Moving Ebola Patients to U.S. Involves Extreme Isolation

When the first American Ebola patients arrive back home in the next few days, they probably won't be greeted with banners or TV cameras. Their route from Atlanta's Hartsfield Airport to the Emory University Medical Hospital will be a closely guarded secret to keep them from getting stuck in traffic or alerting the public.

Two humanitarian aid workers, Kent Brantly of Texas and Nancy Whitebol of North Carolina, were stricken by the disease while working in Liberia. They're being flown back in a private jet. It's not clear which of them will be taken to Emory, according to a hospital statement.

Emory has a special isolation unit, one of four in the country, to treat patients with serious infectious diseases. It is physically separated from other patient areas and is run in conjunction with the U.S. Centers for Disease Control and Prevention in Atlanta, the hospital said.

From the hospital in Monrovia, to the Liberian airport and then during the 12-hour flight across the Atlantic, the patients will be in special chambers the whole time, according to Andrew Pekosz, associate professor of molecular microbiology and immunology at Johns Hopkins University who has worked on highly-contagious infectious diseases.

"This is not something being put together at the last minute," Pekosz said. "The CDC has been planning and putting protocol and facilities and equipment for exactly this kind of event for many years. There is a well-worked-out system from any part of the world where a patient can be identified, prepared and transported and delivered to the containment facility."

Here's how the medical team will protect themselves and others from the Ebola virus raging inside the patients:

- Clothes: Health-care workers wear impermeable polyvinyl chlorine (PVC) coveralls, a separate hood, vinyl boots and three pairs of gloves. A special high-efficiency particulate air (HEPA) filtered respirator powered by a rechargeable battery supplies air for breathing and cooling. Those filters remove particles down to .03 micrometers, including viruses like Ebola, according to CDC protocols.

- Stretcher: The patients will be placed inside the Vickers aircraft transport isolator (VATI), designed for prolonged patient transportation and in-flight care. It uses negative air pressure and filters that exchange the air five times per hour. Medical workers will administer to the patients through special gloves built into the sides of the transparent chamber.

- Patient care: Since air travel is stressful and involves the effects of altitude and confinement, only patients that are expected to survive the flight would be moved. Doctors and nurses have to be watching for signs of respiratory failure and the presence of gas inside the body that could pose a problem at high altitude.

- Stopping the virus: Since there's no cure for Ebola, the most that doctors can do is try and help the body's own immune system fight it. They will also be trying to keep vital organs, like the liver and kidneys, functioning against the blood-borne virus, as well as removing excess fluid building up in the body, according to Pekosz.

- Hospital trip: Once the plane lands, there's another transfer to a special ambulance with a tent-like structure covering the patient. The route will be kept quiet to minimize traffic and publicity. At the hospital, workers deploy a well-rehearsed plan that details where the ambulance is supposed to pull up. The patient is put into a containment center and is not allowed to leave. Staff members have to go through a two-phase decontamination procedure for all of their clothing, while chemical sprays used to kill the virus must also go to a separate system instead of the normal hospital sewer pipe.

- Staying alive: The infection can last from several days to several weeks. "What the doctors are trying to do is minimize the damage and get the organs through the infection and stay alive," Pekosz said. "Clearly it can be done at Emory, but it cannot be done on the ground in Africa."

In Africa, officials from the CDC and the U.S. Army Medical Research Institute of Infectious Diseases are working overtime to control the spread of the disease and perhaps develop a treatment. USAMRIID virologist Randal Schoepp has been in Monrovia for the past two weeks using a molecular genetic test to identify patients who have contracted the disease. Schoepp said the rate of new infections is rising in Liberia, Guinea and Sierra Leone.

The World Health Organization said Friday that the outbreak has killed 729 people and infected another 1,200. However, Schoepp said that could be an underestimate.

"We are only seeing the tip of the iceberg," Schoepp said during a teleconference from Monrovia. "To really control the outbreak, you need contact tracing, contacts with confirmed Ebola patients that could be then followed for the possibility of them being infected. We don't have a good system here set up for that. I believe we are only seeing a small portion of the actual cases out there. It's putting a tremendous stress on the medical system."

Schoepp said drivers are afraid to bring back medical samples to scientists like him working in a specialized laboratory.

"In Sierra Leone and Liberia, we are seeing an increase in samples and positive samples," Schoepp said. "That indicates that we are still on an increasing slope and haven't reached the peak yet."

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