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Faith, medicine or ZMapp?
For Ebola survivors Dr. Kent Brantly and Nancy Writebol, the answer is clear.
“I would say the Lord. His merciful, gracious hand saved me in a way that used people and medication and a drug that had not been released. I think all of those things have played into our recovery,” Writebol told NBC News in an exclusive interview for the Friday NBC News Special "Saving Dr. Brantly: The Inside Story of a Medical Miracle.”
The doctors who treated them have another idea and they think what they’ve learned can save Ebola patients in Africa. What almost killed Brantly, they say, were irregular heart rhythms caused by what’s called electrolyte imbalance — the loss of minerals because of his constant, unending diarrhea.
“The closest infectious disease we can compare it to is cholera,” Dr. Bruce Ribner, who heads the special containment unit at Emory University Hospital in Atlanta where Writebol and Brantly were treated, told NBC News.
As with cholera, the constant vomiting and diarrhea pull all the fluids from the body, and with them sodium, potassium, magnesium and calcium — the so-called electrolytes that help the cells in organs such as the heart, brain and kidneys to function.
Brantly was losing five to seven quarts a day of fluid, Ribner said.
“The first night each time he got out of bed to go to the bathroom, he was getting weaker and weaker,” said Crystal Johnson, one of the nurses who cared to Brantly and Writebol. “He was febrile. He could barely stand. Every hour was tedious. We could not leave the room. We had to stay in our Tyvek suits and stay in the room.”
“It was water. It was just water coming out of him,” added infectious diseases specialist Dr. Aneesh Mehta, another member of Emory’s Ebola team.
And with every bout of diarrhea, Brantly was losing the electrolytes that make the heart beat regularly. “He was having rhythm problems because his electrolytes were so out of balance,” Ribner said.
“The closest infectious disease we can compare it to is cholera."
Ebola horrifies people because it kills so quickly and takes so many of its victims — up to 90 percent in some outbreaks, and fully half in this current epidemic. And it’s a hemorrhagic fever, one that causes internal and external bleeding. It’s this especially horrific aspect of the illness that captures the imagination.
But after weeks of treating Writebol and Brantly under first-world conditions — in a sterile hospital room, with the facility to take regular blood draws and watch hour by hour what their bodies were doing, the doctors at Emory have some new ideas about what’s killing Ebola patients. It’s not the scary stuff so much as the fluid loss.
Doctors knew this to some extent. Medecins Sans Frontieres (MSF or Doctors Without Borders) says its teams have found that if people get saline treatment early on in the course of infection, the survival rate goes up to as high as 75 percent.
But Dr. Colleen Kraft, an infectious disease specialist at Emory, says replacing fluids is not enough.
“Over there, they don’t have a way to monitor those electrolytes,” she said. Yes, you could give patients an “electrolyte replacer” such as Pedialyte or Gatorade. “But you need to replace it in a very monitored and aggressive way,” she said.
In fact, it’s important to measure each electrolyte individually and replace it in a precise fashion, said Mehta. “The magnesium, potassium, each one is important in its own way,” he said.
“The laboratory testing, I think, would have a significant impact in improving their outcomes.”