The Ebola-related death on Monday of a surgeon from Sierra Leone at a Nebraska hospital should serve as a painful reminder of the deadly nature of the disease even under the best circumstances, doctors said at news conference at the University of Nebraska Medical Center. They also stressed the importance of prevention in the fight to contain the outbreak.
Dr. Martin Salia, a surgeon from Sierra Leone who Saturday was transported from West Africa to the bio-containment unit at the University of Nebraska Medical Center, on Monday morning became the second Ebola patient to succumb to the disease in the U.S.
UNMC Chancellor Dr. Jeffrey Gold offered the hospital's condolences to Salia's family, and commended the team of doctors and nurses who treated him, despite the outcome.
“The Ebola virus is obviously a very deadly disease,” Gold said. “We are reminded today that even though this was the best possible place for a patient with this virus to be in the very advanced stages, even the most modern techniques that we have at our disposal are not enough to help these patients once they reach a critical threshold.”
The hospital, prior to Salia's arrival, had successfully treated two patients for Ebola. In those cases, the patients were still in the relatively early stages of the disease when they began receiving treatment, which increased their chances for recovery.
Dr. Dan Johnson, chief of the critical-care division for UNMC, said Salia was in “very critical condition” upon his arrival, which required him to undergo continuous dialysis during his first few hours of treatment. Salia never improved, Johnson said, eventually experiencing complete respiratory failure after 12 hours, which required him to go onto a ventilator.
“We really gave it everything we could,” Johnson said. “All modern medical therapies were provided, and we wish there could have been a different outcome. But I am also proud of the team for what they were able to try.”
Part of Salia's treatment included use of the experimental Ebola drug ZMapp, which was provided ahead of his arrival to the hospital from San Diego-based manufacturer Mapp Biopharmaceutical.
ZMapp has been used in the treatment of a number of Ebola cases, including Dr. Kent Brantly and Nancy Writebol, the first two Americans to contract the virus. Both Brantly and Writebol contracted Ebola while conducting humanitarian work in Liberia, and were transported from West Africa to Emory University Hospital in Atlanta, where they eventually recovered.
ZMapp has stirred debate over the question of the use of therapies that have yet to be fully tested for efficacy or safety in humans. Also, it was thought that supplies of ZMapp were exhausted in August after the company sent doses to the Liberian government in an effort to save the lives of two Liberian doctors infected with the disease.
Doctors said Salia also received blood plasma from a recovered Ebola patient in a treatment known as convalescent therapy. The premise involves transfusing blood from those who have developed antibodies to fight Ebola to give the sick patient's immune system time to develop it own defenses. Gold would not disclose who provided the blood plasma used for Salia, saying only that it was a former patient.
There are no approved treatments for Ebola. Experts say immediate and vigilant supportive care can reduce the chances of death from as high as 70% to 50%.
Salia reportedly had been working as a general surgeon at Kissy United Methodist Hospital in the Sierra Leone capital of Freetown. It's not known whether he was caring for Ebola patients.
Follow Steven Ross Johnson on Twitter: @MHsjohnson
