By the time he got to Nebraska, Dr. Martin Salia was unconscious, struggling to breathe and his kidneys had failed.
The medical team at Nebraska Medical Center, experienced from saving the lives of two previous patients, swung into action, pumping Salia full of salt water and vital compounds to replace lost fluids, working to save his kidneys with dialysis, helping him to breathe with a ventilator. They gave him blood serum full of antibodies from one of the eight U.S. survivors — they didn’t say which one — and scraped up a dose of the rare experimental treatment ZMapp.
But Salia died Monday, despite this "truly heroic effort,” said Dr. Jeffrey Gold, chancellor of the University of Nebraska’s medical center.
It’s a clear example of why Ebola has a 70 percent mortality rate in Africa, while most patients treated in the U.S. have lived. Most patients in Liberia, Guinea and Sierra Leone are not showing up for treatment until they are already very ill and it’s too late to reverse the damage the virus has caused to their bodies.
“We are reminded today that even though this was the best possible place for an Ebola patient to be … even the best technologies that we have at our disposal are not enough to help these patients once they have reached a critical threshold," Gold told a news conference.
And of course, clinics in West Africa often cannot even deliver intravenous saline, let alone more advanced treatment.
"We used every possible treatment available to give Dr. Salia every possible opportunity for survival."
Salia, working at a Methodist hospital in Sierra Leone, first felt ill during the first week of November. But he hadn’t been treating Ebola patients and he’d already come through a 21-day incubation period after a close call with an Ebola patient. And his first blood test for Ebola came back negative on November 7.
The usual diagnosis for fever and other symptoms in West Africa is malaria, so he treated himself for that, but didn’t get any better. A second test came back positive for Ebola Nov. 10.
Those few days of delay may have made the difference between life and death for Salia, 44, a legal resident of the U.S. with a wife and two children in Maryland. He was flown to the U.S. on Saturday but his organs had already started shutting down.
"We used every possible treatment available to give Dr. Salia every possible opportunity for survival," said Dr. Phil Smith, who successfully treated medical missionary Dr. Rick Sacra and NBC camera operator Ashoka Mukpo for Ebola. "As we have learned, early treatment with these patients is essential. In Dr. Salia's case, his disease was already extremely advanced by the time he came here for treatment."
It may not look good on the surface — eight Americans treated for Ebola in the U.S. have survived, while two Africans, Liberian-born Thomas Eric Duncan and now Salia, died. But Salia and Duncan both got delayed diagnoses, while the eight U.S. patients all were isolated and treated from the moment they developed fevers.
Experts have said all along it’s not unusual to get a negative test for Ebola the first time. It takes a while for the virus to build up in the blood.
Smith said people usually develop fever about a week after infection. “If you check right then, often you get a false negative,” Smith told a news conference. “Usually you have fever for three to four days, then you start getting other symptoms like diarrhea, nausea and vomiting,” he added. That’s when patients then almost always test positive. If there’s enough virus in the blood to set off a positive test, it’s also enough to cause more advanced symptoms.
"As we have learned, early treatment with these patients is essential."
“I am very, very proud of the care we provided. I know that we gave him every possible chance to survive,” infectious disease specialist Dr. Dan Johnson told the news conference. He said he couldn’t immediately see anything the team at Nebraska could have done differently to save Salia.
“We are going to analyze this. We are going to learn from it,” Johnson said.
Ebola has killed more than 5,000 people in Guinea, Sierra Leone and Liberia, causing an epidemic of more than 14,000 cases—a number the World Health Organization says it certainly an underestimate. The epidemic has spread to Mali, with three deaths, four reported cases and officials checking on hundreds of people at possible risk.
Salia's wife and two children, who live in the Washington, D.C. suburb of New Carrollton, Maryland, have asked for privacy.