e coli, I can tell you that the amount of protein recovered could be minute and the amount varied based on the conditions the cells were grown under.  Grow them too fast or neglect them for even half an hour and you might have to start all over again.  Growing in tobacco plants would seem to give the company a little more control over the product but it still takes time.  Then there is the issue of purification, which still can seem like an art form in some cases.  And the damn things have to fold properly AND they have to not aggregate, which I understand is an issue with antibodies.  They loves to aggregate.  Even if they grow the tobacco at lightening speed and collect as much ZMapp as they can, it’s going to be small quantities of an unproven drug.

Come to think of it, you have to wonder why governments, including our own, are not calling on all of the out of work drug discovery professionals to lend a hand.  Oh, that’s right.  We’d have to be paid and as we all know, government isn’t good for anything.

So, don’t count on Mr. Duncan to receive any miracle cures.  Let’s just hope he gets decent care in Texas to help his body ride out the storm.

In the meantime, I have read that Glaxo Smith Kline (GSK) is trying out a vaccine.  I haven’t heard a lot about this but vaccines are generally good things, unless you’re Jenny McCarthy or some clueless control freak, overeducated but bored, suburban helicopter mom who managed to get through college without ever taking a basic biology course.  How much you wanna bet a whole lot of them in Texas suddenly get religion when it comes to vaccines, demanding on TV with righteous indignation that GSK provide freebies of an almost untested, non-FDA approved vaccine? There’s a satire just waiting to be written but it really isn’t funny.  Anyway, I hope it can produce some kind of immune response but it’s probably too late to help Mr. Duncan.

As for the rest of Texas, let’s hope it can survive the bumbling first responses.  Since Mr. Duncan returned to the US, he has had ample opportunity to infect his girlfriend’s kids- who go to school. (See paragraph above)  His poor girlfriend is probably in jeopardy if they had sex without a condom because the virus can persist in semen for a time even after the patient recovers. Well, I’m still not panicking but I’d feel a lot more confident about a vigilant response if Mr. Duncan had landed in Hawaii where everyone is insured, there’s a whole ocean separating the islands and there’s a history of treating people with infectious disease.

Somedays, it just seems like Texas is giving the rest of the country the finger.